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Ibrahim AA, Gabr Ali AMM, Fadulelmulla IA, Ragab MMM, Aldemery AA, Mohamed AR, Dewir IM, Hakami HA, Hussein HM. Using Inspiratory Muscle Training to Improve Respiratory Strength, Functional Capacity, Fatigue, and Stress in Breast Cancer Patients Undergoing Surgery. J Multidiscip Healthc 2024; 17:1931-1941. [PMID: 38706507 PMCID: PMC11070168 DOI: 10.2147/jmdh.s463961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
Purpose The main aim of the trial was to assess the effectiveness of inspiratory muscle training on respiratory muscle strength, functional capacity, fatigue, and stress in post-surgical breast cancer survivors. Methods Forty-seven females who had undergone unilateral post-mastectomy were randomly assigned to an intervention group (IG; n = 24) and a control group (CG; n = 23). Both groups received aerobic exercise training. In addition, the intervention group received inspiratory muscle training 3 days a week for 8 weeks. Maximum inspiratory and expiratory pressure (Pimax) (Pemex), 6-minute walk test, Handgrip strength by hand-held dynamometer, Fatigue Assessment Scale (FAS), and Perceived Stress Scale pss 10 values were measured before the training and then at the eighth week for both groups. Results No differences were detected between the groups in terms of sample and clinical characteristics 8 weeks post-intervention. In favor of the intervention group, a significant difference with medium to high effect size was found in terms of Pimax, Pemax, FAS, PS, and 6MWT (p < 0.05). However, there was no difference in terms of handgrip strength (p-value: 0.072), with a medium effect size (0.070). Regarding within-group comparisons, IG exhibited substantial differences in all outcome measures (p < 0.05) compared to CG, with the exception of PImax and 6MWT. Conclusion In post-operative breast cancer survivors, respiratory muscle training combined with aerobic training increases respiratory muscle strength and functional ability while lowering stress and tiredness.
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Affiliation(s)
- Ahmed Abdelmoniem Ibrahim
- Department of Physical Therapy, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia
| | | | | | | | | | - Amany Raafat Mohamed
- Department of Physical Therapy for Internal Medicine & Geriatrics, Faculty of Physical Therapy, Suez University, Suez, Egypt
| | - Ibrahim Metwally Dewir
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Hamad Ali Hakami
- Department of Physical Therapy, Jazan General Hospital, Jazan, Saudi Arabia
| | - Hisham Mohamed Hussein
- Department of Physical Therapy, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia
- Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Wang S, Zhang Y, Ma X, Lin L, Tian L. Nursing measures in the fast-track surgery on negative emotions in breast cancer patients: A meta-analysis. Medicine (Baltimore) 2023; 102:e34896. [PMID: 37746946 PMCID: PMC10519519 DOI: 10.1097/md.0000000000034896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To critically evaluate the effects of different nursing measures based on the concept of fast-track surgery (FTS) on the negative emotions of patients with breast cancer. METHODS A systematic search of 8 databases, namely PubMed, Cochrane Library, Embase, Psycho info, China national knowledge infrastructure, Wanfang, China science and technology journal database, and China biomedical literature database, was performed to find randomized controlled trials from inception to April 2023. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. RESULTS Ten studies were included in the systematic review, with a total of 830 patients (FTS group: 415; control group: 415). The results showed that different nursing measures based on the concept of FTS could significantly reduce anxiety (MD = -1.74, 95% confidence intervals [-2.41, -1.08], P < .00001) and depression (MD = -1.98, 95% confidence intervals [-2.44, -1.51], P < .00001) in patients after modified breast cancer surgery compared with the control group. CONCLUSIONS Based on the concept of FTS, the nursing measures such as reducing preoperative fasting time, posture management, preventive analgesia, and early functional exercise can effectively reduce the anxiety and depression of patients during the perioperative period.
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Affiliation(s)
- Shaotong Wang
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Yueyue Zhang
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Xiaomin Ma
- The First People’s Hospital of Kunshan, Suzhou, People’s Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
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Guloglu S, Basim P, Algun ZC. Efficacy of proprioceptive neuromuscular facilitation in improving shoulder biomechanical parameters, functionality, and pain after axillary lymph node dissection for breast cancer: A randomized controlled study. Complement Ther Clin Pract 2023; 50:101692. [PMID: 36528984 DOI: 10.1016/j.ctcp.2022.101692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Axillary lymph node dissection and radiotherapy have been associated with pain, physical symptoms, and decreased functional abilities in the upper extremity. This study aimed to evaluate the potential effects of the proprioceptive neuromuscular facilitation (PNF) technique on muscle strength, pain and functionality in this patient group in comparison with progressive resistance training (PRT). METHODS The study was conducted with a randomized clinical trial design. Sixty-six women were included in the study and randomly divided into three groups: the PNF group (n = 22), the PRT group (n = 22), and the control group (n = 22). The participants were evaluated at the baseline and after eight weeks of treatment. Outcome measures were determined as pain (the Visual Analog Scale), upper extremity strength (isokinetic dynamometer), functionality (the Disabilities of the Arm, Shoulder and Hand questionnaire), and perception of change (the Global Rating of Change Scale). TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05288036. RESULTS The results showed statistically significant changes in both treatment groups in terms of shoulder flexors/extensors, abductor/adductors, internal/external rotators strength/power/endurance measurement, pain, and functionality (p < 0.05). Concerning functionality and perception of change, the PNF group had a statistically significantly higher improvement compared to the remaining two groups (p < 0.05). CONCLUSION PNF is an effective technique in increasing upper extremity muscle strength, reducing pain during rest and activity, and improving functionality in patients receiving breast cancer treatment.
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Affiliation(s)
- Selen Guloglu
- Istanbul Medipol University, Institute of Health Sciences, Department of Physical Therapy and Rehabilitation, Istanbul, Turkey.
| | - Pelin Basim
- Istanbul Medipol University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey.
| | - Z Candan Algun
- Istanbul Medipol University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
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Hanna MHZ, RezkAllah SS, Shalaby AS, Hanna MZ. Efficacy of transcranial direct current stimulation (tDCS) on pain and shoulder range of motion in post-mastectomy pain syndrome patients: a randomized-control trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2023. [DOI: 10.1186/s43161-022-00116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Background
Post-mastectomy pain syndrome (PMPS) is a highly prevalent complication after surgical treatment for breast cancer, and it affects the patient’s quality of life in aspects of losing shoulder full range of motion, pain, and depression. Transcranial direct current stimulation (tDCS) is non-invasive brain stimulation technique that was used in numerous clinical applications and in pain reduction in cancer patients. However, the effectiveness of tDCS on PMPS has never been evaluated in an experimental study.
Aim
To investigate the effect of bilateral anodal tDCS of motor cortex (M1) on pain, depression, and shoulder range of motion (ROM) in post-mastectomy pain syndrome.
Study design
Randomized controlled trial.
Methods
A total of 30 female patients with post-mastectomy neuropathic pain were randomized into two groups; the intervention group which received bilateral tDCS on motor cortex (M1) and the control group that received sham bilateral tDCS on M1. As pain affects shoulder range of motion (ROM), shoulder ROM was measured by electronic goniometer pre- and post-tDCS application. In addition, the levels of pain and depression have been measured pre and post treatment. Pain has been measured with visual analogue scale (VAS) and depression with Beck-Depression-Inventory-BDI questionnaire (BDI).
Results
A significant difference was noted in group A regarding pain, depression and shoulder ROM (p= 0.001, p= 0.003, and p= 0.003, respectively). Between group comparison revealed a significant difference of VAS scores and shoulder flexion ROM between groups, the study group and the control group (p=0.041 and 0.048, respectively). Pain decreased by 32% and Shoulder flexion increased by 4.8% post-treatment while there were no significant difference in group B (p=0.567 and p=0.866, respectively).
Conclusions
The application of tDCS decreases the severity of pain and improves shoulder range of motion suffered by breast cancer patients after total mastectomy surgery.
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Güloğlu S, Özdemir Y, Basim P, Tolu S. YouTube English videos as a source of information on arm and shoulder exercise after breast cancer surgery. Eur J Cancer Care (Engl) 2022; 31:e13685. [PMID: 35970600 DOI: 10.1111/ecc.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/06/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the reliability, quality and content of YouTube videos on exercises that can be performed after breast cancer (BC) surgery. METHODS Videos selected from YouTube using the search terms 'shoulder exercise and BC surgery', 'arm exercise and BC surgery' and 'physiotherapy/physical therapy and BC surgery' were categorised as useful or misleading by a surgeon and a physiotherapist. The videos were analysed using the 5-point DISCERN scale for reliability, the Global Quality Scale for quality and a 10-item scale for comprehensiveness. RESULTS Of the 180 videos initially analysed, 82 were included in the study, and 42 (51.2%) were classified as having misleading information and 40(48.8%) as having useful information. The reliability, quality and content scores of the videos containing useful information were higher (p < 0.001). Most of the videos in the useful information group (80%) were uploaded by universities/professional organisations/physicians/physiotherapists, while the majority of those in the misleading information group (47.6%) were uploaded by websites providing independent healthcare information. CONCLUSION YouTube can be an important instrument to protect patients from musculoskeletal system complications after BC treatment and improve existing complications. Universities, physicians and physiotherapists should be encouraged to prepare more videos containing full and accurate information on this subject.
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Affiliation(s)
- Selen Güloğlu
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Beykoz/İstanbul, Turkey
| | - Yunus Özdemir
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Beykoz/İstanbul, Turkey
| | - Pelin Basim
- Department of General Surgery, Faculty of Medicine, Istanbul Medipol University, Bağcılar/İstanbul, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Medipol University, Bağcılar/İstanbul, Turkey
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Rao MS, Pattanshetty RB. Effect of myofascial release, stretching, and strengthening on upper torso posture, spinal curvatures, range of motion, strength, shoulder pain and disability, and quality of life in breast cancer survivors. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1939. [PMID: 35044712 DOI: 10.1002/pri.1939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND PURPOSE Breast cancer survivors are known to develop upper torso pain and stiffness including shoulder elevation and ipsilateral inclination of the trunk within a short period of time as a result of cancer adjuvant therapies correlating with the type and side of surgery. Hence, the study. METHODS Twenty-two breast cancer survivors at a tertiary care hospital, Belgaum, Karnataka, have participated in this pre-post experimental study which included myofascial release (MFR), stretching, and strengthening for four sessions per week for 3 weeks that is, a total of 12 sessions. The participants were assessed at baseline and post-intervention using photogrammetry for Posture and shoulder range of motion (ROM), flexicurve for spinal curvatures, digital inclinometer for cervical ROM, manual muscle testing and hand dynamometer for strength of the upper back, shoulder muscles and hand grip, Shoulder Pain and Disability Index (SPADI) for shoulder impairment and Functional Assessment of Cancer Therapy-Breast (FACT-B) for quality of life. RESULTS The outcomes were analyzed with a p-value set at ≤0.05. The results of the study demonstrated a substantial improvement in the posture alignment (p = 0.001), shoulder and cervical ROM (p = 0.001), upper back and shoulder muscle and hand grip strength (p = 0.001), SPADI (p = 0.001), and FACT-B (p = 0.001) values. DISCUSSION The upper torso malalignment and muscular imbalance is seen in patients who has undergone surgeries involving the chest wall and early physiotherapy intervention can benefit the patients overall physical performance and quality of life. Hence, MFR, stretching and strengthening has shown to be beneficial in improving upper torso malalignment in breast cancer survivors. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE The suggested techniques can be applied at a larger scale which can involve patients with head and neck cancer since the areas of intervention are identical. CTRI (Clinical Trial Registry- India) Registration No.: CTRI/2021/01/030453.
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Affiliation(s)
- Mounica Srinivas Rao
- Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, India
| | - Renu B Pattanshetty
- Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, India
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Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study. Sci Rep 2021; 11:10432. [PMID: 34002007 PMCID: PMC8129134 DOI: 10.1038/s41598-021-89908-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023] Open
Abstract
After breast cancer (BC) surgery, women may experience a physical decline. The effect of physical activity (PA) on the course of recovery after BC surgery has not yet been thoroughly examined. To analyze the impact of physical activity performed by women undergoing breast cancer surgery on measures of function, range of motion, and self-efficacy. A prospective study was carried out in 157 patients who underwent surgery for BC between October 2018 and April 2019, divided into four groups according to the intensity of PA with 6 months follow-up. 50 sedentary patients and 107 active patients were enrolled; the mean age was 52.6. Women who performed physical activity, moderate to vigorous, demonstrated lower function disabilities (QuickDASH 2.22) compared with inactivity or light physical activity (QuickDASH 7.0, p < 0.001), with better shoulder flexion (159.0° vs. 150.7°, p = 0.007) and abduction (159.5° vs. 152.2°, p = 0.008). Higher PA levels, displayed in higher self-efficacy reports (9.5 vs. 8.8, p = 0.002), and return to prior job status (0.005). The PA level does not influence pain at one, three and 6 months postoperatively (p = 0.278, p = 0.304 and p = 0.304 respectively). High PA levels increase the risk of axillary web syndrome (p = 0.041), although, it reduces the incidence of chronic pain (p = 0.007). Women who practice physical activity recover better from BC surgery than sedentary women. The higher the intensity and frequency of training, the better the results. Vigorous activity cause axillary web syndrome, despite, it has a beneficial effect on lowering the rate of chronic pain.
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Shao YW, Shu Q, Xu D, Teng H, Wu GS, Hou JX, Tian J. Effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative breast cancer patients: study protocol for a randomized controlled trial. Trials 2021; 22:16. [PMID: 33407753 PMCID: PMC7789409 DOI: 10.1186/s13063-020-04954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Due to advancements in treatment, the survival of breast cancer (BC) patients has significantly improved. Improving the postoperative quality of life has become a widespread concern for patients and doctors. At present, the staged rehabilitation training program for postoperative BC patients has been recognized. However, there is not yet a consensus about the optimal time to initiate rehabilitation training. We designed this study to investigate the optimal intervention times for postoperative BC patients to begin different stages of rehabilitation. Design This is a randomized controlled trial. Female participants with BC who are scheduled to undergo mastectomy, including unilateral total breast or breast-conserving surgery plus axillary lymph node dissection, will be enrolled in this study. The intervention includes the following: 200 participants will be allocated using a 1:1:1:1 ratio to the A, B, C, and D groups, which have four different rehabilitation timelines for four phases of rehabilitation exercises. A therapist will evaluate the patient’s overall health and then adjust the training intensity before initiating training. The assessments include upper limb mobility, grip, limb circumference, postoperative drainage volume (PDV), and pain. The training will last for 12 weeks, and patients will undergo follow-up twice within 6 weeks after discharge. Outcomes include the following: Constant-Murley Score (CMS) is the primary parameter. European Organization Research and Treatment of Cancer Quality of Life Questionnaire-BR23 (EORTC QLQ-BR23), SF-36, range of motion (ROM), strength, grip, circumference, PDV, and pain are the secondary parameters. All enrolled subjects will be assessed at 1 day, 3 days, 1 week, and 2, 3, 6, 9, 12, and 18 weeks after the surgery. Discussion This is a randomized controlled trial to evaluate the effect of different rehabilitation training timelines to prevent shoulder dysfunction among postoperative patients with BC. If the results are confirmed, this study will establish an optimal timeline for postoperative BC rehabilitation. Trial registration ClinicalTrials.gov NCT03658265. Registered on September 2018.
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Affiliation(s)
- Yu-Wei Shao
- The Second Clinical College of Wuhan University, Wuhan, Hubei, China.,Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qing Shu
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dan Xu
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Hui Teng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Gao-Song Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jin-Xuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jun Tian
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Ryans K, Davies CC, Gaw G, Lambe C, Henninge M, VanHoose L. Incidence and predictors of axillary web syndrome and its association with lymphedema in women following breast cancer treatment: a retrospective study. Support Care Cancer 2020; 28:5881-5888. [PMID: 32270312 DOI: 10.1007/s00520-020-05424-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Axillary web syndrome (AWS) presents as a common postsurgical complication in individuals with breast cancer. Breast cancer-related lymphedema (BCRL) contributes to the shoulder and arm morbidity common in breast cancer survivors and often associated to cancer treatment. A paucity of literature exists evaluating the risk factors for developing AWS and the association between AWS and BCRL. The purposes of this study were (1) to identify risk factors for AWS in individuals with breast cancer, (2) to examine the association between BCRL and AWS, and (3) to determine if AWS increases the risk for developing BCRL. METHODS A retrospective study of 354 women who underwent breast cancer treatment and received physical therapy was included. RESULTS Axillary web syndrome developed in a third of women and predominately occurred in the first 8 postoperative weeks. The odds of AWS development were 73% greater for participants over the age of 60 (OR = 1.73, CI 95% 1.05-2.84). Women with AWS had 44% greater risk to develop lymphedema during the first postoperative year (RR = 1.44, CI 95% 1.12-1.84, p = 0.002). If AWS developed within the first postoperative month, women were almost 3 times more likely to develop lymphedema within the first 3 postoperative months compared with other women with AWS (RR = 2.75, CI 95% 1.199-6.310, p = 0.007). CONCLUSIONS Our findings suggest that 30% of breast cancer survivors will have AWS during the first year of survivorship. As institutions prioritize screening efforts, early postoperative prospective surveillance is needed for women over 60 due to high risk for AWS development and any women with AWS for increased risk of lymphedema development based on our findings.
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Affiliation(s)
- Kathryn Ryans
- Department of Physical Therapy, Mercy College, Dobbs Ferry, NY, USA. .,Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA.
| | - Claire C Davies
- Nursing and Allied Health Research Office, Baptist Health Lexington, Lexington, KY, USA
| | - Gizela Gaw
- Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA
| | - Caroline Lambe
- Department of Oncology Rehabilitation, Regional Cancer Center at Lee Health , Cape Coral, FL, USA
| | - Morgan Henninge
- Physical Therapy and Rehabilitation, United Health Services, Vestal, NY, USA
| | - Lisa VanHoose
- Department of Physical Therapy, University of Louisiana Monroe, Monroe, LA, USA
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Feyzioğlu Ö, Dinçer S, Akan A, Algun ZC. Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery? Support Care Cancer 2020; 28:4295-4303. [PMID: 31907649 DOI: 10.1007/s00520-019-05287-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement. METHODS Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)). RESULTS Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05). CONCLUSION Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433).
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Affiliation(s)
- Özlem Feyzioğlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey. .,Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Selvi Dinçer
- Department of Radiation Oncology, Ministry of Health Okmeydanı Research and Training Hospital, Istanbul, Turkey
| | - Arzu Akan
- Department of Breast and Endocrine Surgery, Ministry of Health Okmeydanı Research and Training Hospital, Istanbul, Turkey
| | - Zeliha Candan Algun
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey
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Giacalone A, Alessandria P, Ruberti E. The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review. Cureus 2019; 11:e6416. [PMID: 31988817 PMCID: PMC6970094 DOI: 10.7759/cureus.6416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Pain and joint dysfunction of the upper limb following treatment for mammary carcinoma are defined as the most frequent side effects of surgery for mammary carcinoma by calculating a prevalence range in the USA that varies between 12% and 51% with regard to pain and between 1.5% and 50% for joint dysfunction. This objective of this study was to describe physiotherapy interventions that demonstrate efficacy based on the type of pain present in patients with shoulder pain who have been treated for breast cancer. We conducted a search for relevant publications in the last 10 years (2009-2019) on the PubMed, Medline, CINAHL, and Cochrane databases. The articles obtained were selected on the basis of correlation criteria, with themes concerning shoulder pain after mammary carcinoma and physiotherapy performed to treat this pain. Studies suggest treating musculoskeletal pain through active exercises, joint and tissue mobilization techniques, with accessory joint mobilization and neurodynamics performed by experienced physiotherapists. In order to treat radio-induced and drug-induced neuropathic pain, both aerobic and strengthening exercises are supervised by an experienced physiotherapist and carried out twice weekly for a total of 150 minutes of exercise. Finally, the treatment suggested to deal with chronic pain uses a multidisciplinary approach, including pain education interventions, pharmacological interventions, psychological interventions, and physiotherapy interventions. To conclude. the classification of different types of shoulder pain following mammary carcinoma treatments requires specific and targeted physiotherapy interventions in which active therapeutic exercise has a central role.
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Affiliation(s)
- Andrea Giacalone
- Department of Industrial Engineering, University of Tor Vergata, Roma, ITA
| | | | - Enzo Ruberti
- Department of Neurology, Sapienza University, Roma, ITA
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Lovelace DL, McDaniel LR, Golden D. Long-Term Effects of Breast Cancer Surgery, Treatment, and Survivor Care. J Midwifery Womens Health 2019; 64:713-724. [PMID: 31322834 DOI: 10.1111/jmwh.13012] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 01/13/2023]
Abstract
Women are increasingly surviving breast cancer, but up to 90% experience unexpected long-term sequelae as a result of treatment. Symptoms may include physical, functional, emotional, and psychosocial changes that can dramatically alter the quality of life for breast cancer survivors. Primary care clinicians, including midwives, are likely to care for these women and should be familiar with common symptoms, treatment, and best practices to avoid permanent dysfunction. A holistic approach to assessment, treatment, and referral as needed is the most effective strategy. Although women experience significant changes after breast cancer treatment, many fail to receive thorough assessment of their symptoms, education about interventions, and treatment options to optimize health promoting strategies. Disparities exist in treatment availability, options, and survivorship. Long-term physical changes include anatomic changes, chronic pain, phantom breast pain, axillary web syndrome, and lymphedema. In addition, women may have decreased strength, aerobic capacity, mobility, fatigue, and cognitive dysfunction. Emotional and psychosocial changes include depression, anxiety, fatigue, concerns about body image, and issues with sexuality. Treatment should be multifactorial based on thorough assessment of symptoms and can include medication, exercise, counseling, physical and occupational therapy, and alternative and complementary therapies. Primary care and gynecologic clinicians are well positioned to provide thorough evaluation, education, treatment, and referral for the most common sequelae of mastectomy and breast cancer treatments.
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A Systematic Review of Electronic Health (eHealth) interventions to improve physical activity in patients with breast cancer. Breast Cancer 2019; 27:25-46. [DOI: 10.1007/s12282-019-00982-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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Mafu TS, September AV, Shamley D. The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment. Cancer Manag Res 2018; 10:81-90. [PMID: 29391829 PMCID: PMC5772395 DOI: 10.2147/cmar.s151714] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Shoulder morbidity is a well-documented sequela of breast cancer treatment, which includes various manifestations such as pain, reduced range of motion, and lymphedema, among others. The multifactorial nature of such morbidities has long been appreciated, and research on reliable risk predictors of development thereof still continues. Previous studies have demonstrated the potential of different types of physical therapy to treat such shoulder problems, and the integration of such interventions into routine care for breast cancer survivors is a requirement in most high-income countries. Although patients at risk for developing shoulder problems would most likely benefit from posttreatment physical therapy, currently, there is no gold standard for identifying this patient group. This is particularly important in low- and middle-income countries where scarce monetary resources need to be directed specifically to those most in need. Modulators of the angiogenesis pathway have been implicated in noncancer shoulder conditions such as rotator cuff disease, adhesive capsulitis, and tendon injuries. The present review summarizes the role of angiogenesis in the development of shoulder morbidity among breast cancer survivors and sets forth the rationale for our belief that angiogenesis signaling may help explain a proportion of the reported clinical variability noted in the development of shoulder pain and dysfunction and upper-limb lymphedema after breast cancer treatment.
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Affiliation(s)
- Trevor S Mafu
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Alison V September
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town
| | - Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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de Oliveira MMF, Gurgel MSC, Amorim BJ, Ramos CD, Derchain S, Furlan-Santos N, dos Santos CC, Sarian LO. Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial. PLoS One 2018; 13:e0189176. [PMID: 29304140 PMCID: PMC5755747 DOI: 10.1371/journal.pone.0189176] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE evaluate whether manual lymphatic drainage (MLD) or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery and whether these parameters have an association with lymphedema formation in the long run. METHODS Clinical trial with 106 women undergoing radical BC surgery, in the Women's Integrated Healthcare Center-University of Campinas. Women were matched for staging, age and body mass index and were allocated to performed AE or MLD, 2 weekly sessions during one month after surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery. RESULTS The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011). CONCLUSION Lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.
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Affiliation(s)
| | - Maria Salete Costa Gurgel
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Bárbara Juarez Amorim
- Department of Nuclear Medicine and Radiology, University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Celso Dario Ramos
- Department of Nuclear Medicine and Radiology, University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Natachie Furlan-Santos
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - César Cabello dos Santos
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
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Maltser S, Cristian A, Silver JK, Morris GS, Stout NL. A Focused Review of Safety Considerations in Cancer Rehabilitation. PM R 2017; 9:S415-S428. [PMID: 28942913 PMCID: PMC5627359 DOI: 10.1016/j.pmrj.2017.08.403] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/12/2022]
Abstract
Cancer and its treatments introduce various adverse effects that may affect survivors' physical, cognitive and psychological functioning. Frequently both tolerance to activity and exercise are affected as well. Rehabilitation providers should have substantive knowledge about the effect of cancer progression and common side effects associated with antineoplastic treatment to safely integrate rehabilitation interventions. Rehabilitation may mitigate loss of function and disability; however, these patients are among the most medically complex that providers treat. This report provides a focused review that synthesizes the current evidence regarding disease progression and oncology-directed treatment side effects within the context of safety considerations for rehabilitation interventions throughout the continuum of cancer care. Descriptive information regarding the evidence for precautions and contraindications is provided so that rehabilitation providers can promote a safe plan of rehabilitation care. It is incumbent upon but also challenging for rehabilitation providers to stay up to date on the many advances in cancer treatment, and there are many gaps in the literature regarding safety issues. Although further research is needed to inform care, this review provides clinicians with a framework to assess patients with the goal of safely initiating rehabilitation interventions.
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Affiliation(s)
- Susan Maltser
- Department of Physical Medicine and Rehabilitation, Hofstra Northwell School of Medicine, Hempstead, NY; Long Island Jewish Medical Center, Manhasset, NY(∗)
| | - Adrian Cristian
- Department of Rehabilitation Medicine, Northwell-Glen Cove Hospital, Glen Cove, NY(†)
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital Network, Boston, MA; Massachusetts General Hospital, Boston, MA; Physiatry, Brigham and Women's Hospital, Boston, MA(‡)
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, NC(§)
| | - Nicole L Stout
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Office of Strategic Research, Department of Rehabilitation Medicine, Clinical Center, National Institutes of Health, MSC 1604, 10 Center Dr, Bethesda, MD 20892-1604(‖).
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Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery. Arch Phys Med Rehabil 2016; 98:256-263. [PMID: 27519926 DOI: 10.1016/j.apmr.2016.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery. DESIGN Clinical trial. SETTING Health care center. PARTICIPANTS Women (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. INTERVENTIONS Women (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up. MAIN OUTCOME MEASURES Shoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods. RESULTS There was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MLD group and 11 (20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21 (39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024). CONCLUSIONS MLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.
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