Original research| Volume 96, ISSUE 12, P2161-2168, December 2015

Discrepant Trajectories of Impairment, Activity, and Participation Related to Upper-Limb Function in Patients With Breast Cancer

Published:September 03, 2015DOI:



      To explore upper-limb disability with respect to health outcomes, operationalized by Disabilities of the Arm, Shoulder, and Hand, and to identify factors associated with each element of upper-limb disability over a 2-year period in breast cancer survivors.


      Prospective cohort study.


      University hospital cancer center.


      Individuals (N=191) recruited from all the patients with newly diagnosed breast cancer before cancer surgery at a university hospital between April 2006 and March 2007.


      Not applicable.

      Main Outcome Measures

      We evaluated demographics, social variables, and upper-limb disability in a baseline assessment preoperatively. Follow-up evaluations were conducted in outpatient clinics 3 months after surgery and at 12 and 24 months after surgery. Linear regression models with the generalized estimating equations of the compound symmetry covariance structure were used.


      Time since surgery was inversely associated with the impairment items score (β=−.20; 95% confidence interval [CI], −.49 to −.08) and positively associated with the activity limitation items score (β=.59; 95% CI, .29–.88). The impact of upper-limb disability preoperatively on the items involving both the activity limitation and participation restrictions scores was positive (β=2.89; 95% CI, .76–5.02) after adjusting for demographic, treatment type, and socioeconomic factors.


      Our study revealed that upper-limb impairment recovered with time after breast cancer surgery; however, upper-limb function-related activity and participation were reduced through 2 years after surgery.


      List of abbreviations:

      CI (confidence interval), DASH (Disabilities of the Arm, Shoulder, and Hand), ICF (International Classification of Functioning, Disability and Health)
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