7.2.1 Exercise, shoulder disability and axillary node dissection: What advice should women with breast cancer be given pre-operatively? (186)

Jacqui Todd, Consultant Physiotherapist Lymphoedema Specalist, Leeds Lymphoedema Services, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom Co authors: Annie Topping & Andy Scally

Abstract:

Background:

Traditionally, as part of routine post-operative care, women are taught arm exercises following surgical axillary node dissection (AND) for breast cancer. The rationale is that exercise will reduce the incidence of lymphoedema and/or adhesive capsulitis Recent reviews have provided conflicting evidence concerning the optimum time to commence above shoulder exercise regimes. This confusion is also evident in the patient information provided for women in the UK (Todd and Topping 2005).

Aims:

This study sought to compare the incidence of treatment related complications including lymphoedema after two programmes of shoulder mobilisation following AND for invasive breast cancer.

Methods:

A two group (intervention/control), two-time point (pre-operation and one year) single blind randomised controlled trial was undertaken. Women (n=116) recruited from two United Kingdom (UK) National Health Service (NHS) Trusts were allocated to one of two exercise regimes. Sample size estimated on basis of 50% reduction in mean limb volume. The control group regime involved early introduction of exercises (day one/two) involving full shoulder movement and the intervention group commenced a modified exercise regime with the introduction of full shoulder exercise after seven days. Data relating to arm volume (water displacement method), shoulder movement (goniometer), grip strength (dynamometer), self report of shoulder disability (Croft et al 1994), quality of life with FACTB 4 (Coster et al 2001) and wound drainages volumes and incidence of seroma were collected.

Results:

Incidence of lymphoedema (¡Ý200mls) was significantly increased in women who had undertaken a programme of early full shoulder mobilisation (control), relative risk 2.7 (95% CI 1.1 ¨C 6.3; p=0.031). There were no statistical differences in shoulder movement, grip strength or self evaluated outcomes between groups at one year.

Discussion:

A programme of exercise that delays full shoulder movement for seven days should be recommended for women following surgical and for breast cancer.

Biography:

Jacqui Todd is Consultant Physiotherapist Lymphoedema Specialist at Leeds Teaching Hospital NHS Trust. She is a respected national figure in the field of lymphology and co authored the UK's key text in lymphoedema.