Singh Chiara, De Vera Mary, Campbell Kristin L
Fraser Health Authority, Surrey, B.C.
Department of Physical Therapy, University of British Columbia, Vancouver B.C.
Physiother Can. 2013 Spring;65(2):183-91. doi: 10.3138/ptc.2012-23O.
Significant arm morbidity is reported following surgery for breast cancer, yet physiotherapy is not commonly part of usual care. This study compared the effect on arm morbidity after surgery for breast cancer of a clinical care pathway including preoperative education, prospective monitoring, and early physiotherapy (experimental group) to that of preoperative education alone (comparison group).
A prospective quasi-experimental pretest-posttest, non-equivalent group design compared two clinical sites; Site A (n=41) received the experimental intervention, and Site B (n=31) received the comparison intervention. At baseline (preoperative) and 7 months postoperative, shoulder range of motion (ROM), upper-extremity (UE) strength, UE circumference, pain, UE function, and quality of life were assessed.
The experimental group maintained shoulder flexion ROM at 7 months, whereas the comparison group saw a decrease (mean 1° [SD 9°] vs. -6° [SD 15°], p=0.03). A lower incidence of arm morbidity and better quality of life were observed in the experimental group, but these findings were not statistically significant. Baseline characteristics and surgical approaches differed between the two sites, which may have had an impact on the findings.
Initial results are promising and support the feasibility of integrating a surveillance approach into follow-up care. This pilot study provides the foundation for a larger, more definitive trial.
据报道，乳腺癌手术后存在明显的手臂并发症，然而物理治疗并不常作为常规护理的一部分。本研究比较了包括术前教育、前瞻性监测和早期物理治疗的临床护理路径（实验组）与仅进行术前教育（对照组）对乳腺癌手术后手臂并发症的影响。
采用前瞻性准实验性前测-后测、非等效组设计，比较两个临床地点；A地点（n = 41）接受实验性干预，B地点（n = 31）接受对照性干预。在基线（术前）和术后7个月，评估肩部活动范围（ROM）、上肢（UE）力量、UE周长、疼痛、UE功能和生活质量。
实验组在7个月时维持了肩部前屈ROM，而对照组则出现了下降（平均1°[标准差9°]对 -6°[标准差15°]，p = 0.03）。实验组观察到手臂并发症的发生率较低且生活质量较好，但这些结果在统计学上并不显著。两个地点的基线特征和手术方法不同，这可能对结果产生了影响。
初步结果很有前景，并支持将监测方法纳入后续护理的可行性。这项试点研究为更大规模、更具确定性的试验奠定了基础。
