Table 5.
Results of studies on rehabilitation methods on physical outcomes
| Chan et al37 (2010) | McNeely et al38 (2010) | Paramanandam and Roberts39 (2014) | Fors et al40 (2011) | Juvet et al22 (2009) | |
|---|---|---|---|---|---|
| Outcomes | |||||
| Upper body symptoms | Exercise: shoulder movement – overall improvement in shoulder mobility, irrespective of time period of implementation. However, most exercise programs were implemented soon after operation. Improvement in flexion and abduction movement measurements of the shoulder joint was significantly better in treatment groups. Most studies had used a goniometer to measure range of motion. | Exercise: shoulder movement – delayed versus early – (ten studies). Early exercise was more effective than delayed in the short-term recovery of shoulder flexion ROM. Structured exercise versus usual care (14 studies) – six were post-operative, three during adjuvant treatment and five following cancer treatment. Structured exercise programs in the post-operative period improved shoulder flexion ROM in the short-term and yielded additional benefit for shoulder function post-intervention and at 6-month follow-up. | Exercise: weight training exercise – limb strength of low to moderate intensity with relatively slow progression improved the upper limb strength and lower limb strength | – | Physiotherapy: shoulder movement – of the seven RCTs examining the effect of physiotherapy, three investigated shoulder function. Shoulder mobility improved after physiotherapy, but results were influenced by type of surgery (ie, BCT or MRM). There is a lack of high quality studies to guide conclusion on the effect of physiotherapy interventions to improve shoulder function after breast cancer surgery. Complex intervention: shoulder movement – inconclusive results. Only one study (psycho-education and exercise) investigated effect on shoulder mobility (ROM) with improvements found in the intervention group. Arm movement – inconclusive results |
| Lymphedema | Exercise: no significant change in incidence of lymphedema in studies involving upper limb exercise. Mean change in arm circumferences in different positions ranged from 0.10 to 0.30 cm, which was not significant. There was minimal difference in arm volume. In two studies a difference of only 0.70 and 2 mL was noted between groups. | Exercise: structured exercise versus usual care – there was no evidence of increased risk of lymphedema from exercise at any time point. | Exercise: weight training exercise of low to moderate intensity with relatively slow progression does not increase arm volume or incidence of lymphedema | – | Physiotherapy: inconclusive results (lack of high quality studies). Of the seven RCTs examining physiotherapy, four studied the effects on arm lymphedema. MLD (three studies) – no significant benefit of MLD. One study showed a decrease in lymphedema with complex decongestive therapy (lymph drainage, compression bandage, evaluation, medical exercise, and skin care) compared to SLNB. Three studies showed that effect of physiotherapy is not influenced by timing. Six studies are done after ALND and not after SLNB, while one study was done in mixed ALND and SLNB population Exercise: moderate level of evidence. Three studies showed that early exercise was not associated with aggravated lymphedema |
| Wound healing | – | Exercise: delayed versus early – early exercise resulted in significant increase in wound drainage volume. | – | – | – |
| Body composition | – | – | Exercise: weight training exercise of low to moderate intensity with relatively slow progression – no significant effects for BMI | – | Exercise: inconclusive results for BMI Nutrition: two RCTs. Inconclusive results on body weight Complex: inconclusive results on body composition |
| Fatigue | – | – | – | Psycho-education: overall significant short-term benefit for fatigue was observed CBT – inconclusive results. Modest short-term benefit on fatigue was found in one study reviewed | Exercise: inconclusive results. Three studies showed that exercise after primary treatment may reduce fatigue. Exercise intervention during primary cancer treatment showed varied result. Psycho-education: inconclusive results. CBT: inconclusive results. Social and emotional support intervention: inconclusive results |
| Hot flashes | – | – | – | – | Complementary/alternative rehabilitation: inconclusive results. Incidence of hot flashes was addressed in two studies, relaxation training intervention reduced the incidence, while acupuncture also reduced but did not reach statistical significance |
Abbreviations: ALND, axillary lymph node dissection; BCT, breast conservative therapy; BMI, body mass index; CBT, cognitive behavior therapy; MRM, modified radical mastectomy; MLD, manual lymph drainage; RCTs, randomized controlled trials; ROM, range of motion; SLNB, sentinel lymph node biopsy.