Table 4.

Characteristics of systematic reviews on rehabilitation methods after breast cancer surgery

No	Review, year	Type of rehabilitation method	Aim	Search strategy	Inclusion and exclusion criteria	No of studies included	Total number and age of participants	Assessed outcomes
1	Chan et al37 (2010)	Exercise	To review the efficacy of exercise programs on shoulder function and lymphedema in post-operative patients with breast cancer having ALND, as revealed by RCT.	Databases: Cumulative Index to Nursing and Allied Health Literature, Ovid MEDLINE, the British Nursing Index, Proquest, ScienceDirect, PubMED, Scopus and the Cochrane Library Published articles between 2000 and 2009 Search terms: breast cancer, exercise, lymphoedema, shoulder mobility, randomized controlled trials. Limited to English language articles	Inclusion: RCT, published in English. Intervention: various types of exercise programs – weight training, aerobic and strengthening exercises, stretching and range of motion (ROM) exercises. Outcome: range of shoulder motion, arm mobility, arm volume (at least one of these outcome variables). Exclusion: therapeutic intervention which only reported decongestive therapy involving MLD, compression garments and/or skin care, studies dealing with patients undergoing SLNB	6 RCTs	429 (range: 27–205); mean age of the participants was <60 years	Shoulder mobility and lymphedema: range of shoulder motion, shoulder mobility, arm circumference and arm volume
2	McNeely et al38 (2010)	Exercise	To examine the evidence of efficacy from RCTs involving exercise for preventing, minimizing and/or improving upper-limb dysfunction due to breast cancer treatment.	Databases: Cochrane Breast Cancer Group Specialised Register, MEDLINE, EMBASE, PEDro, LILACS No language restriction Search strategy: specified Published and unpublished up to 2008	Inclusion: adults: 17 years and older. Interventions – therapeutic exercise interventions for the upper-limb therapy program: 1) ROM exercises; 2) Passive ROM/manual stretching exercises; 3) Stretching exercises; 4) Strengthening or resistance exercises. Outcomes: upper-extremity ROM, muscular strength, lymphedema and pain, upper-extremity/shoulder function and QoL, early post-operative complications such as seroma formation, post-operative wound drainage, wound healing and effect modifiers such as adherence to exercise.	24 RCTs	2,132; mean age of participants ranged from 46.3 to 62.1 years	Primary outcomes: upper-extremity ROM, muscular strength, lymphedema and pain Secondary outcomes: upper-extremity/shoulder function (eg, reaching overhead, fastening a brassiere, doing a zipper up from behind) and QoL, early post-operative complications such as seroma formation, post-operative wound drainage, wound healing and effect modifiers such as adherence to exercise.
3	Paramanandam and Roberts39 (2014)	Weight training exercise	To investigate whether weight-training exercise intervention is harmful to women with or at risk of breast cancer related lymphedema.	Databases: PubMED, EMBASE, PsycINFO, CINAHL, AMED, Cochrane, PEDro, SPORTDiscus and Web of Science. Search terms: specified Published after 2001–2012	Inclusion: Design – RCTs, peer reviewed, published in English after 2001. Population – women at risk of developing lymphedema. Intervention – weight-training exercises outcomes – lymphedema, strength, QoL, comparison – sham exercise, no-intervention control, only lower body exercises and education	11 RCTs	1,091; age of participants ranged from 49 to 57 years	Lymphedema onset or exacerbation, limb strength, QoL, BMI
4	Fors et al40 (2011)	Psychosocial	To determine the efficacy of psycho-education, CBT and social support interventions used in rehabilitation of breast cancer patients.	Databases: Cochrane Library, The Centre for Reviews and Dissemination databases, Medline, Embase, Cinahl, PsycINFO, AMED, PEDro Published articles between 1999 and 2008 Search terms: specified in Juvet et al22 (2009)	Inclusion: RCTs investigating the effect of psychosocial rehabilitation with ≥20 female breast cancer Exclusion: low quality studies, less than 20 participants in each group, patients with metastatic cancer, data not presented separately for breast cancer and studies with other types of cancer	18 RCTs	3,272; N/A	QoL, fatigue, mood, health behavior, social functioning
5	Hoving et al41 (2009)	Occupational rehabilitation	To determine the effects of interventions on breast cancer survivors on return to work.	Databases: Ovid Medline, EMBASE, PsycInfo and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006) Published articles between 1970 and 2007 Search term: specified	Inclusion: types of studies: RCTs, cohort studies and observational studies, Interventions: all non-pharmacological interventions, types of outcome measures: work-related outcomes such as return to work, absenteeism, work disability, sick leave or employment status	4 studies (1 controlled study, 3 uncontrolled studies)	1,172; N/A	Return to work, absenteeism, work disability, sick leave or employment status
6	Juvet et al22 (2009)	Physical exercise, physiotherapy, psychosocial interventions, nutrition, complementary treatment, complex interventions	To assess the efficacy of single treatments and combination of treatments with respect to improvements in physical function and psychological wellbeing.	Databases: Cochrane Library, The Centre for Reviews and Dissemination databases, Medline, Embase, Cinahl, PsycINFO, AMED, PEDro Published articles up until 2008 Search term: specified	Inclusion: study design: RCTs. Physical exercise, therapy, psychosocial interventions, nutritional complementary or complex interventions. Outcomes: somatic, psycho-social outcomes. Exclusion: low quality studies, studies with less than 20 per arm	46 RCTs	5,645; N/A	Outcomes: somatic, psychological, and social outcomes
7	Selamat et al7 (2014)	Cognitive rehabilitation	To review qualitative studies that explored the life/daily experiences of “chemo-brain” among breast cancer survivors, with particular attention given to the impact of “chemo-brain” on daily living and quality of life.	Databases: CINAHL, Web of Knowledge, EMBASE, Proquest, OVID SP, MEDLINE, Oxford Journal, ScienceDirect, PubMED, Wiley Published from 2002 to 2014. English language text Search terms: specified	Inclusion: breast cancer and “chemo-brain”, qualitative study, studies published from 2002 to 2014, English publication. Exclusion: study design other than a qualitative design Methodology, studies with patients with cancers other than breast cancer, non-English papers	7 qualitative studies	193; N/A	Cognitive functioning or “chemo-brain”: Perception of “chemo-brain”, coping strategies towards cognitive dysfunction, self- management in being breast cancer survivor

Abbreviations: ALND, axillary lymph node dissection; BMI, body mass index; CBT, cognitive behavior therapy; CPT, mastectomy; MLD, manual lymph drainage; N/A, not assessed; QoL, quality of life; RCTs, randomized controlled trials; SLNB, sentinel lymph node biopsy.