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

Tamknat  Ilyas; Affan  Iqbal; Mehwish  Niaz; Rabia  Majeed; Rabia  Jawa; Mamoona  Anwar

doi:10.54393/pbmj.v5i4.406

Authors

Tamknat Ilyas University of Management & Technology, Lahore
Affan Iqbal Riphah International University, Islamabad
Mehwish Niaz School of Health Sciences, University of Management & Technology, Lahore
Rabia Majeed School of Health Sciences, University of Management & Technology, Lahore
Rabia Jawa School of Health Sciences, University of Management & Technology, Lahore
Mamoona Anwar School of Health Sciences, University of Management & Technology, Lahore

DOI:

https://doi.org/10.54393/pbmj.v5i4.406

Keywords:

Mastectomy, Breast neoplasms, Physical Therapy, Pre-operative Rehabilitation, Post-Operative Rehabilitation

Abstract

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 operatively. Group B received post rehabilitation exercises only. Data was analyzed by SPSS 16.0. Independent t test was applied to analyze between group differences and paired sample t test to see within group improvement. Descriptive statistics was in form of mean, variance and appropriate graphs. RESULTS: Independent sample test results regarding post interventional disability of arm, shoulder, and hand (DASH) score showed significant p value 0.000 with a mean difference of 23.28000 while assuming equal variances. The mean and standard deviation of pain score was 3.76 (SD+0.778) pre/post combination group and post-operative rehabilitation program alone 4.1200 (SD+0.78102) with a statistically equal improvement in both groups (0.109). CONCLUSION: The study concluded that there was significant difference with better outcomes in terms of improvement in function, pain and range in patients having combination protocol i.e. pre-operative and post-operative rehab protocol in patient of mastectomy as compared to post-operative rehabilitation protocol alone.

References

Nesvold I-L, Dahl AA, Løkkevik E, Marit Mengshoel A, Fosså SD. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta oncologica. 2008,47(5):835-42.doi.org/10.1080/02841860801961257

Sclafani LM, Baron RH. Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction. The Cancer Journal. 2008,14(4):216-22.doi.org/10.1097/PPO.0b013e31817fbe5e

Jansen CW, Buford WL, Patterson RM, Gould LJ, editors. A Model of Length Increases of the Pectoralis Major Muscle to Provide Rehabilitation Precautions for Patients after Mastectomy. 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference 2006. doi.org/10.1109/IEMBS.2005.1616294

Blomqvist L, Stark B, Engler N, Malm M. Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiotherapy. Acta oncologica. 2004,43(3):280-3. doi.org/10.1080/02841860410026170

de Oliveira RR, Pinto e Silva MP, Gurgel MSC, Pastori-Filho L, Sarian LO. Immediate Breast Reconstruction With Transverse Latissimus Dorsi Flap Does Not Affect the Short-term Recovery of Shoulder Range of Motion After Mastectomy. Annals of plastic surgery. 2010,64(4). doi.org/10.1097/SAP.0b013e3181b142ea

Freitas-Silva R, Conde DM, Freitas-Júnior Rd, Martinez EZ. Comparison of quality of life, satisfaction with surgery, and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast reconstruction. Clinics. 2010,65:781-7. doi.org/10.1590/S1807-59322010000800007

Fernández-Lao C, Cantarero-Villanueva I, Fernández-de-las-Peñas C, Del-Moral-Ávila R, Menjón-Beltrán S, et al. Development of active myofascial trigger points in neck and shoulder musculature is similar after lumpectomy or mastectomy surgery for breast cancer. Journal of bodywork and movement therapies. 2012,16(2):183-90.doi.org/10.1016/j.jbmt.2011.01.022

Akoochakian M, Davari HA, Alizadeh MH, Rahnama N. Evaluation of shoulder girdle strength more than 12 month after modified radical mastectomy and axillary nodes dissection. J Res Med Sci. 2017,22:81.doi.org/10.4103/jrms.JRMS_649_16

Bendz I, Fagevik Olsén M. Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection – A randomised controlled trial. The Breast. 2002,11(3):241-8.doi.org/10.1054/brst.2001.0412

Cinar N, Seckin Ü, Keskin D, Bodur H, Bozkurt B, et al. The effectiveness of early rehabilitation in patients with modified radical mastectomy. Cancer nursing. 2008,31(2):160-5. doi.org/10.1097/01.NCC.0000305696.12873.0e

Ryttov N, Holm N, Qvist N, Blichert-Toft M. Influence of adjuvant irradiation on the development of late arm lymphedema and impaired shoulder mobility after mastectomy for carcinoma of the breast. Acta oncologica. 1988,27(6):667-70. doi.org/10.3109/02841868809091766

de Oliveira RR, e Silva MPP, Gurgel MSC, Pastori-Filho L, Sarian LO. Immediate breast reconstruction with transverse latissimus dorsi flap does not affect the short-term recovery of shoulder range of motion after mastectomy. Annals of plastic surgery. 2010,64(4):402-8. doi.org/10.1097/SAP.0b013e3181b142ea

Leonardis JM, Diefenbach BJ, Lyons DA, Olinger TA, Giladi AM, et al. The influence of reconstruction choice and inclusion of radiation therapy on functional shoulder biomechanics in women undergoing mastectomy for breast cancer. Breast cancer research and treatment. 2019,173(2):447-53.doi.org/10.1007/s10549-018-5003-8

Kilbreath S, Refshauge K, Beith J, Lee M. Resistance and stretching shoulder exercises early following axillary surgery for breast cancer. Rehabilitation Oncology. 2006,24(2):9. doi.org/10.1097/01893697-200624020-00003

Ahmed EM, Mekkawy MM, Sayed AA. Effect of Applying Shoulder Exercises on Shoulder Function after Modified Radical Mastectomy. Assiut Scientific Nursing Journal. 2017,5(12):74-84. doi.org/10.21608/asnj.2017.60617

Crosbie J, Kilbreath SL, Dylke E, Refshauge KM, Nicholson LL,et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Physical therapy. 2010,90(5):679-92.doi.org/10.2522/ptj.20090104

Cathrine Lauridsen M, Overgaard M, Overgaard J, Hessov I, Cristiansen P. Shoulder disability and late symptoms following surgery for early breast cancer. Acta oncologica. 2008,47(4):569-75.doi.org/10.1080/02841860801986627

Haddad CAS, Saad M, Perez MdCJ, Miranda Júnior F. Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy. Einstein (Sao Paulo). 2013,11:426-34.doi.org/10.1590/S1679-45082013000400004

Lauridsen MC, Christiansen P, Hessov I. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta oncologica. 2005,44(5):449-57.doi.org/10.1080/02841860510029905

Wingate L, Croghan I, Natarajan N, Michalek AM, Jordan C. Rehabilitation of the Mastectomy Patient: A Randomized, Blind, Prospective Study. Archives of physical medicine and rehabilitation. 1989,70(1):21-4.doi.org/10.1016/S0003-9993(21)01639-7

Flew T. Wound drainage following radical mastectomy: the effect of restriction of shoulder movement. British Journal of Surgery. 1979,66(5):302-5.doi.org/10.1002/bjs.1800660503