Table 1.
Detailed best evidence table.
| Author, Year (Design) | Target Population | Rehabilitation Modality | Comparator | Pain-Related Outcomes | Rehabilitation Setting | Rehabilitation Providers | Conclusion |
|---|---|---|---|---|---|---|---|
| 1. Education | |||||||
| Oldenmenger et al. 2018 (Systematic review of RCTs) |
- adults - solid malignancies - cancer-related pain |
Educational intervention: information, behavioural instructions + advice (by verbal, written, audio- or videotaped or computer-aided modalities) | Usual care or active control intervention | - pain intensity (NRS or VAS) - pain interference (Brief Pain Inventory or an equivalent) - knowledge about cancer-related pain, pain barriers (Barriers Questionnaire) - medication adherence (Medication Adherence Scale, Medication Event Monitoring System or self-report) |
Outpatient and inpatient | (Oncology) nurse, research assistant/nurse | stat. sign. differences in favour of education were found for: - pain intensity in 31% of studies - pain interference in 33% of studies (only evaluated in 40% of included RCTs) - pain knowledge or barriers in 68% of studies (only evaluated in 84% of included RCTs) - medication adherence in 50% of studies (only evaluated in 23% of included RCTs) |
| Prevost et al. 2016 (systematic review of (non-) RCTs | - adults - cancer patients with pain |
Patient educational programs (PEP): information, behavioural instructions + advice (by verbal, written, audio- or videotaped, telecare, or computer-aided modalities) | Usual care, general patient education, nutrition education | - pain intensity (NRS) - pain interference (Brief Pain Inventory or an equivalent) - knowledge about cancer-related pain, pain barriers (Barriers Questionnaire) - medication adherence (questionnaires or self-reported) |
Ambulatory, home care, and hospital settings | (Oncology) nurse | stat. sign. differences in favour of education were found for: - pain intensity in 52% of studies - pain interference in 12% of studies (only evaluated in 37% of included RCTs) - pain knowledge and barriers in 81% of studies (only evaluated in 70% of included RCTs) - medication adherence in 45% of studies (only evaluated in 25% of included RCTs) |
| Ling et al. 2012 (review of RCTs) | - adults - cancer-related pain |
Educational intervention: information, behavioural instructions and advice by means of verbal, written or audio/video-tape messages | Non-educational treatment, no treatment or usual care | - pain intensity (Brief Pain Inventory, Total Pain Quality Management) - pain interference (Brief Pain Inventory, Total Pain Quality Management) |
Outpatient | Healthcare staff | - 50% of studies reported stat. sign. decrease in pain intensity - no stat. sign. results for pain interference |
| 2. Specific exercise therapy | |||||||
| McNeely et al. 2010 (review + meta-analysis of RCTs) |
- female adults - breast cancer patients who had surgical removal of breast tumour, axillary lymph node dissection or sentinel node biopsy - during and after cancer treatment |
1) Active or active-assisted ROM exercises; 2) Passive ROM/manual stretching exercises; 3) Stretching exercises (including formal exercise interventions such as yoga and Tai Chi Chuan); 4) Strengthening or resistance exercises. Carried out following surgery, during adjuvant treatment and following cancer treatment |
1) Early (day 1–3 post-surgery) vs. delayed (day 4 or later post-surgery) 2) usual care/comparison 3) supervised vs. unsupervised |
- pain incidence - pain intensity (VAS) |
Outpatient and inpatient | Physical therapist, manual therapist, occupational therapist or exercise specialist |
1) Early vs. delayed post-operative exercises: - no stat. sign. difference in pain incidence at 2w, 1Mo, 6Mo and 2y FU (Bendz et al 2002) and 3Mo FU (Le Vu 1997) 2) Specific exercises vs. usual care/comparison - no stat. sign. difference in pain incidence post-intervention (OR: 1.65; 95% CI: 2.50 to 0.81) or at 6Mo FU (OR: 1.51; 95% CI: 2.35 to 0.67) (Beurskens et al 2007) - stat. sign. different decrease in pain intensity: −3.4 vs. −0.5 (p < 0.01) at 3Mo; −3.8 vs. −1.0 (p > 0.05) at 6Mo (Beurskens et al 2007) 3) Supervised vs. unsupervised - no stat. sign. difference in pain intensity post-intervention (MD: −5.40 points; CI: −19.16 to 8.36) (Hwang et al 2008) |
| De Groef et al. 2015 (review of (pseudo-) RCTs) |
- female adults- breast cancer - maximum of 6 weeks postoperative |
Active exercises | 1) Early (day 1–3 post-surgery) vs. delayed (day 4 or later post-surgery) 2) usual care/comparison/no exercise program |
- pain incidence - pain intensity (NRS or VAS) |
Outpatient | NS | 1) Early vs. delayed post-operative exercises: - no stat. sign. differences for pain intensity (reported in only one study, Bendz et al 2002) 2) Specific exercises vs. usual care - no stat. sign. difference in pain incidence post-intervention (OR: 1.65; 95% CI: 2.50 to 0.81) or at 6Mo FU (OR: 1.51; 95% CI: 2.35 to 0.67) (Beurskens et al 2007) - stat. sign. different decrease in pain intensity: −3.4 vs. −0.5 (p < 0.01) at 3Mo; −3.8 vs. −1.0 (p > 0.05) at 6Mo (Beurskens et al 2007) |
| Carvalho et al. 2012 (review + meta-analyses of RCTs) |
- adults - head and neck cancer - during and after cancer treatment - with dysfunction of the shoulder due to having received any type of cancer treatment |
1) Active or active-assisted range of motion exercises 2) Passive range of motion exercises 3) Stretching exercises 4) Resistance exercises 5) Proprioceptive neuromuscular facilitation 6) Any other exercise with a focus on shoulder dysfunction treatment or prevention, whether combined or not with pharmacological intervention. |
No treatment, usual care, placebo, sham exercises or pharmacological interventions | - pain subscale of the Shoulder Pain and Disability Index (SPADI) (0–100) | Inpatient: Cross Cancer Institute and University of Alberta in Edmonton, Canada (McNeely et al 2004 and 2008) | NS | - stat. sign. beneficial effects for Progressive Strengthening Training (12 weeks) compared to standard care for pain subscale of the SPADI; MD −6.26 95% CI (12.20 to −0.31) |
| 3. Manual therapy | |||||||
| De Groef et al. 2015 (review of (pseudo-) RCTs) |
- female adults- breast cancer - max 6 weeks postoperative. |
Passive mobilizations | 1) Early (day 1–3 post-surgery) vs. delayed (day 4 or later post-surgery) 2) Usual care/comparison/no exercise program |
- pain incidence - pain intensity (NRS or VAS) |
Outpatient | NS | - pain or sensitivity problems: 74% in no physical therapy vs. 70% mobilisation group vs. 72% massage groups vs. 68% mobilisation and massage group at 3 Mo (p > 0.05) - locoregional pain: 5% in mobilization group vs. 13% in no mobilization group (p = 0.03) at 8–24 Mo Follow-Up (Le Vu et al., 1997) |
| Shin et al. 2016 (review + meta-analyses of RCTs) | - adults and children - metastatic, colorectal, advanced, breast, lung, paediatric and non-specified cancer |
Massage therapy: tissue manipulation using a carrier oil or blended carrier oil with essential oils (i.e., aromatherapy); excluding touch therapies such as therapeutic touch, acupressure, and reflexology. |
No massage | - pain intensity (NRS, VRS or VAS) | Outpatient and inpatient | Trained therapists or not mentioned | - massage significant effect in 1/5 studies on present pain intensity (NRS 0–10): MD −1.60, 95% CI (−2.67 to −0.53) |
| Boyd et al. 2016 (review + meta-analyses of RCTs) | - adults - metastatic, colorectal, advanced, breast, paediatric and non-specified cancer - with pain |
Massage therapy: the systematic manipulation of soft tissue with the hands that positively affects and promotes healing, reduces stress, enhances muscle relaxation, improves local circulation, and creates a sense of well-being. | Sham, no treatment, or active comparator (i.e., participants are actively receiving any type of intervention) |
- pain intensity/severity (VAS) | Inpatient, at patient’s or therapist’s home or a hospice | Massage therapist, unspecified therapist, nurse, healing-arts specialist, caregiver, or a researcher trained in massage | - 79% (11/14) of studies showed significant beneficial effects of massage therapy on pain intensity - meta-analysis massage vs. no treatment including 3 studies: SMD= −0.20, 95% CI (−0.99 to 0.59); reduction in pain intensity = −5.075, 95% CI (−24.80 to 14.63) - meta-analysis massage vs. active comparator including 6 studies: SMD = −0.55, 95% CI (−1.23 to 0.14); reduction in pain intensity = −13.63, 95% CI (−30.78 to 3.5) |
| 4. General exercise therapy | |||||||
| Nakano et al. 2018 (SR and meta-analyses of RCTs |
- adults - during and after cancer treatment |
1) Aerobic exercise program 2) Resistance exercise program 3) Mixed exercise program |
Not receiving any (major) exercise intervention or other interventions (e.g., cognitive behavioural therapy); groups with only attention, relaxation, or education | - EORTC-QLQ-C30 – pain symptom subscale | NS | NS | - overall effect of exercise on EORTC-QLQ-C30 – pain symptom subscale: SMD −0.17, 95% CI (−0.32 to −0.03); p = .02; - no stat. sign. difference among 3 subgroups: 1) aerobic exercise program (4 studies): NS 2) resistance exercise program (3 studies): NS 3) mixed exercise program (4 studies): SMD −0.28; 95% CI (−0.47 to −0.09); p = .005 |
| Mishra et al. 2012 (SR and meta-analyses of RCTs and CCTs) | - adults - after cancer treatment (i.e., survivors) - excluding those who are terminally ill and receiving hospice care |
Exercise interventions and any physical activity causing an increase in energy expenditure, and involving a planned or structured movement of the body performed in a systematic manner in terms of frequency, intensity, and duration and is designed to maintain or enhance health-related outcomes | No exercise, another intervention, or usual care (e.g., with no specific exercise program prescribed) | - pain intensity (EORTC-QLQ-C30 – pain symptom subscale or Shoulder Pain and Disability Index (SPADI)) | NS | NS | - pain intensity: −0.29 95% CI (−0. 55 to −0.04) standard deviation units after 12 weeks follow-up; (4 studies) A standard deviation unit is equivalent to about a 28-point change on the QLQ-C30 pain sub-scale |
| Mishra et al. 2012 (SR and meta-analyses of RCTs and CCTs) | - adults - during active cancer treatment - excluding those who are terminally ill and receiving hospice care |
Exercise interventions and any physical activity causing an increase in energy expenditure, and involving a planned or structured movement of the body performed in a systematic manner in terms of frequency, intensity, and duration and is designed to maintain or enhance health-related outcomes | No exercise, another intervention, or usual care (e.g., with no specific exercise program prescribed) | - Pain intensity (MOS SF-36 – pain subscale, EORTC QLQ-C30 – pain symptom subscale, VAS, MD Anderson Symptom Inventory - pain subscale) | Individual or group, home or facility based | Professionally led or not | - no significant effect was obtained when pooling trials that reported change in pain from baseline to follow-up nor overall pain for follow-up values |
| 5. Mind-body therapy | |||||||
| Pinto-Carral et al. 2018 (SR and meta-analyses of RCTs and CCTs) | - adults - breast cancer - during and after cancer treatment |
Pilates exercises: focused on core muscle strengthening, spine flexibility and shoulder girdle range of motion | Other exercise interventions | - Pain intensity (Brief Pain Inventory, VAS) | NS | Specialized pilates centres (outpatient) or at home | - stat. sign effect for pain intensity: SMD −0.48; 95% CI (−0.88 to −0.07) |
| Danhauer et al 2019 (SR of RCTs) | - adults - breast, prostate, lymphoma colorectal or mixed cancer groups - during and after cancer treatment |
Yoga: multicomponent protocols (i.e., movement/postures, breathing and mediation) based on several different yoga types (Anusara, Eischens, Iyengar, Tibetan, Bali, Vivekananda Yoga Anusandhana Samsthana) | Waitlist, usual care or active comparator | - Pain (not further specified) | NS | NS | - 1/1 study stat. sign. improvement of pain during cancer treatment - 2/3 studies stat. sign. improvement of pain after cancer treatment |
| Pan et al. 2015 (SR and MA of RCT) |
- adults - breast cancer - after active cancer treatment |
Tai Chi Chuan (NS) | Psychosocial therapy intervention, standard care, health education | - pain (not specified health-related quality of life questionnaire or SF-36) | NS | NS | - no stat. sign. effect for pain: SMD 0.11; 95% CI (−0.41 to 0.18) |
Stat. sign. = Statistically Significant; RCT = Randomized Controlled Trial; SR = Systematic Review; NRS = Numeric Rating Scale; VAS = Visual Analogue Scale; VRS = Verbal Rating Scale; SMD = Standardized Mean Difference; MD = Mean Difference; CI = Confidence Interval; Mo = Months; w = weeks; y = years; EORTC-QLQ-C30 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30; MOS SF-36 = Medical Outcome Study 36-Item Short From Survey; NS = Not specified.