Comparison of Rehabilitation Training at Different Timepoints to Restore Shoulder Function in Patients With Breast Cancer After Lymph Node Dissection: A Randomized Controlled Trial

Qing Shu; Yanan Yang; Yuwei Shao; Hui Teng; Rong Liao; Zhengfa Li; Gaosong Wu; Jinxuan Hou; Jun Tian

doi: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

Arch Phys Med Rehabil. 2023 May;104(5):728-737. doi: 10.1016/j.apmr.2023.01.021. Epub 2023 Feb 20.

Authors

Qing Shu¹, Yanan Yang², Yuwei Shao¹, Hui Teng¹, Rong Liao¹, Zhengfa Li¹, Gaosong Wu³, Jinxuan Hou³, Jun Tian⁴

Affiliations

¹ Department of Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.
² Department of Traditional Chinese Medicine, China Resources & WISCO General Hospital, Wuhan, China.
³ Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.
⁴ Department of Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China. Electronic address: tianjun@znhospital.cn.

PMID: 36813015
DOI: 10.1016/j.apmr.2023.01.021

Abstract

Objective: To investigate whether advancing the initiation of rehabilitation training compared with 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 (N=200).

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, European Organization Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module (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 4 groups, with no significant differences among the 4 groups.

Conclusions: 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.

Trial registration: ClinicalTrials.gov NCT03658265.

Keywords: Breast cancer; Randomized controlled trial; Rehabilitation; Shoulder dysfunction; Time factors.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms*
Female
Humans
Lymph Node Excision / adverse effects
Prospective Studies
Quality of Life
Range of Motion, Articular
Shoulder*

Associated data

ClinicalTrials.gov/NCT03658265