1 Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada.
2 Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.
Clin Rehabil. 2018 Jun;32(6):811-826. doi: 10.1177/0269215518757292. Epub 2018 Feb 23.
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. Complex arm morbidity indicated ≥2 domains impaired. Second, the cost of the PSTP program was described.
At 12 months, 18 (49%) participants (10 PSTP and 8 EDU) had arm morbidity, with EDU participants presenting more complex arm morbidity compared to PSTP participants. PSTP participants attended 4.4 of 5 assessments with 90% retention. The PSTP program cost was $150 covered by the Health Care Provider and the Patient Out-of-Pocket Travel cost was CAN$40.
Our results suggest that PSTP is feasible among women with breast cancer for early identification of arm morbidity. A larger study is needed to determine the cost and effectiveness benefits.
评估前瞻性监测和针对性物理治疗（PSTP）与教育（EDU）相比，在手臂发病率方面的效果，并描述相关的项目成本。
试点随机单盲对照试验。
城市，评估和治疗在医院进行。
计划接受乳腺癌手术的女性。
参与者被随机分配（1:1）至 PSTP（n=21）或 EDU（n=20）组，并在术前和术后 12 个月进行评估。所有参与者均接受常规护理，即术前教育和提供术后锻炼的教育手册。PSTP 组每 3 个月监测一次手臂发病率，如果发现手臂发病率，则转介进行物理治疗。EDU 组接受了 3 次关于营养、压力和疲劳管理的教育课程。
手臂发病率基于手术手臂从术前的四个方面变化：（1）肩部活动范围，（2）力量，（3）体积，和（4）上半身功能。复杂手臂发病率表示≥2 个部位受损。其次，描述了 PSTP 计划的成本。
在 12 个月时，18 名（49%）参与者（10 名 PSTP 和 8 名 EDU）出现手臂发病率，EDU 参与者的复杂手臂发病率高于 PSTP 参与者。PSTP 参与者参加了 5 次评估中的 4.4 次，保留率为 90%。PSTP 计划的成本为 150 美元，由医疗保健提供者支付，患者自付旅行费用为 40 加元。
我们的结果表明，PSTP 对于早期发现手臂发病率，在乳腺癌女性中是可行的。需要更大规模的研究来确定成本和效果效益。
