Comparison of effect of exercise alone to that of exercise plus physical therapy modalities on shoulder disabilty in female patients with operated breast cancer

Comparıson Of Effect Of Exercıse Alone To That Of Exercıse Plus Physıcal Therapy Modalıtıes On Shoulder Dısablıty In Female Patıents Wıth Operated Breast Cancer Objectives: To compare effect of exercise alone to that of exercise plus physical therapy modalities for upper extremity disorders leading to pain and/or limited range of motion at middle and late postoperative term in patients who underwent radical or breast-conserving surgery owing to breast cancer. Materials: 40 consecutive patients applying to Celal Bayar University School of Medicine, Physical Therapy and Rehabilitation outpatient clinics for shoulder complaints following breast cancer surgery included in the study. In physical examination, range of motion for shoulder joint along with pain during rest and activity were assessed use manual goniometry and visual analogue scale of 10 cm, respectively. DASH (Disabilities of the Arm, Shoulder and Hand) inquiry and constant scale were used to evaluate disability. SF-36 was used for assessing life quality. Patients were then divided into two groups one of which composed those who were treated with exercise plus physical therapy modalities including hot pack, intermittent ultrasound and TENS while the other one composed those treated with home exercise therapy alone. Patients were examined just after therapy and 3 months following therapy. In statistical analysis; Mann Whitney U, Wilcoxon signed-rank and Spearman?s correlation tests were used for comparing groups, treatments of choice and detecting associations between parameters, respectively. A ?p? value of lower than 0.05 was considered significant for all determinations. Results: Mean age of patients was 47.6±9.5 years while mean time from surgery was 18.1±7.1 months. 40% of patients underwent modified radical mastectomy (MRM) while 60% did breast-conserving surgery (BCS). 65% of patients had a history of radiotherapy. 23 patients (57.5%) defined milD shoulder pain (VAS=1.2±1.3) during rest while 37 patients (92.5%) did mild-moderate pain (VAS=1.2±1.3) during activity. 52.7% of patients had a limited range of motion for shoulder joint in at least one direction. Mean DASH and constant scale scores were 67.6±11.8 and 35.3±8.7, respectively. Angles of flexion, abduction and extension were shown to be correlated with VAS, DASH, Constant and SF-36 scales (p<0,05). Between the groups, there was no significant difference regarding age, body mass index, range of motion, VAS, DASH and constant scores along with all parameters of SF-36. Following the treatment in physical therapy group, significant improvements were observed in terms of flexion, abduction, extension, outer rotation, DASH & constant scores, VAS scores during rest and activity together with ? among SF-36 parameters ? physical & social functioning and pain. Besides, there observed some significant improvements also in exercise group following the treatment period which included flexion, abduction, VAS activity score and ? among SF-36 parameters ? physical functioning. When comparing post-treatment results; flexion (p<0.001), abduction (p<0.001), outer rotation (p<0.015), DASH score (p<0.001), constant score (p<0.001) along with rest (p=0.038) & activity (p<0.001) VAS scores were found more improved in physical therapy group. At third month; flexion, abduction, DASH, constant and VAS activity scores were still observed more improved in physical therapy group. Conclusion: In this study we observed disorders of shoulder joint are common in patients with operated breast cancer and caused significant disability. In late disability rehabilitation after breast surgery combined physical therapy had positive influences on pain, range of motion, disability and life quality of these patients. It was shown that physical therapy added to exercise therapy program increases the effectiveness of treatment and prolong the duration and impact of treatment. Key Words: breast cancer, physical treatment, exercises, shoulder disability