Summary of findings 2. Early shoulder mobilising exercises compared to delayed shoulder mobilising exercises for patient surgically treated for breast cancer.
| Early shoulder mobilising exercises compared to Delayed shoulder mobilising exercises for patient surgically treated for breast cancer | ||||||
| Patient or population: patients at risk for secondary upper limb lymphoedema after breast cancer treatment Settings: hospital Intervention: early shoulder mobilising exercises Comparison: delayed shoulder mobilising exercises | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Delayed shoulder mobilising exercises | Early shoulder mobilising exercises | |||||
| Lymphoedema ‐ medium term follow up Volumetry/ Circumference Follow‐up: 6‐12 months | Low1 | RR 1.69 (0.94 to 3.01) | 378 (3 studies) | ⊕⊝⊝⊝ very low2,3,4 | ||
| 5 per 100 | 8 per 100 (5 to 15) | |||||
| High1 | ||||||
| 27 per 100 | 46 per 100 (25 to 81) | |||||
| Shoulder range of motion for abduction ‐ short term follow up goniometer. Scale from: 0 to 180. Follow‐up: 1 month | Not estimable | The mean shoulder range of motion for abduction ‐ short term follow up in the intervention group ranged from 6° to 43° higher | 262 (2 studies) | ⊕⊝⊝⊝ very low2,5 | ||
| Shoulder range of motion for abduction ‐ medium term follow up goniometer. Scale from: 0 to 180. Follow‐up: 6 to 12 months | Not estimable | The mean shoulder range of motion for abduction ‐ medium term follow up in the intervention group ranged from 8.3° lower to 21.3° higher | 378 (3 studies) | ⊕⊝⊝⊝ very low6,7,8 | ||
| Shoulder range of motion for forward flexion ‐ short term follow up goniometer. Scale from: 0 to 180. Follow‐up: 1 month | Not estimable | The mean shoulder range of motion for forward flexion ‐ short term follow up in the intervention group ranged from 7° to 35.7° higher | 262 (2 studies) | ⊕⊕⊝⊝ low2,9 | ||
| Shoulder range of motion for forward flexion ‐ medium term follow up goniometer. Scale from: 0 to 180. Follow‐up: 6 to 12 months | Not estimable | The mean shoulder range of motion for forward flexion ‐ medium term follow up in the intervention group ranged from 0.6° lower to 5° higher | 321 (3 studies) | ⊕⊝⊝⊝ very low6,7,10 | ||
| Shoulder range of motion for external rotation ‐ medium term follow up11 goniometer. Scale from: 0 to 90. Follow‐up: 6 to 12 months | Not estimable | The mean shoulder range of motion for external rotation ‐ medium term follow up in the intervention group ranged from 1° lower to 8° higher | 378 (3 studies) | ⊕⊝⊝⊝ very low6,12 | ||
| Shoulder range of motion for internal rotation ‐ medium term follow up goniometer. Scale from: 0 to 90. Follow‐up: 6 to 12 months | The mean shoulder range of motion for internal rotation ‐ medium term follow up in the control groups was 76° | The mean shoulder range of motion for internal rotation ‐ medium term follow up in the intervention groups was 2.4°higher (0.14° lower to 4.9° higher) | 378 (3 studies) | ⊕⊕⊝⊝ low6 | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Assumed range of background risk taken from observed control‐group incidence in the included studies 2 No allocation concealment in one study (Bendz 2002). No blinding of outcome assessment in one study (Bendz 2002). No explicit statistical consideration for cluster randomisation (Bendz 2002). Unclear risk of bias for allocation procedure and concealment and attrition in one study (Cinar 2008). Unequal treatment of groups besides intervention in one study (Cinar). 3 Large and statistically‐significant effect in favour of intervention in one study (Todd 2008). Statistically non‐significant effects in favour of control group in another study (Bendz 2002). 4 Broad 95% confidence interval including clinically‐relevant effect in non‐significant meta‐analysis. 5 Small and non‐significant effect in one study (Bendz 2002). Large statistically‐significant effect in another study (Cinar 2008). Data pooling could not be performed due to significant statistical heterogeneity. 6 No allocation concealment in one study (Bendz 2002). No blinding of outcome assessment in one study (Bendz 2002). High risk of attrition bias in one study (Todd 2008). No explicit statistical consideration for cluster randomisation (Bendz 2002). Unclear risk of bias for allocation procedure and concealment and attrition in one study (Cinar 2008). Unequal treatment of groups besides intervention in one study (Cinar). 7 No meta‐analysis could be performed due to significant statistical heterogeneity, with contradicting effect estimates in three studies: (Bendz 2002; Cinar 2008; Todd 2008) 8 Very broad 95% CIs including both neutral values and large clinically‐relevant effects in two studies (Bendz 2002, Todd 2008). Data pooling was not possible due to significant statistical heterogeneity. 9 No data pooling was possible due to significant statistical heterogeneity, but point estimates are in favour of early mobilisation and statistically significant in both studies (Bendz 2002; Cinar 2008). 10 95% confidence interval includes both neutral and potentially clinically relevant values in one study (Todd 2008), and a small clinically‐irrelevant effect in the lower boundary of the CI in a second study (Bendz 2002). 11 Pooled data are from 6 month follow‐up (Bendz 2002) and 12 month follow‐up (Todd 2008). 12 Two studies with non‐significant effect with point estimate favouring delayed exercise (Bendz 2002, Todd 2008), one study with a large statistically‐significant effect favouring early exercise (Cinar 2008).