Patient-reported upper extremity outcome measures used in breast cancer survivors: a systematic review

Arch Phys Med Rehabil. 2014 Jan;95(1):153-62. doi: 10.1016/j.apmr.2013.07.022. Epub 2013 Aug 6.


Objectives: (1) To identify English-language published patient-reported upper extremity outcome measures used in breast cancer research and (2) to examine construct validity and responsiveness in patient-reported upper extremity outcome measures used in breast cancer research.

Data sources: PubMed, Cumulative Index to Nursing and Allied Health Literature, and ProQuest MEDLINE databases were searched up to February 5, 2013.

Study selection: Studies were included if a patient-reported upper extremity outcome measure was administered, the participants were diagnosed with breast cancer, and the study was published in English.

Data extraction: A total of 865 articles were screened. Fifty-nine full text articles were assessed for eligibility. A total of 46 articles met the initial eligibility criteria for aim 1. Eleven of these articles reported means and SDs for the outcome scores and included a comparison group analysis for aim 2.

Data synthesis: Construct validity was evaluated by calculating effect sizes for known-group differences in 6 studies using the Disabilities of Arm, Shoulder and Hand (DASH), University of Pennsylvania Shoulder Score, Shoulder Disability Questionnaire-Dutch, and 10 Questions by Wingate. Responsiveness was analyzed comparing a treatment and control group by calculating the coefficient of responsiveness in 5 studies for the DASH and 10 Questions by Wingate.

Conclusions: Eight different patient-reported upper extremity outcome measures have been reported in the peer-review literature for women with breast cancer; some that were specifically developed for breast cancer survivors (n=3) and others that were not (n=5). Based on the current evidence, we recommend administering the DASH to assess patient-reported upper extremity function in breast cancer survivors because the DASH has the most consistently large effects sizes for construct validity and responsiveness. Future large studies are needed for more definitive recommendations.

Keywords: Breast neoplasms; CI; DASH; Disabilities of Arm, Shoulder and Hand; ES; KAPS; Kwan's arm problem scale; Outcome assessment (health care); Rehabilitation; ULDQ; Upper extremity; confidence interval; effect size; upper limb disability questionnaire.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Arm
  • Breast Neoplasms / physiopathology*
  • Breast Neoplasms / psychology
  • Disability Evaluation*
  • Female
  • Hand
  • Humans
  • Outcome Assessment, Health Care
  • Physical Therapy Modalities
  • Psychometrics
  • Reproducibility of Results
  • Self Report*
  • Shoulder
  • Upper Extremity / physiopathology*