KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, Belgium.
Univeristy of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium.
Musculoskelet Sci Pract. 2017 Jun;29:52-59. doi: 10.1016/j.msksp.2017.03.005. Epub 2017 Mar 14.
The aim of this study was to explore the treatment, patient, and impairment-related risk factors associated with upper limb dysfunctions in breast cancer survivors.
A cross-sectional study was performed in 274 women treated for breast cancer. The following risk factors were analysed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy and trastuzumab); 2) patient's related variables (age and Body Mass Index); 3) and finally impairment-related variables such as pain (intensity, quality and pressure hypersensitivity, signs of central sensitisation, the degree of pain catastrophizing and vigilance and awareness to pain), active ROM and upper limb strength were investigated. The dependent variable was upper limb function measured with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Additionally, a stepwise regression was performed.
An impaired upper limb function was noted in 170 (62%) of patients. Mean time after surgery was 1.5 (1.6) years. From multivariable analysis, it appears that in particular certain pain characteristics such as pain intensity, pain quality, signs of central sensitisation and pain catastrophizing are contributing to upper limb dysfunctions after breast cancer treatment at long term. Additionally, higher age, shoulder ROM and handgrip strength are possible contributing factors. The stepwise regression analysis revealed that central sensitisation mechanisms alone can explain about 40% of the variance in upper limb function.
At long term, especially pain and central sensitisation mechanisms contribute to upper limb function in breast cancer survivors.
本研究旨在探讨与乳腺癌幸存者上肢功能障碍相关的治疗、患者和损伤因素。
对 274 名接受乳腺癌治疗的女性进行了横断面研究。通过单变量和多变量分析，分析了以下风险因素：1）治疗相关变量（手术类型、淋巴结清扫水平、放疗、化疗、激素治疗和曲妥珠单抗）；2）患者相关变量（年龄和身体质量指数）；3）最后是损伤相关变量，如疼痛（强度、质量和压力超敏反应、中枢敏化迹象、疼痛灾难化程度和对疼痛的警觉和意识）、主动 ROM 和上肢力量。因变量是用手臂、肩部和手残疾问卷（DASH）测量的上肢功能。此外，还进行了逐步回归分析。
170 名（62%）患者上肢功能受损。术后平均时间为 1.5（1.6）年。多变量分析表明，特别是某些疼痛特征，如疼痛强度、疼痛质量、中枢敏化迹象和疼痛灾难化，是导致乳腺癌治疗后上肢功能长期受损的原因。此外，较高的年龄、肩部 ROM 和握力可能也是促成因素。逐步回归分析显示，中枢敏化机制单独可以解释上肢功能的 40%左右的差异。
长期来看，疼痛和中枢敏化机制是乳腺癌幸存者上肢功能的主要影响因素。
