- Email: [email protected]
The effect of early rehabilitation intervention on the limited upper limb movement after breast cancer surgery
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Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-0400
Cardiorespiratory fitness and handgrip strength in breast cancer patients with lymphedema: Preliminary study J. Kim 1,∗ , N.R. Yun 2 , E. Jung 2 , K.M. Lee 2 Wonkwang University and Hospital, PM & R, Iksan, Republic of Korea 2 Wonkwang University and Hospital, Physical medicine & Rehabilitation, Iksan, Republic of Korea ∗ Corresponding author. E-mail address: [email protected] (J. Kim)
1
Introduction/Background To investigate of the cardiorespiratory fitness of breast cancer patients with lymphedema and to understand the association between CRF and hand grip strength in breast cancer patients with lymphedema. Material and method Patients with breast cancer who had treatment-related lymphedema were included retrospectively (n = 20). The control group reviewed the medical records of females participating in health screening who had cardiopulmonary function test (n = 33). CRF classified by aerobic capacity and cardiovascular response. To assess hand grip strength, by using a hand dynamometer was used. Two attempts were made with each hand and the average of the two scores was used. Body mass index (BMI), Beck Depression Index inventory (BDI), Montreal cognitive assessment-K (MOCA-K) were measured to investigate the association between handgrip strength and physical, psychological factors. Results In breast cancer patients with lymphedema experimental, metabolic equivalent tasks (METs), peak oxygen consumption (VO2 peak), anaerobic threshold were significantly lower than control group. The handgrip strength of affected arm is lower than unaffected arm. Handgrip strength showed no significant association with age, BMI, difference of circumference, BDI, MOCA-K. Handgrip strength showed no strong correlation with cardiorespiratory fitness. Conclusion To improve of quality of life and survival rate of breast cancer patients with lymphedema, it is important to educate aerobic and strengthening exercise. Keywords Lymphedema; Breast cancer; Cardiorespiratory fitness Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.672 ISPR8-2124
The effectiveness of botulinum toxin A for persistent pain at the pectoral region after breast cancer treatment: Randomized controlled trial A. De Groef 1,∗ , N. Devoogdt 1 , L. Dams 1 , E. Van der Gucht 1 , K. Peers 2 , P. Debeer 3 1 KU Leuven, Rehabilitation Sciences, Leuven, Belgium 2 University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium 3 University Hospitals Leuven, Department of Development and Regeneration, Leuven, Belgium ∗ Corresponding author. E-mail address: [email protected] (A. De Groef), stijn [email protected] (N. Devoogdt) Introduction/Background Upper limb pain after breast cancer treatment is a common and difficult to treat problem. The aim of the present study was to investigate the effect of a single botulinum toxin A infiltration in the pectoralis major muscle in addition to
a standard physical therapy program for treatment of persistent upper limb pain in breast cancer survivors. Material and method Fifty breast cancer patients with pain participated in a double-blinded randomized controlled trial. The intervention group received a single botulinum toxin A (BTX-A) infiltration. The control group received a placebo (saline) infiltration. Within one week after the infiltration, all patients attended an individual physical therapy program (12 sessions) during the first 3 months and a home exercise program up to 6 months after infiltration. The primary outcome was change in pain intensity at the upper limb (Visual Analogue Scale [VAS] [0–100]) after 3 months. Secondary outcomes were prevalence rate of pain, pressure hypersensitivity, pain quality, shoulder function and quality of life. Measures were taken before the intervention and at 1, 3 and 6 months follow-up. Results No significant difference in change in pain intensity after 3 months was found (mean difference in change of 3/100; 95% CI: −13 to 19). From baseline up to 6 months, a significantly different change in upper limb pain intensity was found between groups in favor of the intervention group (mean difference in change of 16/100; 95% CI: 1 to 31). Conclusion A single botulinum toxin A infiltration in combination with an individual physical therapy program has been found to significantly decrease pain intensity at the upper limb in breast cancer survivors up to 6 months. However, the effect size was not clinically relevant and no other beneficial effects were found. Keywords Breast cancer; Upper limb pain; Botulinum toxin Disclosure of interest This study was funded by the MSD OncoAward. The funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. No support from any organisation for the submitted work no financial relationships with any organisations that might have an interest in the submitted work in the previous three years no other relationships or activities that could appear to have influenced the submitted work. We have full control of all primary data and we agree to allow the journal to review the data if requested. The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.673 ISPR8-2318
The effect of early rehabilitation intervention on the limited upper limb movement after breast cancer surgery N. Xie 1,∗ , J. Jia 1 , X. Ruan 1 , L. Li 2 , L. Jiang 2 Huashan Hospital-Fudan University, Rehabilitation Medicine, Shanghai, China 2 Shanghai Jing’an district central hospital, Rehabilitation Medicine, Shanghai, China ∗ Corresponding author. E-mail address: [email protected] (N. Xie)
1
Introduction/Background To observe the effect of early systemic rehabilitation intervention on the upper limb function of patients with breast cancer after operation. Material and method One hundred and twenty eight cases of breast cancer after radical mastectomy were divided into the treatment group and the control group by random grouping. In the control group, the patients had the upper limb brake in 24 hours after operation, and the daily living ability training was carried out. In the treatment group, after applied 24 hours shoulder joint brake, the simple finger joint flexion and extension training was carried out, and the early system rehabilitation training was started after 24 hours, including 6 stages. At the 2 weeks, 4 weeks and 12 weeks after operation, the upper extremity function was assessed by Constant–Murley shoulder function score. The shoulder joint mobility and quality of life scale (QLQ-C30) were used to evaluate the curative effect of 2 groups.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Results As the time went on, the treatment group and the control group of ipsilateral shoulder function and shoulder joint activity and life quality score were gradually improved, and in the 12 weeks after the operation, the patients in the treatment group Constant–Murley score [(96.32 + 10.14)%], the shoulder joint activity and QLQ-C30 score were significantly better than the control group (P < 0.05). Conclusion Systematic rehabilitation intervention in early stage of breast cancer can improve the recovery of upper limb function and life quality of patients, which has important clinical and social value. Keywords Breast cancer; Rehabilitation; Upper limb Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.674 ISPR8-2069
Multi-stakeholder attitudes regarding risk-based thresholds for initiating impairment-directed interventions among patients with breast cancer
A. Cheville ∗ , J. Basford Mayo Clinic, Physical Medicine and Rehabilitation, Rochester, USA ∗ Corresponding author. E-mail address: [email protected] (A. Cheville) Introduction/Background Physical impairments are prevalent following breast cancer (BC) treatment and associated with poor outcomes. Predictive models permit estimation of impairment risk, and can be the basis for directing screening and validated risk reduction measures. At present, few BC survivors receive anticipatory treatment for their impairments. The objective of this study was to characterize diverse clinical stakeholders’ risk thresholds for initiating BC impairment-directed education, screening, preventive activities, and specialist referrals. Material and method A purposive sample of 40 breast cancer survivors, as well as 10 Breast Clinic physicians, 10 breast surgeons, 10 radiation oncologists, 10 medical oncologists, 10 Breast Clinic nurses, and 10 cancer rehabilitation therapists from academic and community settings were queried about their thresholds for initiating “More frequent and sensitive screening”, “Education”, “Instruction in preventive activities”, and “Referral to a physical or occupational therapist”. Participants indicated on numerical rating scales the risk level (0–1.0) at which they would start activities for lymphedema, upper quadrant pain, functionally limiting chemotherapy-induced peripheral neuropathy, shoulder contracture, and fatigue. Results Across impairments, mean risk thresholds were consistently ordered as follows: education (0.07–0.12), prevention (0.14–0.25), screening (0.250–0.31), and therapist referral (0.37–0.45). BC Survivors had the lowest thresholds for initiating education; lymphedema 0.02, pain 0.04, neuropathy 0.02, contracture 0.03, and fatigue 0.03, while therapists had the lowest thresholds for screening and referrals. Among physicians, risk thresholds varied widely across impairments, interventions, and disciplines, however breast surgeons had significantly higher thresholds for screening, prevention, and therapist referral, P < 0.03. Conclusion Risk thresholds for initiating BC impairment-directed activities are inconsistent across stakeholder groups. BC survivors, however, had the lowest thresholds for initiating impairmentdirected education. Keywords Impairment; Breast cancer; Risk reduction Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.675
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Physiotherapy in the management of patients with peritoneal carcinomatosis receiving cytoreductive surgery L. Josse 1,∗ , J. Weyrech 1 , M.H. Houzé 1 , R. Habrias 1 , G.R. Perez Torres 1 , S. Saez Lopez 1 , Foudhaili 1 , A. Yelnik 2 , M. Pocard 3 1 Hôpital Lariboisière, AP–HP, C2R de Rééducation, Paris, France 2 Hôpital Fernand-Widal, AP–HP, Service de Médecine physique et de réadaptation, Paris, France 3 Hôpital Lariboisière, AP–HP, Service de chirurgie digestive, Paris, France ∗ Corresponding author. E-mail address: [email protected] (L. Josse) Introduction/Background The development of multidisciplinary work around patients receiving cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) with thoracic epidural analgesia led us to articulate our reciprocal skills in a care program. Since 2012, a preoperative consultation of physiotherapy has been set up for these patients. Between 2009 and 2013, 124 patient’s files have been analysed, comparing “Patient controlled epidural analgesia (PCEA) with physiotherapy” (67 patients) and “PCEA without physiotherapy” (57 patients). The reduction of the patient’s apprehension of physiotherapy and mobilization contributed to the reduction of the length of stay in intensive care unit (on average 5 days instead of 7) and an early out of bed mobilization (one day gained). Material and method After 4 years of operation, we conducted a retrospective study of patient’s files in order to evaluate the efficiency of this first step programme about the role of physiotherapy in this patient’s care pathway. We estimated the length of stay and the way to go back home. Results Three hundred and sixty-six files had been analysed. Patient’ pathway had been systematically organized including this physiotherapy consultation during the month before surgery. The content of the consultation has been adapted including 3 parts leading to a real therapeutic educational program; –information on the physiotherapy that will begin the day after the surgery: respiratory mechanics, interest of early mobilization to warn the postoperative complications; –education of the patient with teaching of techniques of respiratory physiotherapy; –a notebook containing advice for improving the physical condition is given to the patient by adjusting the dosage and the intensity according to his basic state. Conclusion Physiotherapy included in preoperative management is part of improving the quality of care provided to patients, allowing them a better participation in the postoperative care. This preoperative consultation had been adapted to better support the patient and his family. Keywords Digestive cancer; Preoperative physiotherapy Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.676
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-0400
Cardiorespiratory fitness and handgrip strength in breast cancer patients with lymphedema: Preliminary study J. Kim 1,∗ , N.R. Yun 2 , E. Jung 2 , K.M. Lee 2 Wonkwang University and Hospital, PM & R, Iksan, Republic of Korea 2 Wonkwang University and Hospital, Physical medicine & Rehabilitation, Iksan, Republic of Korea ∗ Corresponding author. E-mail address: [email protected] (J. Kim)
1
Introduction/Background To investigate of the cardiorespiratory fitness of breast cancer patients with lymphedema and to understand the association between CRF and hand grip strength in breast cancer patients with lymphedema. Material and method Patients with breast cancer who had treatment-related lymphedema were included retrospectively (n = 20). The control group reviewed the medical records of females participating in health screening who had cardiopulmonary function test (n = 33). CRF classified by aerobic capacity and cardiovascular response. To assess hand grip strength, by using a hand dynamometer was used. Two attempts were made with each hand and the average of the two scores was used. Body mass index (BMI), Beck Depression Index inventory (BDI), Montreal cognitive assessment-K (MOCA-K) were measured to investigate the association between handgrip strength and physical, psychological factors. Results In breast cancer patients with lymphedema experimental, metabolic equivalent tasks (METs), peak oxygen consumption (VO2 peak), anaerobic threshold were significantly lower than control group. The handgrip strength of affected arm is lower than unaffected arm. Handgrip strength showed no significant association with age, BMI, difference of circumference, BDI, MOCA-K. Handgrip strength showed no strong correlation with cardiorespiratory fitness. Conclusion To improve of quality of life and survival rate of breast cancer patients with lymphedema, it is important to educate aerobic and strengthening exercise. Keywords Lymphedema; Breast cancer; Cardiorespiratory fitness Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.672 ISPR8-2124
The effectiveness of botulinum toxin A for persistent pain at the pectoral region after breast cancer treatment: Randomized controlled trial A. De Groef 1,∗ , N. Devoogdt 1 , L. Dams 1 , E. Van der Gucht 1 , K. Peers 2 , P. Debeer 3 1 KU Leuven, Rehabilitation Sciences, Leuven, Belgium 2 University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Leuven, Belgium 3 University Hospitals Leuven, Department of Development and Regeneration, Leuven, Belgium ∗ Corresponding author. E-mail address: [email protected] (A. De Groef), stijn [email protected] (N. Devoogdt) Introduction/Background Upper limb pain after breast cancer treatment is a common and difficult to treat problem. The aim of the present study was to investigate the effect of a single botulinum toxin A infiltration in the pectoralis major muscle in addition to
a standard physical therapy program for treatment of persistent upper limb pain in breast cancer survivors. Material and method Fifty breast cancer patients with pain participated in a double-blinded randomized controlled trial. The intervention group received a single botulinum toxin A (BTX-A) infiltration. The control group received a placebo (saline) infiltration. Within one week after the infiltration, all patients attended an individual physical therapy program (12 sessions) during the first 3 months and a home exercise program up to 6 months after infiltration. The primary outcome was change in pain intensity at the upper limb (Visual Analogue Scale [VAS] [0–100]) after 3 months. Secondary outcomes were prevalence rate of pain, pressure hypersensitivity, pain quality, shoulder function and quality of life. Measures were taken before the intervention and at 1, 3 and 6 months follow-up. Results No significant difference in change in pain intensity after 3 months was found (mean difference in change of 3/100; 95% CI: −13 to 19). From baseline up to 6 months, a significantly different change in upper limb pain intensity was found between groups in favor of the intervention group (mean difference in change of 16/100; 95% CI: 1 to 31). Conclusion A single botulinum toxin A infiltration in combination with an individual physical therapy program has been found to significantly decrease pain intensity at the upper limb in breast cancer survivors up to 6 months. However, the effect size was not clinically relevant and no other beneficial effects were found. Keywords Breast cancer; Upper limb pain; Botulinum toxin Disclosure of interest This study was funded by the MSD OncoAward. The funding source had no role in study design, data collection, data analysis, data interpretation, or writing of the report. No support from any organisation for the submitted work no financial relationships with any organisations that might have an interest in the submitted work in the previous three years no other relationships or activities that could appear to have influenced the submitted work. We have full control of all primary data and we agree to allow the journal to review the data if requested. The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.673 ISPR8-2318
The effect of early rehabilitation intervention on the limited upper limb movement after breast cancer surgery N. Xie 1,∗ , J. Jia 1 , X. Ruan 1 , L. Li 2 , L. Jiang 2 Huashan Hospital-Fudan University, Rehabilitation Medicine, Shanghai, China 2 Shanghai Jing’an district central hospital, Rehabilitation Medicine, Shanghai, China ∗ Corresponding author. E-mail address: [email protected] (N. Xie)
1
Introduction/Background To observe the effect of early systemic rehabilitation intervention on the upper limb function of patients with breast cancer after operation. Material and method One hundred and twenty eight cases of breast cancer after radical mastectomy were divided into the treatment group and the control group by random grouping. In the control group, the patients had the upper limb brake in 24 hours after operation, and the daily living ability training was carried out. In the treatment group, after applied 24 hours shoulder joint brake, the simple finger joint flexion and extension training was carried out, and the early system rehabilitation training was started after 24 hours, including 6 stages. At the 2 weeks, 4 weeks and 12 weeks after operation, the upper extremity function was assessed by Constant–Murley shoulder function score. The shoulder joint mobility and quality of life scale (QLQ-C30) were used to evaluate the curative effect of 2 groups.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Results As the time went on, the treatment group and the control group of ipsilateral shoulder function and shoulder joint activity and life quality score were gradually improved, and in the 12 weeks after the operation, the patients in the treatment group Constant–Murley score [(96.32 + 10.14)%], the shoulder joint activity and QLQ-C30 score were significantly better than the control group (P < 0.05). Conclusion Systematic rehabilitation intervention in early stage of breast cancer can improve the recovery of upper limb function and life quality of patients, which has important clinical and social value. Keywords Breast cancer; Rehabilitation; Upper limb Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.674 ISPR8-2069
Multi-stakeholder attitudes regarding risk-based thresholds for initiating impairment-directed interventions among patients with breast cancer
A. Cheville ∗ , J. Basford Mayo Clinic, Physical Medicine and Rehabilitation, Rochester, USA ∗ Corresponding author. E-mail address: [email protected] (A. Cheville) Introduction/Background Physical impairments are prevalent following breast cancer (BC) treatment and associated with poor outcomes. Predictive models permit estimation of impairment risk, and can be the basis for directing screening and validated risk reduction measures. At present, few BC survivors receive anticipatory treatment for their impairments. The objective of this study was to characterize diverse clinical stakeholders’ risk thresholds for initiating BC impairment-directed education, screening, preventive activities, and specialist referrals. Material and method A purposive sample of 40 breast cancer survivors, as well as 10 Breast Clinic physicians, 10 breast surgeons, 10 radiation oncologists, 10 medical oncologists, 10 Breast Clinic nurses, and 10 cancer rehabilitation therapists from academic and community settings were queried about their thresholds for initiating “More frequent and sensitive screening”, “Education”, “Instruction in preventive activities”, and “Referral to a physical or occupational therapist”. Participants indicated on numerical rating scales the risk level (0–1.0) at which they would start activities for lymphedema, upper quadrant pain, functionally limiting chemotherapy-induced peripheral neuropathy, shoulder contracture, and fatigue. Results Across impairments, mean risk thresholds were consistently ordered as follows: education (0.07–0.12), prevention (0.14–0.25), screening (0.250–0.31), and therapist referral (0.37–0.45). BC Survivors had the lowest thresholds for initiating education; lymphedema 0.02, pain 0.04, neuropathy 0.02, contracture 0.03, and fatigue 0.03, while therapists had the lowest thresholds for screening and referrals. Among physicians, risk thresholds varied widely across impairments, interventions, and disciplines, however breast surgeons had significantly higher thresholds for screening, prevention, and therapist referral, P < 0.03. Conclusion Risk thresholds for initiating BC impairment-directed activities are inconsistent across stakeholder groups. BC survivors, however, had the lowest thresholds for initiating impairmentdirected education. Keywords Impairment; Breast cancer; Risk reduction Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.675
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Physiotherapy in the management of patients with peritoneal carcinomatosis receiving cytoreductive surgery L. Josse 1,∗ , J. Weyrech 1 , M.H. Houzé 1 , R. Habrias 1 , G.R. Perez Torres 1 , S. Saez Lopez 1 , Foudhaili 1 , A. Yelnik 2 , M. Pocard 3 1 Hôpital Lariboisière, AP–HP, C2R de Rééducation, Paris, France 2 Hôpital Fernand-Widal, AP–HP, Service de Médecine physique et de réadaptation, Paris, France 3 Hôpital Lariboisière, AP–HP, Service de chirurgie digestive, Paris, France ∗ Corresponding author. E-mail address: [email protected] (L. Josse) Introduction/Background The development of multidisciplinary work around patients receiving cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) with thoracic epidural analgesia led us to articulate our reciprocal skills in a care program. Since 2012, a preoperative consultation of physiotherapy has been set up for these patients. Between 2009 and 2013, 124 patient’s files have been analysed, comparing “Patient controlled epidural analgesia (PCEA) with physiotherapy” (67 patients) and “PCEA without physiotherapy” (57 patients). The reduction of the patient’s apprehension of physiotherapy and mobilization contributed to the reduction of the length of stay in intensive care unit (on average 5 days instead of 7) and an early out of bed mobilization (one day gained). Material and method After 4 years of operation, we conducted a retrospective study of patient’s files in order to evaluate the efficiency of this first step programme about the role of physiotherapy in this patient’s care pathway. We estimated the length of stay and the way to go back home. Results Three hundred and sixty-six files had been analysed. Patient’ pathway had been systematically organized including this physiotherapy consultation during the month before surgery. The content of the consultation has been adapted including 3 parts leading to a real therapeutic educational program; –information on the physiotherapy that will begin the day after the surgery: respiratory mechanics, interest of early mobilization to warn the postoperative complications; –education of the patient with teaching of techniques of respiratory physiotherapy; –a notebook containing advice for improving the physical condition is given to the patient by adjusting the dosage and the intensity according to his basic state. Conclusion Physiotherapy included in preoperative management is part of improving the quality of care provided to patients, allowing them a better participation in the postoperative care. This preoperative consultation had been adapted to better support the patient and his family. Keywords Digestive cancer; Preoperative physiotherapy Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.676