Development of an exercise intervention for the prevention of musculoskeletal shoulder problems after breast cancer treatment: the prevention of shoulder problems trial (UK PROSPER) (original) (raw)
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BMJ open, 2018
Musculoskeletal shoulder problems are common after breast cancer treatment. Early postoperative exercises targeting the upper limb may improve shoulder function. This protocol describes a National Institute for Health Research-funded randomised controlled trial (RCT) to evaluate the clinical and cost-effectiveness of an early supervised structured exercise programme compared with usual care, for women at high risk of developing shoulder problems after breast cancer surgery. This pragmatic two-armed, multicentre RCT is underway within secondary care in the UK. PRevention Of Shoulder ProblEms tRial (PROSPER) aims to recruit 350 women from approximately 15 UK centres with follow-up at 6 weeks, 6 and 12 months after randomisation. Recruitment processes and intervention development were optimised through qualitative research during a 6-month internal pilot phase. Participants are randomised to the PROSPER intervention or best practice usual care only. The PROSPER intervention is delivere...
2017
Shoulder dysfunction and pain following breast cancer treatment is common, impacting upon postoperative quality of life. Exercise may improve shoulder function and reduce the risk of postoperative complications. However, there is uncertainty around the optimal timing (commencement) and exercise dosage (frequency, intensity, length of time and type of exercise) required for optimal results. We considered Medical Research Council (MRC) guidance for the development of a complex intervention, which highlights the need for a planned, phased approach based on available evidence, appropriate theoretical principles and thorough piloting. We developed a complex intervention for the prevention of shoulder dysfunction following breast cancer treatment for evaluation within the framework of a large pragmatic multicentre randomised controlled trial in the UK NHS setting
Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT
Health Technology Assessment
Background Upper limb problems are common after breast cancer treatment. Objectives To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. Design This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). Setting Breast cancer centres, secondary care. Participants Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. Interventions All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included s...
2020
Title: Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer Authors: I-Hui Chen (ichen4@tmu.edu.tw) Chia-Hui Wang (wangch@tmu.edu.tw) Shu-Yi Wang (swang@regis.edu) Sue-Yueh Cheng (sycheng@tmu.edu.tw) Tzu-Jou Yu (ee56073@tmu.edu.tw) Shu-Fen Kuo (sfkuo6@tmu.edu.tw) Version: 1 Date: 23 Apr 2020 Author’s response to reviews: Manuscript ID: BMWH-D-20-00136 Title: Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer April 6, 2020 Dear reviewers and editors, Thank you for your thoughtful and insightful comments about our article. We revised the manuscript to reflect the reviewers’ and your suggestions. The revised manuscript is attached (revisions are in red type), and the revisions are summarized below:
BMC Women's Health, 2020
Background The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. Methods A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. Results In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = ...
Physical Therapy, 2019
Abtract Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isomet...
BMJ, 2021
Objective To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery. Design Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation. Setting 17 UK National Health Service cancer centres. Participants 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196). Interventions Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months. Main outcome measures Disability of Arm, Hand and Shoulder (DASH) questionnaire at 1...
Clinical rehabilitation, 2018
To evaluate prospective surveillance and targeted physiotherapy (PSTP) compared to education (EDU) on the prevalence of arm morbidity and describe the associated program cost. Pilot randomized single-blinded controlled trial. Urban with assessments and treatment delivered in hospitals. Women scheduled for breast cancer surgery. Participants were randomly assigned (1:1) to PSTP ( n = 21) or EDU ( n = 20) and assessed presurgery and 12 months postsurgery. All participants received usual care, namely, preoperative education and provision of an education booklet with postsurgical exercises. The PSTP group was monitored for arm morbidity every three months and referred for physiotherapy if arm morbidity was identified. The EDU group received three education sessions on nutrition, stress and fatigue management. Arm morbidity was based on changes in the surgical arm(s) from presurgery in four domains: (1) shoulder range of motion, (2) strength, (3) volume, and (4) upper body function. Comp...
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.3\_March2022/IJHSR-Abstract.018.html, 2022
Early breast cancer treatment can cause shoulder dysfunction, which is a well-known and prevalent adverse effect (1). In individuals treated surgically for breast cancer, physiotherapy was found to enhance shoulder function considerably (1). Breast cancer is the most common type of cancer in women and the leading cause of death and morbidity (2). Every year, 1.67 million new instances of breast cancer are identified worldwide, with 458,000 fatalities (2). Although 89 percent of breast cancer survivors live for at least five years after treatment, side symptoms can continue for months or even years(2). The most common upper-limb side effects are pain and joint dysfunction, with prevalence rates ranging from 12% to 51% for pain and 1.5 percent to 50% for joint dysfunction. Surgery is the most common treatment for primary breast cancer. Shoulder exercises are commonly advised to reduce mobility and strength loss as well as prevent lymphedema. Several clinical services have been developed to help with shoulder range of motion rehabilitation and secondary lymphedema prevention(3). The goal of this study was to see how additional postoperative physiotherapy affected shoulder function after the initial postoperative healing period, especially when given for a longer period. Patients who have had a mastectomy are always at risk of getting shoulder pain and adhesive capsulitis, and they must take precautions (3).