Reliability And Validity Study Of The Evaluation Tool For Myofascial Adhesions In Patients After Breast Cancer In Turkish Language

Study Overview
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Brief Summary
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The aim of this observational study is to translate the MAP-BC Evaluation Tool into Turkish by adapting it to Turkish society and to conduct a validity and reliability study in women who have received breast cancer treatment. The main questions it aims to answer are: Are the same researcher's MAP-BC Evaluation Tool results similar at intervals to detect myofascial adhesions in breast cancer patients in Turkish population? Are the different researchers' MAP-BC Evaluation Tool results similar to detect myofascial adhesions in breast cancer patients in Turkish population? After comparing the results of Turkish version of both The Patient and Observer Scar Assessment Scale Observer Subscale and MAP-BC Evaluation Tool, is there a sufficient correlation between them?

Detailed Description
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Breast cancer is the most frequently diagnosed malignancy in all over the world. Breast and axillary surgery, radiotherapy, hormone therapy and chemotherapy treatments may cause upper extremity dysfunction and pain which negatively affect quality of life and daily living activities of breast cancer patients. Lymphedema, severe pain, decreased range of motion of shoulder joint, axillary web syndrome, myofascial trigger points and myofascial adhesions are the leading causes affecting upper extremity function in patients with breast cancer. Myofascial dysfunction presents as a problem characterized by trigger points, adhesions, and limitation of myofascial tissue and tissue gliding. Muscle manipulation during surgery, scar tissue, soft tissue adhesions, adaptive posture development following surgery and radiotherapy induced fibrosis can cause myofascial adhesions. However, there is not sufficient research or tools for the evaluation of scar tissue and adhesions. Detection, quantitative measurement and scoring of myofascial adhesions in upper extremity dysfunctions after breast cancer treatment are important for both developing target-oriented treatment plan and evaluation of treatment effectiveness (myofascial therapy, physical therapy modalities). The Patient and Observer Scar Assessment Scale is an evaluation tool utilized to detect scar tissue and was shown for reliable and valid in patients who have undergone breast cancer surgery. Its reliability and validity study for Turkish population has been done earlier. A new diagnostic method called MAP-BC (Myofascial Adhesions in Patients after Breast Cancer) has been developed to evaluate scar tissue after breast cancer treatments and to quantitatively measure myofascial adhesions. Its reliability and validity have been proven in various countries, however, it is yet to be tested in Turkey. The aim of this observational study is to translate the MAP-BC evaluation tool into Turkish by adapting it to Turkish society and to conduct a validity and reliability study in women who have received breast cancer treatment. Firstly, the original version of MAP-BC will be translated into Turkish and its semantic and conceptual equivalence will be checked. Later it will be finalized by the committee consisting of two translators and four expert physiatrists. For intra-rater reliability, the same researcher will re-evaluate patients at 14-days intervals. For inter-rater reliability, 2 different researchers will evaluate the first 15 patients by using the Patient and Observer Scar Assessment Scale and MAP-BC tools unaware of each other's results. If the outcome of the two researchers evaluation are found in agreement at a reliable rate, then the study will be continued by a single researcher. The convergent validity of the Turkish version of MAP-BC will be assessed by comparing the results of Turkish version of both the Patient and Observer Scar Assessment Scale observer subscale (Patient and Observer Wound Assessment) and MAP-BC. Their correlation will be analyzed.

Official Title
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Reliability And Validity Study Of MAP-BC Evaluation Tool In Turkish Language To Detect Myofascial Adhesions Among Women Under Breast Cancer Treatment

Conditions
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Breast Cancer, Upper Extremity Dysfunction, Tissue Adhesion

Intervention / Treatment
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* Diagnostic Test: MAP-BC (Myofascial Adhesions in Patients after Breast Cancer) Evaluation Tool
* Diagnostic Test: Patient And Observer Scar Assessment Scale ( Observer Subscale)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Breast cancer patients aged between 18-75 years who had undergone breast surgery providing a written consent to participate in the study Exclusion Criteria : Patients who do not agree to participate the study Patients with active skin disease/infection which limits physical examination (palpation) Patients with a secondary breast cancer and/or metastasis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Breast Cancer Patients<br>Patients who had undergone breast cancer surgery, aged between 18-75 years-old | Diagnostic Test: MAP-BC (Myofascial Adhesions in Patients after Breast Cancer) Evaluation Tool<br>* It's a tool to evaluate scar tissues that occured after breast cancer treatment. It quantitatively measures myofascial adhesions. The degree of adhesion is scored for each area at 3 different depth levels (skin, superficial, deep) as a 4-point scale (0: no adhesion - 3: severe adhesion). Axillary scar, breast/mastectomy scar, m. pectoralis region, frontal chest wall, lateral chest wall, axilla and inframammary fold are evaluated separately. Sum of the scores from three levels of each area gives the total score. The minimal total score is: 0 and the maximum total score is 63.<br>Diagnostic Test: Patient And Observer Scar Assessment Scale ( Observer Subscale)<br>* This assesment tool consists of two different scales evaluated by the observer and the patient.The observer scale rates five variables, which include vascularity, pigmentation, thickness, relief, pliability and surface area, between 1-10 points (1:normal skin). The total score ranges from 5 to 50.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MAP-BC Evaluation Tool | This tool was developed to evaluate scar tissues that occured after breast cancer treatments. It quantitatively measures myofascial adhesions. The degree of adhesion is scored for each area at 3 different depth levels (skin, superficial, deep) as a 4-point scale (0: no adhesion - 3: severe adhesion). Axillary scar, breast/mastectomy scar, m. pectoralis region, frontal chest wall, lateral chest wall, axilla and inframammary fold are evaluated separately. Sum of the scores from three levels of each area gives the total score. The maximum score is 63. In Breast cancer patients, the inter-rater reliability of the detection of myofascial adhesions by palpation has been reported good to excellent. | 11 months | 
| POSAS | This assesment tool consists of two different scales evaluated by the observer and the patient. Its validity and reliability have been proven for the detection of scar tissue in patients who have undergone breast cancer surgery. The observer scale rates five variables, which include vascularity, pigmentation, thickness, relief, pliability and surface area, between 1-10 points (1:normal skin). The total score ranges from 5 to 50. The Turkish version of POSAS, whose validity and reliability studies were conducted, will be used in our study. | 11 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myofascial adhesions, Breast Cancer, POSAS, MAP-BC Evaluation Tool, myofascial dysfunction, validity and reliability study