Impact of Scapular Mobilization And Strengthening Exercises on Shoulder Function Post Mastectomy

Study Overview
=================
Brief Summary
-----------------
The most common complications following mastectomy are pain, lymphedema of the upper limb ipsilateral to surgery, decreased range of motion (ROM), limited to 90° of flexion, abduction, and external rotation to 40° of the shoulder, and postural changes. It was reported that 60% of breast cancer patients show a reduction in shoulder flexion and abduction at 1-month post-surgery and 10% of survivors show a persistent ROM reduction at 12 months. So, The purpose of the study was to evaluate the therapeutic impact of scapular mobilization and strengthening exercises on shoulder function post-mastectomy.

Detailed Description
-----------------
In this randomized controlled trial study (RCT), forty female patients The patient's ages ranged from 40 to 55 years suffering from post-mastectomy shoulder dysfunction ((20° ≥ ROM limitation compared to the sound shoulder & 3 months to 6 months post mastectomy) were randomly assigned into two equal groups, each one had 20 patients. Group A (study group): This group included 20 patients with shoulder dysfunction post-mastectomy who received scapular mobilization and strengthening exercise in addition to their conventional physical therapy program for four weeks, three sessions/week. Group B (control group): This group included 20 patients with shoulder dysfunction who received conventional physical therapy programs in form of joint mobilization, posterior capsule stretching, and range of motion exercise (ROM) for four weeks, 3 sessions/week. Equipment and tools: Measurement tools were (The shoulder Pain and Disability Index (SPADI): for measurement of shoulder disability and inclinometer: for measurement of shoulder flexion, abduction, external rotation, and scapular upward rotation), the measurements were recorded before and after the study. Therapeutic equipment and tools were (Thera Bands of different colors and resistance and dumbbells of different weights). The potential participants were excluded if they met any of the following criteria: Diseases such as rheumatoid arthritis, history of trauma or accidental injuries, neurological involvement (stroke, Parkinsonism), history of surgery on the involved shoulder, and diabetic patient.

Official Title
-----------------
Impact of Scapular Mobilization And Strengthening Exercises on Shoulder Function Post Mastectomy

Conditions
-----------------
Oncologic Complications, Exercise Therapy, Shoulder Pain, Shoulder Syndrome

Intervention / Treatment
-----------------
* Other: Scapular mobilization and Scapular strengthening exercises
* Other: Conventional physical therapy program


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Female patients with ages ranging from 40-55 years. All patients had shoulder dysfunction post-mastectomy (20° ≥ ROM limitation compared to the sound shoulder). Patients were 3 months to 6 months post-mastectomy. All enrolled patients signed the informed consent. Exclusion Criteria: Disease such as rheumatoid arthritis. History of trauma or accidental injuries. Neurological involvement (stroke, Parkinsonism). History of surgery on the involved shoulder. Diabetic patient.

Ages Eligible for Study
-----------------
Minimum Age: 40 Years
Maximum Age: 55 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Forty patients suffering from post-mastectomy shoulder dysfunction were randomly assigned into two equal groups each one has 20 patients. Group A (study group): Who received scapular mobilization and strengthening exercises in addition to their conventional physical therapy program. Group B (control group): Who received a conventional physical therapy program in form of joint mobilization, posterior capsule stretching, and range of motion exercise.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Scapular mobilization and strengthening exercise<br>Group A (study group): This group included 20 patients with shoulder dysfunction post-mastectomy who received scapular mobilization and strengthening exercise in addition to their conventional physical therapy program in form of joint mobilization, posterior capsule stretching and range of motion exercise (ROM). | Other: Scapular mobilization and Scapular strengthening exercises<br>* The intervention was applied for four weeks, 3 sessions/week. and the Shoulder Pain and Disability Index (SPADI): for measurement of shoulder disability and the Inclinometer: for measurement of shoulder flexion, abduction, external rotation, and scapular upward rotation were used for shoulder assessment before and after the intervention for both groups.<br>Other: Conventional physical therapy program<br>* The intervention was applied for four weeks, 3 sessions/week. and the Shoulder Pain and Disability Index (SPADI): for measurement of shoulder disability and the Inclinometer: for measurement of shoulder flexion, abduction, external rotation, and scapular upward rotation were used for shoulder assessment before and after the intervention for both groups.<br>|
| Active Comparator: Conventional physical therapy program<br>This group included 20 patients with shoulder dysfunction who received conventional physical therapy programs in form of joint mobilization, posterior capsule stretching, and range of motion exercise (ROM). | Other: Conventional physical therapy program<br>* The intervention was applied for four weeks, 3 sessions/week. and the Shoulder Pain and Disability Index (SPADI): for measurement of shoulder disability and the Inclinometer: for measurement of shoulder flexion, abduction, external rotation, and scapular upward rotation were used for shoulder assessment before and after the intervention for both groups.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Inclinometer reading before and after the treatment. | for measurement of shoulder flexion, abduction, external rotation, and scapular upward rotation | Baseline and four weeks after the intervention | 
| Changes in Shoulder Pain and Disability Index (SPADI) before and after the treatment. | for measurement of shoulder disability | Baseline and four weeks after the intervention | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Scapular mobilization, Scapular strengthening exercises, Mastectomy, Shoulder function