Pilates Exercise Versus Manual Lymphatic Drainage On Axillary Web Syndrome Post Mastectomy
Condition: Mastectomy; Lymphedema
MeSH terms: Lymphedema
Study type: Interventional

Summary: 
      1-Subjects: Sixty-eight patients sample size according to G power who have Axillary web
      syndrome post mastectomy participated in this study. Their ages ranged from 35 to 55 years.
      The participants selected from learning hospitals (Al kasr Al Ayni hospital and National
      cancer institute) and randomly distributed into 2 equal groups.

      1.1 Design of study: In this study the patients randomly assigned into two equal groups (34
      patients for each group) 1.1(a) Group A: (Pilates Exercise)

      1.1(b) Group B: (Manual Lymphatic Drainage)

      2. Equipment's and Tools: Equipment in this study divided into two main categories: measuring
      and therapeutic equipment.

      2.1. Measuring Equipment:

      The following tools are used to assess Range of motion and pain for shoulder joint:

      2.1 (a) Measuring and assessment of pain by:

        -  Visual analogue scale 2.2 (b) Measuring range of motion (ROM) by:

        -  Electronic Goniometer 2.3 (c) Measuring Disability of the arm, shoulder and hand by:

        -  DASH questionnaire (Disability of the arm, shoulder and hand). 2.2. Therapeutic
           Equipment: 1. Pilates exercise 2- Manual lymphatic drainage 3. Procedures of the study:

      The procedures of this study are classified into the following:

      3.1 Measurement Procedures: All measurements have been taken before treatment (pre) after 9
      weeks (post 1) after 9 weeks (post 2).

      1.1 (a) Assessment of pain of shoulder joint

      • Assessment of upper limb pain using visual analogue scale 3.1(b) Assessment of Range of
      motion of shoulder joint: By Electronic Goniometer. 3.1 (c) Assessment of Disability of the
      arm, shoulder and hand The disabilities of the arm, shoulder and hand questionnaire (DASH)
      1.2 Therapeutic procedures: 3.2(a) procedures of Pilates exercise program:

        1. Shoulder Abduction with External Rotation exercise

        2. Shoulder bridge exercise

        3. Mermaid sitting exercise.

        4. Standing Pilates mermaid exercise with towel

        5. Rocking exercise

        6. Saw Pilates exercise.

        7. Bird-dog Pilates exercise.

        8. Roll up exercise.

        9. Cobra pose exercise.

       10. Child pose exercise.
    

Detailed description: 
      1-Subjects: Sixty-eight patients sample size according to G power who have Axillary web
      syndrome post mastectomy participated in this study. Their ages ranged from 35 to 55 years.
      The participants have been selected from learning hospitals (Al kasr Al Ayni hospital and
      National cancer institute) and randomly distributed into 2 equal groups.

      1.1 Design of study: In this study the patients randomly assigned into two equal groups (34
      patients for each group) 1.1(a) Group A: (Pilates Exercise) This group includes 34 patients
      who have axillary web syndrome received Pilates exercise with traditional physical therapy
      exercise program (strength, core stability, flexibility, muscle control, posture and
      breathing). Patients will receive 3 sessions per week for 8 weeks; time of session is 30
      minutes.

      1.1(b) Group B: (Manual Lymphatic Drainage) This group includes 34 patients who axillary web
      syndrome received Manual lymphatic drainage massage with traditional physical therapy
      exercise program (strength, core stability, flexibility, muscle control, posture and
      breathing). Patients received 3 sessions per week for 8 weeks; time of session is 30 minutes.

      2. Equipment's and Tools: Equipment in this study divided into two main categories: measuring
      and therapeutic equipment.

      2.1. Measuring Equipment:

      The following tools are used to assess Range of motion and pain for shoulder joint:

      2.1 (a) Measuring and assessment of pain by:

        -  Visual analogue scale 2.2 (b) Measuring range of motion (ROM) by:

        -  Electronic Goniometer 2.3 (c) Measuring Disability of the arm, shoulder and hand by:

        -  DASH questionnaire (Disability of the arm, shoulder and hand). 2.2. Therapeutic
           Equipment: 1. Pilates exercise

      Parameters:

        -  Duration 30 minutes.

        -  Patient own choice with guidance.

        -  Suitable equipment chosen for specific situation.

        -  Measurement and follow up

        -  Three session per week

        -  For 9 weeks 2- Manual lymphatic drainage

      Parameters:

        -  Duration 30 minutes.

        -  Patient own choice with guidance.

        -  Suitable equipment chosen for specific situation.

        -  Measurement and follow up

        -  Three session per week

        -  For 9 weeks 3. Procedures of the study:

      The procedures of this study are classified into the following:

      3.1 Measurement Procedures: All measurements have been taken before treatment (pre) after 9
      weeks (post 1) after 9 weeks (post 2).

      1.1 (a) Assessment of pain of shoulder joint

        -  Assessment of upper limb pain using visual analogue scale

        -  VAS will be used to assess the degree of pain intensity subjectively by same subject.
           This scale consists of 10cm line with the words "No Pain" on the right side.

      3.1(b) Assessment of Range of motion of shoulder joint: By Electronic Goniometer.

        -  A standardized means of measuring and recording and a goniometer is aligned over a joint
           and with a click of a button the ROM measurement is entered automatically into E-LINK
           computer software, generating progress reports that can be utilized as definitive
           outcome measures. Goniometer to obtain goniometric measurements for shoulder flexion,
           abduction and external rotation will be used.

             -  Measuring of shoulder flexion range while patient is in supine position

             -  Measuring of shoulder abduction range while patient in sitting or supine position.

             -  Measuring of shoulder external rotation range while patient in supine position. 3.1
                (c) Assessment of Disability of the arm, shoulder and hand The disabilities of the
                arm, shoulder and hand questionnaire (DASH)

        -  The disabilities of the arm, shoulder and hand (DASH) questionnaire is a
           self-administered region-specific outcome instrument developed as a measure of
           self-rated upper-extremity disability and symptoms.

        -  The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability)
           to 100 1.2 Therapeutic procedures: 3.2(a) procedures of Pilates exercise program:

             1. Shoulder Abduction with External Rotation exercise

             2. Shoulder bridge exercise

             3. Mermaid sitting exercise.

             4. Standing Pilates mermaid exercise with towel

             5. Rocking exercise

             6. Saw Pilates exercise.

             7. Bird-dog Pilates exercise.

             8. Roll up exercise.

             9. Cobra pose exercise.

            10. Child pose exercise.
    

Intervention name(s): Pilates exercise; Manual lymphatic massage
Intervention type(s): Other; Other
Intervention description(s): Shoulder Abduction with External Rotation exercise
Shoulder bridge exercise
Mermaid sitting exercise.
Standing Pilates mermaid exercise with towel
Rocking exercise
Saw Pilates exercise.
Bird-dog Pilates exercise.
Roll up exercise.
Cobra pose exercise.
Child pose exercise.; procedures of Manual lymphatic drainage program Things to know about MLD Massage
Use only gentle pressure, just enough to see your skin move.
Massage should not be painful.
Do not rub your skin red.
Do massage each day.
Repeat each step 5 to 10 times.
The massage should take about 15 to 30 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Group A:( Pilates exercise) This group includes 34 patients who have axillary web syndrome received Pilates exercise with traditional physical therapy exercise program (strength, core stability, flexibility, muscle control, posture and breathing). Patients received 3 sessions per week for 8 weeks; time of session is 30 minutes.
) Group B: (Manual Lymphatic Drainage) This group includes 34 patients who axillary web syndrome received Manual lymphatic drainage massage with traditional physical therapy exercise program (strength, core stability, flexibility, muscle control, posture and breathing). Patients received 3 sessions per week for 8 weeks; time of session is 30 minutes.
Masking: None (Open Label)
Primary purpose: Treatment