The Effect of Multidimensional Physiotherapy Program on Shoulder Function, Pain, and Lymphedema After Surgery in Elderly Breast Cancer Patients (2025)

Two Exercise Schemes In Postoperative Breast Cancer: Comparison of Effects on Shoulder Movement and Lymphatic Disturbance

Tumori, 2006

A Case Report on the Impact of Physiotherapy on Shoulder Function in Breast Cancer Patients Undergoing Surgery

https://www.ijhsr.org/IJHSR_Vol.12_Issue.3_March2022/IJHSR-Abstract.018.html, 2022

Early breast cancer treatment can cause shoulder dysfunction, which is a well-known and prevalent adverse effect (1). In individuals treated surgically for breast cancer, physiotherapy was found to enhance shoulder function considerably (1). Breast cancer is the most common type of cancer in women and the leading cause of death and morbidity (2). Every year, 1.67 million new instances of breast cancer are identified worldwide, with 458,000 fatalities (2). Although 89 percent of breast cancer survivors live for at least five years after treatment, side symptoms can continue for months or even years(2). The most common upper-limb side effects are pain and joint dysfunction, with prevalence rates ranging from 12% to 51% for pain and 1.5 percent to 50% for joint dysfunction. Surgery is the most common treatment for primary breast cancer. Shoulder exercises are commonly advised to reduce mobility and strength loss as well as prevent lymphedema. Several clinical services have been developed to help with shoulder range of motion rehabilitation and secondary lymphedema prevention(3). The goal of this study was to see how additional postoperative physiotherapy affected shoulder function after the initial postoperative healing period, especially when given for a longer period. Patients who have had a mastectomy are always at risk of getting shoulder pain and adhesive capsulitis, and they must take precautions (3).

Application of a domicile-based exercise program for shoulder rehabilitation after breast cancer surgery

Revista Latino-Americana de Enfermagem, 2012

The aim of this study was to evaluate the effectiveness of an exercise program for the recuperation of the range of motion (ROM) of the shoulder. This is a quasi-experimental study developed at the Mastology Outpatient Clinic of the Federal University of São Paulo -Brazil, from August 2006 to June 2008, with 64 breast cancer patients undergoing surgery. The intervention consisted of: preoperative evaluation of the ROM, verbal and written guidance, demonstration and implementation of the exercises and revaluation at the outpatient follow-up appointments until the 105 th postoperative day (PO). From the 7 th PO a significant increase was observed in the ROM, which continued until the 105 th PO. The minimum time for recovery was 105 days for the women undergoing mastectomy, and 75 days for those undergoing quadrantectomy. There was satisfactory adherence of 78.6% of the women. The domicile program was effective for the recovery of ROM in the study population, benefiting women who can not attend a presential program. Aplicação de programa de exercícios domiciliares na reabilitação do ombro pós-cirurgia por câncer de mama O objetivo desta pesquisa foi avaliar a efetividade de um programa de exercícios para recuperação da amplitude de movimento (ADM) do ombro. Foi usado o método experimental, e o estudo foi desenvolvido no Ambulatório de Mastologia da Universidade Federal de São Paulo, Brasil, de agosto de 2006 a junho de 2008, com 64 mulheres com câncer de mama, submetidas à cirurgia. A intervenção constou de: avaliação préoperatória da ADM, orientação verbal e escrita, demonstração e execução dos exercícios e reavaliações nos retornos ambulatoriais até o 105º dia de pós-operatório (PO). Os resultados mostraram, a partir do 7ºPO, acréscimo significante e contínuo na ADM, até o 105º PO. O tempo mínimo para recuperação foi de 105 dias para as mulheres mastectomizadas, e de 75 dias para aquelas submetidas à quadrantectomia. Houve adesão satisfatória de 78,6% das mulheres. Conclui-se que o programa domiciliar se mostrou efetivo para a recuperação da ADM na população estudada, beneficiando mulheres que não poderiam frequentar um programa presencial.

Physiotherapy improves shoulder function after treatment in women with early breast cancer

Cancer Treatment Reviews, 2006

Abstracted from: Lauridsen MC, Christiansen P, Hessov I. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomised study. Acta Oncol 2005; 44:449-57.

Manual therapy associated with upper limb exercises vs. exercises alone for shoulder rehabilitation in postoperative breast cancer

Physiotherapy Theory and Practice, 2012

Our objective was to evaluate the effectiveness of manual therapy (MT) associated with upper limb (UL) exercises in women with impaired shoulder range of motion (ROM) after axillary lymph node dissection (ALND) for breast cancer. A randomized, prospective, blinded clinical trial with 131 women with a ROM < -100°for shoulder flexion and/or abduction on the first day postoperatively were evaluated. Sixty-six women were allocated to group exercises and 65 underwent the exercises followed by MT. Shoulder ROM was measured by goniometry, and function was evaluated by the Modified-University of California at Los Angeles Shoulder Rating Scale-the UCLA Scale, in the 1st, 6th, 12th, and 18th month after surgery. The chi-square test was used for the relationship between clinical characteristics and oncological treatment between groups, and ANOVA for repeat measures was used. No difference in recovery of shoulder ROM as well as UL function was observed between groups. Improvement in ROM was gradual from the 1st to the 18th month, and the function achieving a good classification at 18th month. MT associated with exercises did not enhance the results obtained with exercises alone for shoulder ROM and ipsilateral UL function.

A Study Protocol on the Effectiveness of Post Mastectomy Exercises in Breast Cancer Patients on Reduction of Lymphedema and Improving Range of Motion among Patients Undergone Mastectomy

Journal of Pharmaceutical Research International

Background: Breast cancer is the most commonly diagnosed type of cancer in the world and it is a major stressor in women&#39;s lives. Breast cancer cases are increasing in both rural and urban settings. Mastectomy is a procedure that removes the breast to prevent cancer cells from returning. Many complications can develop after a mastectomy but lymphedema and limited range of motion are the most prevalent. The present study aimed to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. Objectives: To assess pre interventional level of lymphedema among patients undergone mastectomy. To assess pre interventional range of motion among patients undergone mastectomy. To evaluate the effectiveness of post mastectomy exercises in reducing lymphedema among patients undergone mastectomy To evaluate the effectiveness of post mastectomy exercises in improving range of motion...

Effect of structured training program on arm dysfunction, lymphedema and quality of life after breast cancer surgery

Journal of the Pakistan Medical Association

Objective: The aim of this study the effect of the education given according to daily living activities (DLA) model on arm dysfunction, lymphedema and quality of life in patients undergoing breast cancer surgery. Interventions/Methods: In the design of the research, a randomized controlled experimental model with recurrent measurement was used. The data were collected from 60 patients (control group: 30, Intervention Group: 30) at a teriary hospital. In Research ,Patient Information Form, SPOFIA, KATZ-DLA indeks, arm, shoulder and hand injuries scale (DASH) and quality of life scale short form (SF-36) were used. Three interviews (1st week, 1st and 3rd month) were performed after surgery with patients. Analysis of data; independent T-Test, Chi-squared and Repeated Measures ANOVA were utilized. Results: SPOFIA, DASH and KATZ, GYA scale averages decreased by the time, SF-36 were found to increase the average score. In the intervention group, the measurements of the upper arm circumfere...

Efficacy of Physical Therapy Methods and Exercise After a Breast Cancer Operation: A Systematic Review

Critical Reviews in Physical and Rehabilitation Medicine, 2001

To evaluate the effects of: (1) different therapy methods on upper limb oedema of breast cancer patients; (2) early versus delayed introduction of shoulder exercise after breast cancer surgery; and (3) exercise therapy and aerobic exercise among breast cancer patients. Searching MEDLINE, EMBASE, and the Scandinavian database ArbSpriSwe were searched from 1980 to 1999 for English-and Scandinavian-language papers. Search terms such as 'breast cancer', 'breast neoplasm', 'physical therapy', 'physiotherapy', 'rehabilitation', 'exercise', 'lymphedema', 'late symptoms', 'quality of life' and 'physical activity', were included. Reference lists were handsearched. Study selection Study designs of evaluations included in the review Prospective randomised, quasi-experimental, uncontrolled, or single-subject experimental (repeated measures) clinical studies were included. Specific interventions included in the review Post-operative therapy, therapy methods used with late symptoms, or therapeutic exercise or training were eligible. The included lymphoedema therapy methods were ultrasound therapy, elastic sleeve, mechanical pressure therapy, electrically-stimulated lymphatic drainage, pneumatic compression, lymph massage by Foldi, bandaging, microwave heating, skin care, self-massage, mechanical massage vibrator, manual lymph drainage, massage with aromatherapy, lowlevel laser therapy, isometrics, and pneumatic massage with uniform or differentiated pressure. The included postoperative shoulder exercises were hand-squeezing, wall climbing, pendulum and pulley, arm use, spontaneous movements, and isometrics. The included exercise therapies involved head and neck, arm-shoulder, arm-leg, on-floor abdominal, back-leg, stretching, active assisted shoulder exercise, functional activities, and instruction in self-care. The included aerobic exercises were pedalling or walking, or were self-chosen. There were wide variations in the introduction, timing, intensity and duration of the interventions, and combinations of interventions were seen in all categories. Participants included in the review Female patients who had undergone breast cancer surgery were included. There was considerable heterogeneity among the populations in terms of age, severity of conditions, time elapsed since breast cancer operations, and prior or concurrent use of medication and therapies for oedema. Outcomes assessed in the review The outcomes assessed were oedema (measures such as volume or circumference difference, bodyweight); shoulder mobility (e.g. goniometric range of motion and circumference measurement); and functional capacity (e.g. oxygen uptake, respiratory values, arm and shoulder function). Several studies also measured the subjective feelings of patients using a variety of tools. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.

Physical Therapy Approach in Shoulder Impairment Along With Lymphedemea after Breast Cancer Surgery: A Case Study

2017

A 52-year-old woman with a history of breast cancer and mastectomy surgery and axillary lymph nodes dissection was referred to a physical therapy clinic. Lymphotherapist assessment revealed that there was a grade II upper limb lymph edema; pitting and palpable fibrotic tissue existed in volar side of forearm. Water displacement measurement to assess the limb volume in affected and unaffected side indicated an obvious difference. In physical examination, there was a significant limitation in shoulder range of motion (ROM) and tightness in shoulder girdle muscles. A multimodal physical approach based on manual therapy, electrotherapy and exercise therapy was conducted to eliminate shoulder impairment along with Manual Lymph Drainage (MLD) and lymphological compression bandage to eliminate lymphedema. The results of final re- assessment indicated that combination of lymphatic massage and compression bandage can lower the lymph edema following the mastectomy. Also, physical therapy appr...

Physiotherapeutic performance in mastectomy after breast cancer: a literature review

Journal of Cancer Prevention & Current Research, 2021

Cancer is characterized by disorganized and chaotic cell growth that results from genetic changes inherited or acquired by the action of certain environmental, chemical, radioactive, viral and hormonal agents named carcinogens, which thereby initiate the process of tumorigenesis. 1 Breast cancer is the second most common form of cancer in the world and the leading cause of death by cancer among females. It mainly affects women aged between 40 and 60 years. 1,2 The main risk factors are genetics and external, such as environment, living habits, eating habits, age, menarche, exposure to estrogen, radiation, obesity, sedentarism and environmental toxins. 1,2 According to the World Health Organization (WHO), about 40% of deaths could be prevented by eliminating or minimizing exposure to carcinogens. Primary prevention consists in promoting health and avoiding external risk factors. Secondary prevention involves actions aimed at early diagnosis of the disease. The main objectives of treatments are to cure, prolong survival and improve the quality of life (QoL) of patients. 1 Primary treatment for breast neoplasm is a surgical intervention called mastectomy, whose goal is tumor removal. The most commonly used surgical procedure is modified radical mastectomy, in which the entire breast is removed, along with axillary lymph nodes. 1,3,4 After mastectomy, women face a psychological trauma. These feelings lead them to explore the possibilities of breast reconstruction, in order to reconstitute their body image, with improvements to QoL and well-being, so it should be considered as an integral part of breast cancer treatment. 5 Treatment-associated morbidities include paresthesia of the axillary region and the lateral wall of the thorax, pain, enlargement of upper limb, reduction of shoulder's range of motion, limitation of daily living activities (DLAs), and interference in QoL. 6 Patients undergoing physical therapy have their recovery time reduced and return more quickly to their daily, occupational and sports activities, as well as can reacquire movement amplitude, strength, good posture, coordination, self-esteem and, mainly, minimize possible postoperative complications and increase their QoL. 3 In the preoperative phase, the work of musculature maintenance is important, besides a previous evaluation of the patient's overall conditions. The post-surgical treatment aims at a significant improvement in skin texture, absence of fibrotic nodulation, reduction of edema, pain relief, minimization of possible tissue adhesions, rapid recovery of areas with hypoesthesia, that is, less of complications and acceleration of patient's return to daily activities. 7,8 The main physical therapy resources used to achieve that, are: manual lymphatic drainage, ultrasound, cryotherapy, laser therapy, electrotherapy, active exercises and complex decongestive therapy (CDT), which is fundamental to the recovery process. 7 Because of the high incidence of breast cancer, and the search for a treatment that ranges from tumor removal surgery to breast reconstruction

Author’s response to reviews Title: Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer Authors

2020

Title: Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer Authors: I-Hui Chen (ichen4@tmu.edu.tw) Chia-Hui Wang (wangch@tmu.edu.tw) Shu-Yi Wang (swang@regis.edu) Sue-Yueh Cheng (sycheng@tmu.edu.tw) Tzu-Jou Yu (ee56073@tmu.edu.tw) Shu-Fen Kuo (sfkuo6@tmu.edu.tw) Version: 1 Date: 23 Apr 2020 Author’s response to reviews: Manuscript ID: BMWH-D-20-00136 Title: Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer April 6, 2020 Dear reviewers and editors, Thank you for your thoughtful and insightful comments about our article. We revised the manuscript to reflect the reviewers’ and your suggestions. The revised manuscript is attached (revisions are in red type), and the revisions are summarized below:

Is physiotherapy useful to the breast cancer patient?

Acta Oncologica, 2005

Comparative Effects of Pre-Operative Versus Post Operative Shoulder Rehabilitation Program Mastectomy Patients; A Cross Sectional Survey

Pakistan BioMedical Journal

Breast cancer is ranked the top in types of cancer that affects internationally. It affects up to 1 in 13 women during their lifetime. Physiotherapy is one of the major sources of recovery in patients of Mastectomy in terms of pain, ranges, and function. OBJECTIVE: To compare the effects of pre-operative shoulder rehabilitation program versus post-operative mastectomy patients. METHODS: This was a randomized clinical trial. The study setting was Oncology Department, Mayo Hospital Lahore, Shokat Khanum and Gulab Devi Hospital Lahore. The study was completed in 6 months. Total 50 subjects were allocated in two groups using lottery method of randomization. Patient with age less than 40 years, diagnosed with breast cancer were included, while those with associated signs of musculoskeletal problems, autoimmune systemic disease and advanced medical problem was excluded. Group A received set of exercises comprised of range of motion exercises and lymph edema education pre and post operativ...

Physiotherapeutic approach in a patient with breast carcinoma – A case report

Medical Science

Breast carcinoma is one of the most serious illnesses in females and a significant because of mortality and morbidity. A variety of treatment programs has now been developed to help with the restoration of shoulder movement while also lowering the occurrence of subsequent lymphedema. Modified radical mastectomy has several advantages, including local cancer management and a lower chance of cancer recurrence, as well as the preservation of the chest muscles, which prevents deformity and allows patients to undergo breast reconstruction. Lymphedema can cause cosmetic issues, functional difficulties, and psychological anguish in breast cancer patients, all of which can reduce the quality of life. Females who receive quick breast reconstruction have a lower risk of depression and have a higher standard of life. For females who have had breast cancer, physiotherapy can assist to reduce pain, restore shoulder mobility, and enhance the quality of life.

The Effect of Rehabilitation Program on Lymphedema-related Arm Pain, and Volume after Mastectomy

Iran Journal of Nursing, 2011

Background &aim: Upper extremity Lymph edema is the most common complication after mastectomy. The aim of this study is determining the effect of home based rehabilitation program on lymph edema related arm pain and arm volume after mastectomy among breast cancer survivors. Material & Methods: In this quasi-experimental (before-after design), 16 post-mastectomy women with mild lymphedema (200 cc) referring to breast disease center affiliated with Jihad branch of Tehran University of Medical Sciences were selected by purposeful sampling. The interventions included; educational program, arm exercises, self lymph drainage (SLD) by massage and compliance with risk reduction behaviors related to lymph edema at home during an 8 weeks program. Arm volume was measured by water displacement and pain was assessed by visual analog scale (VAS) before, one and two months after intervention. Study Participants were followed by call and in person in the clinic. Data was analyzed using repeated measurement. Results: The findings showed a significant reduction in lymphedema volume (from 160 ±44 ml, to 35±23 ml) and pain (from 4.6, to .03) (p0/001). Conclusion: Home based rehabilitation program reduces the volume of edema and intensity of pain after mastectomy. Evaluation of this method in patients with more edema volumes using control groups is recommended.

Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer

BMC Women's Health, 2020

Background The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. Methods A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. Results In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = ...

Revitalizing Post-Mastectomy Lives: Unveiling the Impact of Aerobic and Mobility with Strengthening Exercises in Improving Shoulder Pain, ROM, and Strength

Journal of health and rehabilitation research, 2024

Background: Breast cancer is the most prevalent cancer among women globally, with Pakistan having one of the highest incidence rates in Asia. Post-mastectomy patients often suffer from shoulder pain, reduced range of motion (ROM), and muscle weakness, impacting their quality of life. This study investigates the efficacy of a comprehensive exercise regimen in alleviating these symptoms. Objective: To evaluate the impact of aerobic, mobility, and strengthening exercises on shoulder pain, ROM, and muscle strength in post-mastectomy patients undergoing chemotherapy. Methods: A six-month case-control study was conducted with 60 participants, aged 25-65, who had undergone radical mastectomy and were in the chemotherapy phase. Participants were randomly assigned to two groups: the case group (n=30), which underwent an eight-week program of aerobic, mobility, and strengthening exercises, and the control group (n=30), which performed only aerobic exercises. Data collection tools included the Visual Analogue Scale (VAS) for pain assessment, a Goniometer for ROM measurement, and Manual Muscle Testing (MMT) for muscle strength evaluation. Data analysis was conducted using SPSS version 25, with paired and independent t-tests applied to compare pre-and post-intervention scores. Results: The case group showed a significant reduction in VAS scores (mean difference = 2.93333, p<0.001) compared to the control group (mean difference = 0.40000, p=0.028). MMT results indicated significant improvements in muscle strength for the right deltoid (mean difference = -0.40000, p=0.009) and left pectoralis major (mean difference = -0.73333, p<0.001) in the case group. ROM improvements were significant for right shoulder extension (mean difference = -0.80000, p<0.001) and left shoulder external rotation (mean difference = -1.73333, p<0.001) in the case group. Conclusion: A comprehensive exercise regimen, including aerobic, mobility, and strengthening exercises, significantly improved shoulder pain, ROM, and muscle strength in post-mastectomy patients. These findings support the integration of multifactorial physiotherapy into rehabilitation protocols for breast cancer survivors to enhance their long-term health and quality of life.

The Effect of Arm Exercises on The Prevention of Lymphedema in Post- Mastectomy Breast Cancer Patients at Haji

2021

Breast cancer is a malignant neoplasm, an abnormal growth of breast tissue that does not see the surrounding tissue, grows infiltrative and destructive, and can metastasize. Every breast cancer patient experiences side effects from various treatment treatments. This is because the therapy that each patient gets varies and also that cancer sufferers have different genetic backgrounds and different environments. Mastectomy in breast cancer patients can cause many patients to suffer from decreased joint mobility, lymphedema, and limitation in daily activities. These complaints can be overcome with arm exercises. Arm exercises are done to improve circulation and muscle strength and to prevent joint stiffness, preventing lymphedema from occurring. The purpose of this study was to analyze the effect of arm exercises on lymphedema prevention by looking at the value of arm measurements before the intervention and after intervention in the intervention and control groups. The research design...

The Impact of Therapeutic Exercises on the Quality of Life and Shoulder Range of Motion in Women After a Mastectomy, an RCT

Journal of Cancer Education, 2020

Breast cancer ranks highest in incidence and mortality among females and second among both genders. Lebanon has the second highest rate of breast cancer worldwide for those 35-39 years old and the highest for those 40-49. Mastectomy often results in deceased shoulder and arm mobility and decreased quality of life. The objective of this study was to assess the effect of an educational program of therapeutic exercises on the quality of life and functional ability in women after a mastectomy. Sixty women undergoing a mastectomy were randomly assigned to either an intervention or control group. The intervention group received extensive pre-surgery education as well as training on therapeutic exercises. Follow-up phone calls to the intervention group were made to ensure that the exercises were being done. Both groups were visited at home at two and four weeks to obtain the outcome variables. The Breast Cancer Patient Version was used to assess quality of life, and the "Goniometer" was used to assess the range of motion of the affected shoulder. At two and four weeks after surgery, women in the intervention group had significant improvements in their shoulder range of motion: flexion, extension, and abduction were significantly different between the control and intervention group at p = 0.04-0.00. For quality of life, physical, psychological, psychological, social, and spiritual well-being were significantly higher for the intervention group at both two and four weeks after surgery, p < 0.001. In a middle-income country, one-to-one education provided by a nurse, which included demonstrations, back demonstrations, and weekly phone calls had a positive impact on women's shoulder range of motion and quality of life. NCT04184102

Physiotherapy for the functioning of breast cancer patients: studies of the effectiveness of physiotherapy methods and exercise, of the content and timing of …

2005

Kärki, Anne Physiotherapy for the functioning of breast cancer patients. Studies of the effectiveness of physiotherapy methods and exercise, of the content and timing of postoperative education and of the experienced functioning and disability