File
I. Ribeiro1, A. Samani2, P. Madeleine2, P. Camargo3, F. Alburquerque-Sendín4, T. Salvini3
1Catholic University of Maule, Kinesiology, Talca, Chile, 2Aalborg University, Laboratory for Ergonomics and Work-Related Disorders, Sport Sciences, Department of Health Science and Technology, Aalborg, Denmark, 3Federal University of Sao Carlos, Department of Physical Therapy, Sao Carlos, Brazil, 4University of Cordoba, Department of Sociosanitary Sciences, Radiology and Physical Medicine, Cordoba, Spain
Background: Breast cancer surgery (BCS) is associated with pain, decreased upward scapular rotation, general shoulder disabilities and the development of future symptomatic rotator cuff disease. Following the surgery, an upper limb rehabilitation (ULRehab) is recommended to improve upper limb function, but there is no evidence on such effects on scapular kinematics.
Purpose: To evaluate the short term effects of ULRehab on scapula kinematics, perceived pain and shoulder disabilities of BCS patients after two months of ULRehab.
Methods: The study was approved by the Ethics Committee of Federal University of Sao Carlos, Brazil (protocol number: 869.208) and registered in Clinical Trials (ID: NCT02604030). Five patients (47.8±8.7 years; 25.4±3.2 kg/m²) participated in the study. Scapula motion was collected with an electromagnetic tracking system (Flock of Birds) during arm elevation, following the International Society of Biomechanics protocol recommendations. Patients completed humeral elevation and resting posture at baseline (B), after one (M1) and two months (M2). ULRehab consisted of 16 sessions including passive and active exercise of upper limb, glenohumeral and scapular mobilization and lymphatic drainage (M1), resistance exercises focused on scapulothoracic muscles (M2). Relative and absolute intra- rater reliability of kinematics outcomes were investigated (n=4) considering two baseline measurements for internal rotation at rest (range:-40.0±0.8°), 30° (-44.7±1.1°), 60° (-45.9±1.9°), 90° (-49.9±3.2°), 120° (-51.6±5.0°); upward rotation at rest (-0.8±1.4°), 30° (-6.6±2.1°), 60° (-17.3±2.5°), 90° (-30.6±1.6°), 120° (-42.9±5.2°); anterior tilt at rest (4.8±1.8°), 30° (3.2±2.4°), 60° (2.2±2.8°), 90° (3.8±0.4°), 120° (4.5±4.3°).
The randomized intraclass correlation coefficient (ICC2,1 for absolute agreement), minimal detectable change (MDC) and standard error of measurement (SEM) were computed. The MDC was considered to evaluate the changes in patient scores for each stage after ULRehab.
The randomized intraclass correlation coefficient (ICC2,1 for absolute agreement), minimal detectable change (MDC) and standard error of measurement (SEM) were computed. The MDC was considered to evaluate the changes in patient scores for each stage after ULRehab.
Results: Intra-rater reliability was considered poor for scapular internal rotation (0.4 at 30°) and for anterior tilt (-0.3 at rest position), moderate to good for the rest of scapular outcomes (ranged from 0.5 to 0.9), except for anterior tilt (1.0 at 120°). Both involved and non-involved sides showed altered scapular kinematics after M1, M2. In three patients, the involved side presented a decreased scapular internal rotation during shoulder evaluations (from rest position to 120°, MDC ranged from: 9.8 to 23.3°). Moreover, four patients showed an increase in anterior tilt (30°-120°, MDC ranged from 8.1 to 18.1°), and also in upward rotation (rest position to 120°, MDC ranged from 2.6 to 15.6°), whereas three patients presented a decreased in upward rotation (rest position to 120°, MDC ranged from 2.6 to 8.4°).
Conclusion(s): We suggest that a long term ULRehab could be a good strategy to improve scapular kinematics after BCS.
Implications: Early intervention of physical therapy after breast cancer surgery may prevent the emergence of biomechanical changes of the upper limb.
Funding, acknowledgements: The study received a scholarship provided by the Coordination for the Improvement of Higher Education Personnel (CAPES, number: 88881.132471/2016-01).
Keywords: Biomechanics, Breast neoplasms, Physiotherapy
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? Yes
Institution: Federal University of Sao Carlos, Brazil
Committee: Ethics Committee of Federal University of Sao Carlos, Brazil
Ethics number: 869208
All authors, affiliations and abstracts have been published as submitted.
