Development of a complex exercise intervention for prevention of shoulder dysfunction in high-risk women following treatment for breast cancer: prevention of shoulder problems trial (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...
BMC health services research, 2018
Musculoskeletal shoulder problems are common after breast cancer treatment. There is some evidence to suggest that early postoperative exercise is safe and may improve shoulder function. We describe the development and delivery of a complex intervention for evaluation within a randomised controlled trial (RCT), designed to target prevention of musculoskeletal shoulder problems after breast cancer surgery (The Prevention of Shoulder Problems Trial; PROSPER). A pragmatic, multicentre RCT to compare the clinical and cost-effectiveness of best practice usual care versus a physiotherapy-led exercise and behavioural support intervention in women at high risk of shoulder problems after breast cancer treatment. PROSPER will recruit 350 women from approximately 15 UK centres, with follow-up at 6 and 12 months. The primary outcome is shoulder function at 12 months; secondary outcomes include postoperative pain, health related quality of life, adverse events and healthcare resource use. A mult...
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...
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...
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 = ...
Revista Latino-Americana de Enfermagem, 2012
The aim of this study was to evaluate the effectiveness of an exercise program for the recuperation of the range of motion (ROM) of the shoulder. This is a quasi-experimental study developed at the Mastology Outpatient Clinic of the Federal University of São Paulo -Brazil, from August 2006 to June 2008, with 64 breast cancer patients undergoing surgery. The intervention consisted of: preoperative evaluation of the ROM, verbal and written guidance, demonstration and implementation of the exercises and revaluation at the outpatient follow-up appointments until the 105 th postoperative day (PO). From the 7 th PO a significant increase was observed in the ROM, which continued until the 105 th PO. The minimum time for recovery was 105 days for the women undergoing mastectomy, and 75 days for those undergoing quadrantectomy. There was satisfactory adherence of 78.6% of the women. The domicile program was effective for the recovery of ROM in the study population, benefiting women who can not attend a presential program. Aplicação de programa de exercícios domiciliares na reabilitação do ombro pós-cirurgia por câncer de mama O objetivo desta pesquisa foi avaliar a efetividade de um programa de exercícios para recuperação da amplitude de movimento (ADM) do ombro. Foi usado o método experimental, e o estudo foi desenvolvido no Ambulatório de Mastologia da Universidade Federal de São Paulo, Brasil, de agosto de 2006 a junho de 2008, com 64 mulheres com câncer de mama, submetidas à cirurgia. A intervenção constou de: avaliação préoperatória da ADM, orientação verbal e escrita, demonstração e execução dos exercícios e reavaliações nos retornos ambulatoriais até o 105º dia de pós-operatório (PO). Os resultados mostraram, a partir do 7ºPO, acréscimo significante e contínuo na ADM, até o 105º PO. O tempo mínimo para recuperação foi de 105 dias para as mulheres mastectomizadas, e de 75 dias para aquelas submetidas à quadrantectomia. Houve adesão satisfatória de 78,6% das mulheres. Conclui-se que o programa domiciliar se mostrou efetivo para a recuperação da ADM na população estudada, beneficiando mulheres que não poderiam frequentar um programa presencial.
Physiotherapy Theory and Practice, 2012
Our objective was to evaluate the effectiveness of manual therapy (MT) associated with upper limb (UL) exercises in women with impaired shoulder range of motion (ROM) after axillary lymph node dissection (ALND) for breast cancer. A randomized, prospective, blinded clinical trial with 131 women with a ROM < -100°for shoulder flexion and/or abduction on the first day postoperatively were evaluated. Sixty-six women were allocated to group exercises and 65 underwent the exercises followed by MT. Shoulder ROM was measured by goniometry, and function was evaluated by the Modified-University of California at Los Angeles Shoulder Rating Scale-the UCLA Scale, in the 1st, 6th, 12th, and 18th month after surgery. The chi-square test was used for the relationship between clinical characteristics and oncological treatment between groups, and ANOVA for repeat measures was used. No difference in recovery of shoulder ROM as well as UL function was observed between groups. Improvement in ROM was gradual from the 1st to the 18th month, and the function achieving a good classification at 18th month. MT associated with exercises did not enhance the results obtained with exercises alone for shoulder ROM and ipsilateral UL function.
Exercise Interventions for Upper Limb Dysfunction Due to Breast Cancer Treatment
Physical Therapy, 2013
highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions-medication, surgery, education, nutrition, exercise-and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. 1 Each article in this PTJ series summarizes a Cochrane review or other scientific evidence on a single topic and presents clinical scenarios based on real patients or programs to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on a woman with a diagnosis of breast cancer who underwent a modified radical mastectomy with a sentinel lymph node biopsy. She subsequently received chemotherapy and radiation therapy and required episodic physical therapy to decrease impairments and improve functional limitations. Could an exercise program for the upper limb delivered preoperatively and postoperatively and along the trajectory of adjuvant chemotherapy and radiation therapy help reduce shoulder and upper extremity impairments? Available With This Article at ptjournal.apta.org • Discussion Podcast with Amy Litterini and authors Mary Lou Galantino and Nichole Stout. Moderated by Diane Jette.