The Recovery of Reaching Movement in Breast Cancer Survivors: Two Different Rehabilitative Protocols in Comparison
Condition: Breast Cancer; Breast Cancer Lymphedema; Pain; Pain, Postoperative; Pain, Chronic; Mastectomy; Lymphedema; Breast Surgery
MeSH terms: Breast Neoplasms; Lymphedema; Breast Cancer Lymphedema; Pain, Postoperative; Chronic Pain
Study type: Interventional

Summary: 
      This study emphasizes the importance of rehabilitation in breast cancer survivors after
      mastectomy, even during the course of radiotherapy and chemotherapy, both for good efficacy
      in reducing pain and for functional recovery of the upper limb. Authors designed a
      randomized-controlled trial to compare two different rehabilitation protocols: the single
      rehabilitative treatment (ST) and the group treatment (GT). The study is the first attempt to
      measure the reaching movement after BC surgery with an optoelectronic evaluation system
      previously standardized in the neurological field during rehabilitation treatment.
    

Detailed description: 
      Breast cancer (BC) is the most common cancer in women in the developed world. Surgery and
      medical protocols have improved significantly over the last 10 years and this guarantees a
      better chance of survival and an improvement in quality of life.

      Then, the focus on "what happen after defeating BC" has become current: patients' and
      physicians' awareness of the sequelae of BC surgery has increased, especially in the case of
      mastectomy or modified radical mastectomy. A large number of these complications, such as
      lymphedema or post-treatment pain with or without functional impotence, which contribute to
      limitations in daily life activities, can be treated favourably and, in sometimes, resolved
      with early rehabilitation protocols. Therefore, it is not only important to start the
      rehabilitation process early after surgery, but, also, during the sub-acute phase, choose
      appropriate exercise programs to allow recovery in "quantity" and "quality" of the movement
      of the operated upper limb (UL). Alterations in muscle activation and reduced shoulder
      mobility are common in patients with BC. It is necessary to consider that winged scapula
      incidence in BC surgery is 8% and the prevalence decreased during 6 months after surgery. In
      particular, patients who developed winged scapula had more shoulder flexion, adduction and
      abduction limitation. These findings suggest that, after BC surgery, soft tissues
      restrictions obstruct short-term scapula motion.

      Reaching movement is a complex multi-articular movement towards a defined point in space and
      allows the hand to interact with the environment. Nevertheless, it is not yet investigated
      during the rehabilitation process. Moreover, the execution of the UL movements, improves if
      the numerous perturbations of the musculoskeletal system, which occur during the execution of
      movements, are compensated. Motor synergy's components should modify their action to
      influence positively the outcome of motor activity, preventing the mistakes of the individual
      components from influencing the overall activity. An important issue is represented by the
      redundancy of the degrees of motor freedom. Actions and movements can be performed in
      different ways because the functional synergies are able to co-vary, without changing the
      result of the action. However, only three spatial dimensions are needed to specify any
      position where the hand could be placed. This excess of kinematic degrees of freedom means
      that there are multiple arm configurations that correspond to any particular position of the
      hand. Thus, improvements in reaching, after BC mastectomy, can be determined, compared to a
      different rehabilitation protocol, by comparing the Single rehabilitative Treatment (ST) with
      Group Treatment (GT). Authors designed a randomized-controlled trial to check if specific
      scapula exercises, included in the ST, could induce changes in the fluidity of the reaching,
      called Jerk (primary outcome), decrease shoulder pain and improve the functioning of the
      operated upper limb (secondary outcomes).
    

Intervention name(s): Single rehabilitative treatment; Group rehabilitative treatment
Intervention type(s): Other; Other
Intervention description(s): The rehabilitation treatment, performed by a physiotherapist trained in oncological rehabilitation, was carried out with a 6-week exercise program for 12 sessions (60 minutes/session, 2/week).). The protocol included a first phase consist in low impact aerobics warming (15-20 minutes), then diaphragmatic breathing and postural exercises for the midline alignment. The awareness of abdominal breathing represents the preliminary phase for a complete psychophysical relaxation of the patient, an important prerequisite for the correct execution of subsequent mobility, stretching and strengthening exercises of spine, scapula and upper limb. Subsequently, isometric strengthening exercises for shoulder stabilizing muscles, first passively and, subsequently, with supervision, were performed. Specific exercises, for passive mobilization and stabilization of the scapula, cervical pumping and stretching of the pectoral muscles, have been performed.; Four-five patients for group. The rehabilitation treatment, performed by a physiotherapist trained in oncological rehabilitation, was carried out with a 6-week exercise program for 12 sessions (60 minutes/session, 2/week). The protocol included at first week mainly breathing techniques, then we introduced exercises gradually more active, according to the improvements of the execution. The exercises had the aim to improve the opening of the scapular chain and to increase the amplitude of the range of motion in order to stimulate better neuromuscular control during the movement of scapular retropulsion, to stretch the pectoral muscles following the rhythm of the breath and the tissues affected by post-surgical scars and fibrotic effects, finally to reinforcing, against gravity, the musculature of the shoulders and back.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Breast Cancer; Pain Chronic and Postoperative; Lymphedema; Posture; Target - Reaching movement; Breast surgery; Functional impotence; Rehabilitive treatment; Physiotherapy; Scapula tilting