Comparison of Rehabilitation Training at Different Timepoints to Restore Shoulder Function in Patients With Breast Cancer After Lymph Node Dissection: A Randomized Controlled Trial.

Abstract

To investigate whether advancing the initiation of rehabilitation training compared with the time recommended by the guidelines after breast cancer (BC) surgery is beneficial to the recovery of shoulder function and quality of life. Prospective, observational, single center, randomized controlled trial. The study was conducted between September 2018 and December 2019, with a 12-week supervised intervention and 6-week home-exercise period concluding in May 2020. Two hundred BC patients received axillary lymph node dissection (N=200). Participants were recruited and randomly allocated into 4 groups (A, B, C, and D). Group A started range of motion (ROM) training at 7 days postoperative and progressive resistance training (PRT) at 4 weeks postoperative; group B started ROM training at 7 days postoperative and PRT at 3 weeks postoperative; group C started ROM training at 3 days postoperative and PRT at 4 weeks postoperative; and group D started ROM training at 3 days postoperative and PRT at 3 weeks postoperative. The primary outcome measure was Constant-Murley Score. Secondary outcome measures included ROM, shoulder strength, grip, European Organization Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module (EORTC QLQ-BR23), and SF-36. Incidence of adverse reactions (drainage and pain) and complications (ecchymosis, subcutaneous hematoma, lymphedema) were also assessed. Participants who started ROM training at 3 days postoperative obtained more benefits in mobility, shoulder function, and EORTC QLQ-BR23 score, while patients who started PRT at 3 weeks postoperative saw improvements in shoulder strength and SF-36. Incidence of adverse reactions and complications were low in all 4 groups, with no significant differences among the 4 groups. Advancing ROM training initiation to 3 days postoperative or PRT to 3 weeks postoperative can better restore shoulder function after BC surgery and lead to faster quality of life improvement.