Surgery and Physical Therapy in breast cancer: effects on scapular kinematics, pain and shoulder function in affected women

• Grant number: 15/02354-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): May 01, 2015
• Effective date (End): August 31, 2017
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Tania de Fatima Salvini
• Grantee: Angélica Viana Ferrari
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Associated scholarship(s): 16/04696-8 - Surgery and physical therapy in breast cancer: effects on scapular kinematics, pain and shoulder function in affected women, BE.EP.IC

Abstract

Introduction: The main disorders of the upper limb related to postoperative breast cancer, such as functional limitations and muscle weakness, have been studied. The three-dimensional movement of the scapula can be changed after the surgical treatment of this condition, but there are still conclusive studies on this topic. Although upper limb rehabilitation programs are recommended after surgery for breast cancer, the great variability in the intervention protocols, associated with lack of control group, make it difficult to compare studies. Objective: To identify the possible changes of three-dimensional movement of the scapula during arm elevation in women after breast cancer surgery and subjected to a standardized program of physical therapy intervention. Also assess pain, upper limb function and quality of life. Methods: Will be evaluated 25 women with a clinical diagnosis of breast cancer and 25 healthy women with no history of musculoskeletal disorders of the upper limbs, matched for age and body mass index. There will be two pre-surgical evaluations in the month preceding the surgical treatment of breast cancer (with an interval of one week between each) and two post-surgical evaluations: the first, after 4 weeks after surgery, when patients have received 8 sessions (2x / week) of physical therapy for the upper limb (passive mobilization glenohumeral and scapular, scar massage, lymphatic drainage, stretching exercises and free assets); the second, after 8 weeks after surgery, when patients completed 16 sessions (2x / week) of physical therapy for the shoulder complex (strengthening and stretching exercises). In each evaluation, bilateral scapular kinematics is analyzed by means of an electromagnetic tracking device during the lifting movement of the arm in the plane of the scapula, in the group with breast cancer. In the healthy group, the side will be evaluated correspondende next, dominant or non-dominant operated. The extent of abduction movements, bending, lateral and medial rotation of the arm rotation is assessed using a digital inclinometer and strength of the abductor and lateral rotator muscles is measured through a digital dynamometer. The pain will be assessed by visual analog scale (VAS), the upper limb function will be assessed by the questionnaire Disabilities of the Arm, Shoulder and Hand (DASH) and the quality of life, through the Medical Oucomes Study 36 questionnaire -item Short Form Health Survey (SF-36). Statistical analysis will include an examination of variables, qualitative and quantitative. Statistical tests will be applied according to the normality of the data and will be adopted a 5% significance level for comparison of the variables during the evaluations. Expected results and clinical implications of the study: To provide information on the biomechanics of the shoulder of women undergoing surgery for breast cancer and a standardized and reproducible program of physical therapy, particularly in relation to the scapular movement patterns and upper limb function, in order to support the rehabilitation of shoulder movement in the postoperative period. (AU)