Masato Kikuuchi1, Yoshiteru Akezaki2, Eiji Nakata3, Natsumi Yamashita4, Ritsuko Tominaga1, Hideaki Kurokawa1, Makiko Hamada1, Kenjiro Aogi5, Shozo Ohsumi5, Tetsuya Tsuji6, Shinsuke Sugihara7,8. 1. Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan. 2. Division of Physical Therapy, Kochi Professional University of Rehabilitation, Kochi, Japan. 3. Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan. 4. Division of Clinical Biostatistics, Clinical Research Center, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. 5. Department of Breast Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. 6. Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan. 7. Department of Rehabilitation Medicine, National Hospital Organization Shikoku Cancer Center, Ko-160, Minamiumemoto-cho, Matsuyama City, 7910280, Japan. sugihara.shinsuke.rk@mail.hosp.go.jp. 8. Department of Orthopaedic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. sugihara.shinsuke.rk@mail.hosp.go.jp.
Abstract
OBJECTIVES: Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. METHODS: The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). RESULTS:Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. CONCLUSION: Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.
RCT Entities:
OBJECTIVES: Postoperative shoulder joint dysfunction has been observed at a certain rate after breast cancer surgery with axillary lymph node dissection. The purposes of this study were to verify the feasibility and effects of home-based exercise using a DVD and clarify the target of intensive intervention with physiotherapy by identifying the factors that cause postoperative shoulder dysfunction. METHODS: The study comprised 237 female patients who underwent breast cancer surgery with axillary lymph node dissection, whose data were acquired until 3 months postoperatively. All patients were instructed to exercise at home using a DVD. Range of motion (ROM) of shoulder flexion and abduction and the disability of the arm, shoulder, and hand (DASH) score were measured before surgery, 1 week and 1, 2, and 3 months after surgery. As factors influencing the recovery of shoulder ROM at 3 months after surgery, the presence or absence of radiation and factors up to 1 month after surgery (age, body mass index, the relationship between operated side and dominant side of the hand, treatment modalities, and complications). RESULTS: Shoulder ROM and DASH scores had gradually recovered from 1 week to 3 months postoperatively. As the results of the multivariate analysis, the factors that were associated with the recovery of ROM of shoulder flexion at 3 months were the side of surgery corresponding to the dominant hand (negative factor) and the presence of paresthesia at 1 week postoperatively (positive factor) (p < 0.05). Radiation therapy and the side of surgery corresponding to the dominant hand were negative factors for the recovery of shoulder abduction (p < 0.01). Regarding the feasibility of the home exercise, 214/229 (93.4%), 172/210 (81.9%), and 139/206 (67.5%) of patients performed exercise at least once a day at 1, 2, and 3 months after surgery, respectively. CONCLUSION: Our result indicated that the side of surgery corresponding to the dominant hand was the inhibiting factor for recovery for both shoulder flexion and abduction at 3 months after surgery. Home-based exercise with DVD was considered feasible. For the verification of this effectiveness, a randomized control study should be planned in the future.
Entities:
Keywords:
Activities of daily living; Axillary lymph node dissection; Breast neoplasms; Rehabilitation; Shoulder joint