Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials

Ivana Leão Ribeiro; Roberta Fátima Carreira Moreira; Angélica Viana Ferrari; Francisco Alburquerque-Sendín; Paula Rezende Camargo; Tania Fátima Salvini

doi:10.1177/0269215519873026

Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials

Clin Rehabil. 2019 Dec;33(12):1876-1886. doi: 10.1177/0269215519873026. Epub 2019 Sep 3.

Authors

Ivana Leão Ribeiro^{1

2}, Roberta Fátima Carreira Moreira², Angélica Viana Ferrari², Francisco Alburquerque-Sendín^{3

4}, Paula Rezende Camargo², Tania Fátima Salvini²

Affiliations

¹ Department of Kinesiology, Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile.
² Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil.
³ Department of Socio-Sanitary Sciences, Radiology and Physical Medicine, Universidad de Córdoba, Córdoba, Spain.
⁴ Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.

PMID: 31480855
DOI: 10.1177/0269215519873026

Abstract

Objective: The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched.

Methods: Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results: Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45-2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4-2.4).

Conclusion: Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.

Keywords: Breast neoplasia; muscle strength; physical therapy; shoulder.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Arm / physiopathology*
Breast Neoplasms / physiopathology
Breast Neoplasms / rehabilitation*
Breast Neoplasms / surgery*
Female
Humans
Muscle Strength / physiology*
Randomized Controlled Trials as Topic
Range of Motion, Articular / physiology*