Physiotherapeutic approach and functional performance after breast cancer surgery

Physical therapy after breast cancer surgery improves range of motion and pain over time

ABSTRACT Treatment of breast cancer can impair range of motion (ROM) and cause homolateral upper limb pain (UL). This study aimed to compare the ROM, intensity and characterization of UL homolateral pain between the 1st, 10th and 20th sessions of physiotherapy, besides correlating these variables. A clinical trial self-controlled study involving 49 women after mastectomy or quadrantectomy with pain complaint on UL was conducted. ROM was evaluated by goniometry and contralateral UL was adopted as control. The intensity of pain was evaluated by the visual analogue scale (VAS) and characterized by the McGill questionnaire, obtaining the number of words chosen (NWC) and the pain evaluation index (PRI). The ROM of the homolateral UL increased significantly over the 20 sessions. Comparing the homolateral UL with the control, only the abduction did not improve significantly after the 20th session. Pain intensity, PRI and NWC reduced significantly between 1st and 10th and between 1st and 20th sessions. The sensory and evaluative categories also decreased significantly. We observed a significant correlation between VAS, PRI and NWC in the 10th and 20th sessions. Physiotherapy increased ROM, reduced pain in the homolateral UL, and fewer words were chosen to characterize the pain. Significant improvements were observed at the beginning of treatment, but with additional gains over time. Exercises for bilateral flexion, abduction, and external rotation should be emphasized.

Fisioterapia após cirurgia de câncer de mama melhora a amplitude de movimento e a dor ao longo do tempo

RESUMO O tratamento do câncer de mama pode prejudicar a amplitude de movimento (ADM) e causar dor no membro superior (MS) homolateral. O objetivo deste estudo foi comparar a ADM, a intensidade e a caracterização da dor no MS homolateral à cirurgia entre as 1ª, 10ª e 20ª sessões de fisioterapia, além de correlacionar estas variáveis. Foi conduzido um ensaio clínico autocontrolado com a participação de 49 mulheres após cirurgia de câncer de mama que se queixavam de dor no MS. A ADM foi avaliada por meio de goniometria e o MS contralateral foi adotado como controle. A intensidade de dor foi avaliada pela escala visual analógica (EVA) e caracterizada pelo Questionário de McGill, obtendo-se o número de palavras escolhidas (NWC) e o índice de avaliação da dor (PRI). Verificou-se aumento significativo da ADM do MS homolateral ao longo das 20 sessões. Comparando o MS homolateral ao contralateral, somente a abdução não melhorou significativamente após a 20ª sessão. Observou-se uma redução significativa da intensidade de dor, do PRI e do NWC entre a 1ª e 10ª e entre a 1ª e 20ª sessão. As categorias sensorial e avaliativa também diminuíram significativamente. Foi encontrada uma correlação significativa entre EVA, PRI e NWC entre a 10ª e a 20ª sessão. A fisioterapia aumentou a ADM, reduziu a dor no MS homolateral e o número de palavras escolhidas para caracterizar a dor. Foram observadas melhoras expressivas no início do tratamento e ganhos adicionais ao longo do tempo. Exercícios para flexão, abdução e rotação externa bilaterais devem ser enfatizados no tratamento.

Can belly dance and mat Pilates be effective for range of motion, self-esteem, and depressive symptoms of breast cancer women?

OBJECTIVE

This study aims to analyse the effect of an intervention with belly dance or mat Pilates on range of motion, self-esteem and depressive symptoms in women with breast cancer receiving hormone therapy.

METHOD

A randomized clinical trial of 52 participants, diagnosed with breast cancer and undergoing adjuvant hormone therapy that were randomized and divided into three groups (1): Belly dance group, which received 16 weeks of Belly Dance classes 2) Mat Pilates group, that performed 16 weeks of Pilates intervention and (3) Control group, that received educational activities in the form of lectures and was invited to maintain its routine activities. The participants answered a questionnaire in which they contained the clinical and personal characteristics; quantification of the range of motion of the upper limbs using the Absolute Axis 360° digital goniometer; self-esteem by the Self-Esteem Scale (EAR) and depressive symptoms by the Beck Depression Inventory (BDI). All data was collected at two moments in the study, in the pre-intervention period (baseline) and at the end of the 16 weeks of intervention.

RESULTS

Only the variable range of motion variable showed significant results in all study groups (p = 0.025), with the Mat Pilates group having the best scores. Although not significant, the other study variables also improved after the intervention period.

CONCLUSION

Belly dance and the Mat Pilates can bring positive results in the range of movement of women undergoing adjuvant treatment of breast cancer, with the Pilates method being the one that most contributed to improvements in this variable.