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

• Grant number: 16/04696-8
• Support Opportunities: Scholarships abroad - Research Internship - Scientific Initiation
• Start date: January 01, 2017
• End date: April 30, 2017
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Tania de Fatima Salvini
• Grantee: Angélica Viana Ferrari
• Supervisor: Francisco Alburquerque Sendin
• Host Institution: Centro de Ciências Biológicas e da Saúde (CCBS). Universidade Federal de São Carlos (UFSCAR). São Carlos , SP, Brazil
• Institution abroad: Universidad de Salamanca (USAL), Spain
• Associated to the scholarship: 15/02354-0 - Surgery and Physical Therapy in breast cancer: effects on scapular kinematics, pain and shoulder function in affected women, BP.IC

Abstract

Introduction: The main disorders of the upper limb related to postoperative breast cancer, such as functional limitations and weakness, have been studied. The three-dimensional movement of the scapula can be changed after the surgical treatment of this condition, but the studies are inconclusive on this topic. Although upper limb rehabilitation programs are recommended after breast cancer surgery, the great variability in 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 who had undergone breast cancer surgery and subjected to a standardized program of physical therapy intervention. Moreover, to assess intensity of 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 in the upper limbs, matched for age and body mass index. There will assess two pre-surgical evaluations in the month prior to the surgical treatment of breast cancer (with an interval of one week between each than) 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); the second, after 8 weeks after surgery, when patients completed 16 sessions (2x/week) of physical therapy for the shoulder complex (strengthening and stretching upper limb exercises). In each evaluation, bilateral scapular kinematics are going to be analyze using an electromagnetic tracking device during the arm elevation in the plane of the scapula, in the group with breast cancer. In the control group, the side who is going to be evaluated will be matched with dominant or non-dominant, operated. The abduction, flexion, external and internal rotation movements are going to be assessed using a digital inclinometer and muscle strength of the abductor external rotator muscles will be evaluated using a digital dinamometer. The pain will be assessed by visual analog scale (VAS), the function of the upper limbs will be assessed by the questionnaire Disabilities of the Arm, Shoulder and Hand (DASH) and the quality of life through the questionnaire Medical Oucomes Study 36-item short Form Health Survey (SF36). 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 comparisons of variables along the expected evaluations. Results and clinical implications of the study: To provide information on shoulder biomechanics submitted to surgical treatment for breast and a standardized program cancer and reproducible physical therapy, particularly in relation to the scapular movement patterns and function of the upper limbs, in order to support the rehabilitation of shoulder movement in the postoperative period. (AU)