Department of Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.
Department of Traditional Chinese Medicine, China Resources & WISCO General Hospital, Wuhan, China.
Arch Phys Med Rehabil. 2023 May;104(5):728-737. doi: 10.1016/j.apmr.2023.01.021. Epub 2023 Feb 20.
To investigate whether advancing the initiation of rehabilitation training compared with the time recommended by the guidelines after breast cancer (BC) surgery is beneficial to the recovery of shoulder function and quality of life.
Prospective, observational, single center, randomized controlled trial.
The study was conducted between September 2018 and December 2019, with a 12-week supervised intervention and 6-week home-exercise period concluding in May 2020.
Two hundred BC patients received axillary lymph node dissection (N=200).
Participants were recruited and randomly allocated into 4 groups (A, B, C, and D). Group A started range of motion (ROM) training at 7 days postoperative and progressive resistance training (PRT) at 4 weeks postoperative; group B started ROM training at 7 days postoperative and PRT at 3 weeks postoperative; group C started ROM training at 3 days postoperative and PRT at 4 weeks postoperative; and group D started ROM training at 3 days postoperative and PRT at 3 weeks postoperative.
The primary outcome measure was Constant-Murley Score. Secondary outcome measures included ROM, shoulder strength, grip, European Organization Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module (EORTC QLQ-BR23), and SF-36. Incidence of adverse reactions (drainage and pain) and complications (ecchymosis, subcutaneous hematoma, lymphedema) were also assessed.
Participants who started ROM training at 3 days postoperative obtained more benefits in mobility, shoulder function, and EORTC QLQ-BR23 score, while patients who started PRT at 3 weeks postoperative saw improvements in shoulder strength and SF-36. Incidence of adverse reactions and complications were low in all 4 groups, with no significant differences among the 4 groups.
Advancing ROM training initiation to 3 days postoperative or PRT to 3 weeks postoperative can better restore shoulder function after BC surgery and lead to faster quality of life improvement.
研究与乳腺癌（BC）手术后指南推荐的时间相比，提前开始康复训练是否有益于肩部功能和生活质量的恢复。
前瞻性、观察性、单中心、随机对照试验。
研究于 2018 年 9 月至 2019 年 12 月进行，为期 12 周的监督干预和 6 周的家庭运动期于 2020 年 5 月结束。
200 名接受腋窝淋巴结清扫术（N=200）的 BC 患者。
参与者被招募并随机分配到 4 组（A、B、C 和 D）。A 组在术后 7 天开始进行运动范围（ROM）训练，在术后 4 周开始进行渐进性抗阻训练（PRT）；B 组在术后 7 天开始进行 ROM 训练，在术后 3 周开始进行 PRT；C 组在术后 3 天开始进行 ROM 训练，在术后 4 周开始进行 PRT；D 组在术后 3 天开始进行 ROM 训练，在术后 3 周开始进行 PRT。
主要观察指标为 Constant-Murley 评分。次要观察指标包括 ROM、肩部力量、握力、欧洲癌症研究与治疗组织乳腺癌特异性生活质量问卷模块（EORTC QLQ-BR23）和 SF-36。还评估了不良反应（引流和疼痛）和并发症（瘀斑、皮下血肿、淋巴水肿）的发生率。
术后 3 天开始 ROM 训练的参与者在活动度、肩部功能和 EORTC QLQ-BR23 评分方面获益更多，而术后 3 周开始 PRT 的患者在肩部力量和 SF-36 方面有所改善。所有 4 组的不良反应和并发症发生率均较低，4 组之间无显著差异。
提前至术后 3 天开始 ROM 训练或提前至术后 3 周开始 PRT 可更好地恢复 BC 手术后的肩部功能，并更快地提高生活质量。
