Upper Limb Function After Breast Cancer Surgery: the Role of Post-operative Physical Therapy Intervention
Upper Limb Function After Breast Cancer Surgery: the Role of Post-operative Physical Therapy Intervention
Surgical treatments can cause late effects influencing activity of daily living, physical
 activity, and overall health. Late effects include persistent pain reported by 30 - 50% of
 women that underwent breast operations, restrictions of arm and shoulder movement were
 reported in 35% of patients, lymphedema in 15 - 25% of women who undergo axillary lymph node
 dissection and in about 6% of women who undergo sentinel lymph node biopsy. Lymphedema
 results in physical impairments including compromised function, diminished strength, fatigue,
 and pain in the affected arm . The axillary web syndrome is a self-limiting and frequently
 overlooked cause of significant morbidity in the early postoperative period after breast
 cancer, which is characterized by axillary pain that runs down the medial arm, limited
 shoulder range of motion (ROM) .

 Physiotherapy and exercise in the postoperative period can result in a significant
 improvement in shoulder ROM in women treated for breast cancer, Additionally, exercises are
 an effective intervention to improve quality of life, cardiorespiratory fitness, physical
 functioning and fatigue in breast cancer patients. However, in the postoperative period
 consideration should be given to the early implementation of exercises because of the
 potential for seroma and increases in wound drainage volume and duration.

 There is limited evidence on the influence of postoperative physiotherapy intervention, and
 instruction program on upper limb range of motion and return to physical activity divided by
 the type of surgery and regarding complications.
Aim The aim of this study is to evaluate the influence of early postoperative physical
 therapy program on upper-limb function and returning to physical activity in the first 6
 months following surgery.

 Hypotheses

 -  Early physical activity performed post-operative will improve ROM and therefore, will
 help women after breast surgeries to return faster to their routine physical activity
 and by that promote physical health.

 -  Early postoperative physical therapy is safe when the program for is tailored to the
 type of surgery.

 Methods

 Study design Parallel group prospective randomized controlled clinical trial. Two surgical
 department's including general surgery department and genecology department in Assuta
 hospital, Tel Aviv, Israel

 Sample All women undergoing breast cancer surgeries in Assuta hospital between 02.01.2018 and
 till 07.01.2019 will be randomized into two groups: Group A (intervention group) will be
 instructed first day post-operative to exercise program; Group B (control group) without
 intervention.
Inclusion Criteria:

 -  Women

 -  Age 18-65.

 -  Diagnosed with breast cancer, undergoing breast surgery,

 -  Functional independence prior to the operation.

 -  Ability to communicate in Hebrew.

 Exclusion Criteria:

 -  Cognitive disorders, patients unable to sign the consent form.

 -  Back and spinal morbidity.

 -  Fibromyalgia or chronic pain disorders.

 -  Neurological disorders.

 -  Renal failure with the need for dialysis.

 -  Lymphedema prior to surgery.

 -  History of breast surgery.

 -  Shoulder surgery or shoulder injuries with limited ROM.

 -  Ischemic heart disease, heart failure and radical heart insufficiency.

 -  Radical mastectomy, LD and DEIP reconstruction, exchange breast prosthesis.