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Original Research|Articles in Press

Comparison of rehabilitation training at different timepoints to restore shoulder function in patients with breast cancer after lymph node dissection: a randomized controlled trial

Published:February 20, 2023DOI:https://doi.org/10.1016/j.apmr.2023.01.021
Comparison of rehabilitation training at different timepoints to restore shoulder function in patients with breast cancer after lymph node dissection: a randomized controlled trial
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      Highlights

      • •
        ROM training and PRT should be initiated earlier after BC surgery than guideline.

      ABSTRACT

      Objective

      To investigate whether advancing the initiation of rehabilitation training compared to the time recommended by the guidelines after breast cancer (BC) surgery is beneficial to the recovery of shoulder function and quality of life.

      Design

      Prospective, observational, single center, randomized controlled trial

      Setting

      The study was conducted between September 2018 and December 2019, with a 12-week supervised intervention and 6-week home-exercise period concluding in May 2020.

      Participants

      Two hundred BC patients received axillary lymph node dissection.

      Interventions

      Participants were recruited and randomly allocated into 4 groups (A, B, C, and D). Group A started range of motion (ROM) training at 7 days postoperative and progressive resistance training (PRT) at 4 weeks postoperative; Group B started ROM training at 7 days postoperative and PRT at 3 weeks postoperative; Group C started ROM training at 3 days postoperative and PRT at 4 weeks postoperative; and Group D started ROM training at 3 days postoperative and PRT at 3 weeks postoperative.

      Main Outcome Measures

      The primary outcome measure was Constant-Murley Score. Secondary outcome measures included ROM, shoulder strength, grip, EORTC QLQ-BR23, and SF-36. Incidence of adverse reactions (drainage and pain) and complications (ecchymosis, subcutaneous hematoma, lymphedema) were also assessed.

      Results

      Participants who started ROM training at 3 days postoperative obtained more benefits in mobility, shoulder function, and EORTC QLQ-BR23 score, while patients who started PRT at 3 weeks postoperative saw improvements in shoulder strength and SF-36. Incidence of adverse reactions and complications were low in all four groups, with no significant differences among the four groups.

      Conclusion

      Advancing ROM training initiation to 3 days postoperative or PRT to 3 weeks postoperative can better restore shoulder function after BC surgery and lead to faster quality of life improvement.

      KEY WORDS

      List of abbreviations:

      ALND (axillary lymph node dissection), ANOVA (Analysis of Variance), BC (breast cancer), CMS (Constant-Murley Score), D7R+W4P (Start ROM training at 7 days and PRT at 4 weeks postoperative), D7R+W3P (Start ROM training at 7 days and PRT at 3 weeks postoperative), D3R+W4P (Start ROM training at 3 days and PRT at 4 weeks postoperative), D3R+W3P (Start ROM training at 3 days and PRT at 3 weeks postoperative), EORTC QLQ-BR23 (European Organization Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module), PRT (progressive resistance training), QOL (quality of life), ROM (range of motion), SLNB (sentinel lymph node biopsy)
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      Article info

      Publication history

      Accepted: January 24, 2023
      Received in revised form: November 29, 2022
      Received: July 3, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      AUTHOR CONTRIBUTIONS: Study conception and design: Qing Shu, Jun Tian; Intervention and assembly of data: Yuwei Shao, Hui Ten, Rong Liao, Zhengfa Li; Recruitment of participants: Jinxuan Hou, Gaosong Wu; Data management and analysis: Yanan Yang, Qing Shu; Supervision: Jun Tian; Writing original draft: Qing Shu; Writing review & editing: Qing Shu, Jun Tian, Yuwei Shao; All authors read and approved the final manuscript.

      Ethics Statement The study protocol and informed consent form were approved by the Medical Ethics Committee of Zhongnan Hospital of Wuhan University in June 2018 (No. 2018013) (Sup.1). All participants gave written informed consent before data collection began. After finished the study, all inquiries about shoulder dysfunction after breast cancer surgery from participants would be properly addressed, or be directed to the corresponding specialist.

      Registration: ClinicalTrials.gov NCT03658265.

      Competing interests: We have no competing interests.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2023.01.021

      Copyright

      © 2023 by the American Congress of Rehabilitation Medicine.

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