ABSTRACT
The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer was examined through a randomized controlled trial. One hundred and thirty-nine patients with newly diagnosed breast cancer were enrolled in the study. Sixty-two (45%) had Breast Conserving Therapy and 77 (55%) had Modified Radical Mastectomy (Axillary dissection of level I and II was included in both procedures). Enrolled patients were randomized to either group A or group B. Group A was offered, team instructed physiotherapy consisting of 12 sessions of 60 min, two sessions a week. The treatment was instituted between the sixth and eight postoperative week. Group B was also offered team instructed physiotherapy, consisting of 12 sessions of 60 minute two sessions a week, but not until the 26th postoperative week. The patients were seen for follow-up examinations four times during the first postoperative year (after 7, 13, 26 and 56 weeks). Shoulder function was assessed by the Constant Shoulder Score preoperatively and at the four follow-up examinations. Team instructed physiotherapy was found to improve the shoulder function significantly in patients treated surgically for breast cancer. The effect of the treatment was influenced by the type of surgery performed, and in mastectomised patients, also by the application of radiation therapy. Compromised shoulder function is a less frequent and less severe side effect to breast conserving therapy as compared to modified radical mastectomy.
Subject(s)
Breast Neoplasms/physiopathology , Breast Neoplasms/rehabilitation , Exercise Therapy , Shoulder Joint/physiopathology , Shoulder/physiopathology , Adult , Aged , Axilla/physiology , Axilla/radiation effects , Axilla/surgery , Breast Neoplasms/therapy , Female , Follow-Up Studies , Humans , Mastectomy, Modified Radical , Middle Aged , Patient Participation , Radiotherapy, Adjuvant , Range of Motion, Articular/radiation effects , Shoulder/radiation effects , Shoulder Joint/radiation effects , Treatment OutcomeABSTRACT
OBJECTIVE: Postoperatively patients have a reduction in nutritional intake and body weight. We studied the effect of postoperative physical training on nutritional intake and body composition. METHODS: Patients > or =60 y admitted for elective colorectal surgery were randomised to train muscular strength (group A) or to nonstrengthening exercises (group B) for 3 months. Fat mass (FM) and lean body mass (LBM) were assessed with bioimpedance preoperatively, 7, 30, and 90 days postoperatively. Nutritional intake was registered in a subpopulation. RESULTS: Of 119 included patients, 60 were randomised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean (s.d.) of 0.4 (2.1) kg in group A compared to -0.7 (2.0) kg in B. The difference between groups of 1.2 (0.5) kg at day 7 was statistically significant (P=0.03). At no other time was observed difference between groups in weight, LBM, or FM. The energy and protein intake rose during postoperative day 1-7 and rose further after discharge. At no time were differences between groups. CONCLUSION: Physical training had little effect on body composition following abdominal surgery. The nutritional intake in well-nourished patients did not increase by training.
Subject(s)
Body Composition/physiology , Colorectal Surgery/adverse effects , Energy Intake/physiology , Exercise/physiology , Muscle, Skeletal/physiology , Aged , Electric Impedance , Female , Humans , Male , Postoperative Care , Time Factors , Weight Lifting/physiologyABSTRACT
Early postoperative nutrition reduces morbidity. We investigated whether the introduction of a new postoperative analgesic and ambulation regimen with enforced mobilization from postoperative day 1 would influence postoperative nutrition intake. Nutrition intake was recorded daily by a record method and compared with the intake in a control group that received the same nutrition regimen but a traditional analgesic and ambulation regimen. The mean intakes of energy during postoperative days 1 to 5 were 73 kJ x kg(-1) x d(-1) in the intervention group and 52 kJ x kg(-1) x d(-1) in the control group (P = 0.04). Protein intakes in the same period were 0.95 g x kg(-1) x d(-1) in the intervention group and 0.57 g x kg(-1) x d(-1) in the control group (P < 0.01). We found that a regimen based on epidural analgesia with local anesthetics, enforced mobilization, and the use of immediate postoperative oral nutrition leads to substantial nutrition intake after colonic surgery during the first postoperative days.