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Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment

Article consultable sur : http://www.archives-pmr.org

OBJECTIVE: To systematically review the effectiveness of various postoperative
physical therapy modalities and timing of physical therapy after treatment of
breast cancer on pain and impaired range of motion (ROM) of the upper limb. DATA
SOURCES: We searched the following databases: PubMed/ MEDLINE, Cumulative Index to
Nursing and Allied Health Literature, Embase, Physiotherapy Evidence Database,
and Cochrane. Articles published until October 2012 were included. STUDY SELECTION: Only (pseudo) randomized controlled trials and nonrandomized
experimental trials investigating the effectiveness of passive mobilization,
manual stretching, myofascial therapy, and/or exercise therapy and timing of
physical therapy after treatment for breast cancer are reviewed. Primary outcomes
are pain of the upper limb and/or ROM of the shoulder. Secondary outcomes are
decreased shoulder strength, arm lymphedema, limitations in activities of daily
living, decreased quality of life, and wound drainage volume. Physical therapy
modalities had to be started in the first 6 weeks after surgery. DATA EXTRACTION:
Articles were selected by 2 independent researchers in 3 phases and compared for
consensus. First the titles were analyzed, and then the selected abstracts and
finally the full texts were reviewed. DATA SYNTHESIS: Eighteen randomized
controlled trials were included in the review. Three studies investigated the
effect of multifactorial therapy: 2 studies confirmed that the combination of
general exercises and stretching is effective for the treatment of impaired ROM
another study showed that passive mobilization combined with massage had no
beneficial effects on pain and impaired ROM. Fifteen studies investigated the
effectiveness of a single physical therapy modality. One study of poor quality
found evidence supporting the beneficial effects of passive mobilization. The
only study investigating the effect of stretching did not find any beneficial
effects. No studies were found about the effectiveness of myofascial therapy in
the postoperative phase. Five studies found that active exercises were more
effective than no therapy or information on the treatment of impairments of the
upper limb. Three studies supported the early start of exercises for recovery of
shoulder ROM, whereas 4 studies supported the delay of exercises to avoid
prolonged wound healing. CONCLUSIONS: Multifactorial physical therapy (ie,
stretching, exercises) and active exercises were effective to treat postoperative
pain and impaired ROM after treatment for breast cancer. High-quality studies are
necessary to determine the effectiveness of passive mobilization, stretching, and
myofascial therapy as part of the multifactorial treatment. In addition, the
appropriate timing and content of the exercise programs need to be further investigated.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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