Accuracy of consumer-based activity trackers as measuring tool and coaching device in breast and colorectal cancer survivors.

PURPOSE: Consumer-based activity trackers are used to measure and promote PA. We studied the accuracy of a wrist- and waist-worn activity tracker in cancer survivors and compared these results to a healthy age-matched control group. METHODS: Twenty-two cancer survivors and 35 healthy subjects wore an activity tracker at the waist and at the wrist combined with a reference activity monitor at the waist (Dynaport Movemonitor). The devices were worn for 14 consecutive days. The mean daily step count from both activity trackers was compared with the reference activity monitor to investigate accuracy and agreement (paired t-test, intraclass correlation, Bland-Altman plots). To evaluate the accuracy as a coaching tool, day-by-day differences within patients were calculated. The Kendall correlation coefficient was used to test the consistency of ranking daily steps between the activity trackers and the reference activity monitor. RESULTS: The wrist-worn wearable significantly overestimated the daily step count in the cancer group (mean ± SDΔ: + 1305 (2685) steps per day; p = 0.033) and in the healthy control group (mean ± SDΔ: + 1598 (2927) steps per day; p = 0.003). The waist-worn wearable underestimated the step count in both groups, although this was not statistically significant. As a coaching device, moderate (r = 0.642-0.670) and strong (r = 0.733-0.738) accuracy was found for the wrist- and waist-worn tracker, respectively, for detecting day-by-day variability in both populations. CONCLUSION: Our results show that wrist-worn activity trackers significantly overestimate daily step count in both cancer survivors and healthy control subjects. Based on the accuracy, in particular, the waist-worn activity tracker could possibly be used as a coaching tool.

The effect of myofascial and physical therapy on trunk, shoulder, and elbow movement patterns in women with pain and myofascial dysfunctions after breast cancer surgery: Secondary analyses of a randomized controlled trial.

INTRODUCTION: Secondary upper limb dysfunctions are common after breast cancer treatment. Myofascial treatment may be a valuable physical therapy modality for this problem. OBJECTIVE: To investigate the effect of myofascial therapy in addition to physical therapy on shoulder, trunk, and elbow movement patterns in women with pain and myofascial dysfunctions at the upper limb after breast cancer surgery. DESIGN: A double-blinded randomized controlled trial. SETTING: Rehabilitation unit of a university hospital. PARTICIPANTS: Forty-eight women with persistent pain after finishing breast cancer treatment. INTERVENTIONS: Over 3 months, all participants received a standard physical therapy program. The experimental (n = 24) and control group (n = 24) received 12 additional sessions of myofascial therapy or placebo therapy, respectively. MAIN OUTCOME MEASURES: Outcomes of interest were movement patterns of the humerothoracic joint, scapulothoracic joint, trunk, and elbow, measured with an optoelectronic measurement system during the performance of a forward flexion and scaption task. Statistical parametric mapping (SPM) analyses were used for assessing the effect of treatment on movement patterns between both groups (group × time interaction effect). RESULTS: A significantly decreased protraction and anterior tilting was found after experimental treatment. No beneficial effects on movement patterns of the humerothoracic joint, trunk, or elbow were found. CONCLUSION: Myofascial therapy in addition to a 12-week standard physical therapy program can decrease scapular protraction and anterior tilting (scapulothoracic joint) during arm movements. Given the exploratory nature of these secondary analyses, the clinical relevance of these results needs to be investigated further.

The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review.

(1) Background: Secondary lymphedema is a chronic, progressive, and debilitating condition with an important impact on quality of life. Lymphedema is a frequently reported complication in oncological surgery but has not been systematically studied in the setting of prostate cancer. (2) Methods: Pubmed/MEDLINE and Embase were systematically searched to identify articles reporting on lower limb or genital lymphedema after primary treatment (surgery of radiation therapy) of the prostate and the pelvic lymph nodes in men with prostate cancer. Primary outcome was the prevalence of lower limb and genital lymphedema. (3) Results: Eighteen articles were eligible for qualitative synthesis. Risk of bias was high in all included studies, with only one study providing a prespecified definition of secondary lymphedema. Eleven studies report the prevalence of lower limb (0-14%) and genital (0-1%) lymphedema after radical prostatectomy with pelvic lymph node dissection (PLND) Seven studies report a low prevalence of lower limb (0-9%) and genital (0-8%) lymphedema after irradiation of the pelvic lymph nodes. However, in the patient subgroups that underwent pelvic irradiation after staging pelvic lymph node dissections, the prevalence of lower limb (18-29%) and genital (2-22%) lymphedema is substantially elevated. (4) Conclusion: Prostate cancer patients undergoing surgery or irradiation of the pelvic lymph nodes are at risk of developing secondary lymphedema in the lower limbs and the genital region. Patients receiving pelvic radiation after pelvic lymph node dissection have the highest prevalence of lymphedema. The lack of a uniform definition and standardized diagnostic criteria for lower limb and genital lymphedema hampers the accurate estimation of their true prevalence. Future clinicals trials are needed to specifically evaluate secondary lymphedema in patients undergoing prostate cancer treatments, to identify potential risk factors and to determine the impact on quality of life.

Exploring the pathophysiology of LARS after low anterior resection for rectal cancer with high-resolution colon manometry.

BACKGROUND: A total mesorectal excision for rectal cancer-although nerve- and sphincter-sparing-can give rise to significant bowel symptoms, commonly referred to as low anterior resection syndrome (LARS). The exact pathophysiology of this syndrome still remains largely unknown, and the impact of radical surgery on colonic motility has only been scarcely investigated. METHODS: High-resolution colon manometry was performed in patients, 12-24 months after restoration of transit. Patients were divided into two groups: patients with major LARS and no/minor LARS, according to the LARS-score. Colonic motor patterns were compared, and the relationship of these patterns with the LARS-scores was investigated. KEY RESULTS: Data were analyzed in 18 patients (9 no/minor LARS, 9 major LARS). Cyclic short antegrade motor patterns did occur more in patients with major LARS (total: p = 0.022; post-bisacodyl: p = 0.004) and were strongly correlated to LARS-scores after administering bisacodyl (p < 0.001). High amplitude propagating contractions (HAPC's) that started in the proximal colon and ended in the mid-section of the colon occurred significantly less in patients with major LARS compared with patients with no/minor LARS (p = 0.015). CONCLUSIONS AND INFERENCES: The occurrence of more cyclic short antegrade motor patterns and less HAPC's (from the proximal to the mid-colon) is more prevalent in patients with major LARS. These findings help to understand the differences in pathophysiology in patients developing major versus no/minor bowel complaints after TME for rectal cancer.

The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial.

BACKGROUND AND OBJECTIVE: Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as low anterior resection syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this has been scarcely investigated in RC patients. The objective was to investigate PFMT effectiveness on LARS in patients after TME for RC. METHODS: A multicenter, single-blind prospective randomized controlled trial comparing PFMT (intervention; n=50) versus no PFMT (control; n=54) 1 month following TME/stoma closure was performed. The primary endpoint was the proportion of participants with an improvement in the LARS category at 4 months. Secondary outcomes were: continuous LARS scores, ColoRectal Functioning Outcome scores, Numeric Rating Scale scores, stool diary items, and Short Form 12 scores; all assessed at 1, 4, 6, and 12 months. RESULTS: The proportion of participants with an improvement in LARS category was statistically higher after PFMT compared with controls at 4 months (38.3% vs 19.6%; P =0.0415) and 6 months (47.8% vs 21.3%; P =0.0091), but no longer at 12 months (40.0% vs 34.9%; P =0.3897). Following secondary outcomes were significantly lower at 4 months: LARS scores (continuous, P =0.0496), ColoRectal Functioning Outcome scores ( P =0.0369) and frequency of bowel movements ( P =0.0277), solid stool leakage (day, P =0.0241; night, P =0.0496) and the number of clusters ( P =0.0369), derived from the stool diary. No significant differences were found for the Numeric Rating Scale/quality of life scores. CONCLUSIONS: PFMT for bowel symptoms after TME resulted in lower proportions and faster recovery of bowel symptoms up to 6 months after surgery/stoma closure, justifying PFMT as an early, first-line treatment option for bowel symptoms after RC.

Is evaluation by questionnaires sufficient to cover all aspects of bowel symptoms in rectal cancer patients after low anterior resection?

AIM: The aim of the study was to investigate whether bowel symptoms related to low anterior resection for rectal cancer can be sufficiently well evaluated by the Low Anterior Resection Syndrome (LARS) questionnaire score or the ColoRectal Functional Outcome (COREFO) questionnaire compared with a stool diary. METHOD: All patients underwent low anterior resection for rectal cancer. They were asked to fill out a stool diary, the LARS questionnaire and the COREFO questionnaire, at 1, 4, 6 and 12 months after low anterior resection or stoma closure. The main outcome measure was the amount of association (calculated by means of canonical correlation analysis) between items on anal incontinence for faeces, frequency of bowel movements, clustering of bowel movements, urgency and soiling. RESULTS: Ninety-five patients were included. Items on anal incontinence for faeces and frequency of bowel movements were significantly correlated between the LARS questionnaire or the COREFO questionnaire, versus the stool diary, respectively. Items on soiling were significantly correlated between the COREFO questionnaire and the stool diary. CONCLUSION: Although the LARS questionnaire and the COREFO questionnaire are reliable and valid for measuring low anterior resection syndrome after rectal cancer, our results show that there are no strong associations with the stool diary. Therefore, we can conclude that there is additional clinical information to be obtained from the stool diary. In order to evaluate all aspects of low anterior resection syndrome, we suggest the addition of a stool diary or a combination of different measurement methods during patient follow-up.

Physical Activity Levels of Breast Cancer Patients Before Diagnosis Compared to a Reference Population: A Cross-Sectional Comparative Study.

PURPOSE: We hypothesize that prediagnosis physical activity (PA) levels of breast cancer patients are below those of a reference population without breast cancer. Therefore, the aim of the present study was to compare prediagnosis PA levels (including total-, occupational-, sport- and household activity levels) of breast cancer patients with activity levels of a reference population. METHODS: Female patients with primary breast cancer (n = 265) filled in the Flemish Physical Activity Computerized Questionnaire (FPACQ) the day before surgery recalling the year before diagnosis. PA levels were expressed as Metabolic Equivalent Task (MET) values. Smooth reference curves of PA levels were estimated in a representative sample of 3466 women without breast cancer with the LMS method, which allowed comparison of prediagnosis PA data of the breast cancer sample with this reference. RESULTS: Compared to women without breast cancer, total PA levels were significantly lower in the year prior to breast cancer diagnosis over all age groups (Mean ± SD z-scores (95% CI) = -1.51 ± 1.86 (-1.74 to -1.29)). More specifically, household PA levels of breast cancer patients were significantly lower between ages 40-60, while occupational PA levels were significantly higher in this age group. No differences were found between sports PA levels. CONCLUSIONS: Patients with breast cancer show significantly lower total PA levels during the year prior to surgery compared to a reference population. Especially household activity levels are lower in patients between ages 40 and 60. Given this, a return to prediagnosis PA levels may not be sufficient for protection from disease in the future.

Cognitions and physical impairments in relation to upper limb function in women with pain and myofascial dysfunctions in the late stage after breast cancer surgery: an exploratory cross-sectional study.

PURPOSE: Upper limb (UL) function is one of the health outcomes that matters the most for women with breast cancer. However, a better understanding of the factors contributing to UL dysfunctions in the late stage after breast cancer surgery is needed. This study explores associations between impairment-related and cognition-related factors and UL function in women with pain and myofascial dysfunctions at the affected UL region in this late stage after breast cancer surgery. METHODS: In forty-one women, UL function (dependent variable) was evaluated by the Disabilities of Arm, Shoulder and Hand questionnaire. As independent impairment-related factors, relative excessive arm volume (perimetry), pain intensity (maximum score on the visual analogue scale past week) and humerothoracic elevation and scapular lateral rotation (kinematic analysis) were assessed. As independent cognition-related factors, pain catastrophizing (Pain Catastrophizing Scale) and pain hypervigilance (Pain Vigilance and Awareness Questionnaire) were evaluated. Bi-variable analyses and a stepwise regression analysis were used to explore associations. RESULTS: A higher pain intensity (r = 0.52; p < 0.001), more pain catastrophizing (r = 0.49; p < 0.001) and more pain hypervigilance (r = 0.40; p = 0.01) were related to more UL dysfunction. Pain intensity (p = 0.029) and pain catastrophizing (p = 0.027) explained furthermore 29.9% of variance in UL function. CONCLUSIONS: Pain intensity and cognition-related factors are significantly associated with UL function in women with pain and myofascial dysfunctions, indicating the need of assessing pain beliefs in women in the late stage after breast cancer surgery.IMPLICATIONS FOR REHABILITATIONPain intensity and pain-related beliefs, including pain attention and catastrophizing, are related to the severity of upper limb dysfunctions in the late stage after breast cancer surgery.Impairments such as lymphedema and movement restrictions seem not related to upper limb function in the assessed sample.To understand upper limb dysfunctions in the late stage after breast cancer, assessing pain beliefs is needed.

The ICC Compression Questionnaire: A Comprehensive Tool to Evaluate Compression Materials or Devices Applied in Subjects with Lymphedema or Chronic Venous Disease.

Background: Compression therapy is an important part of the treatment of patients with lymphedema or chronic venous disease. However, there is no validated questionnaire evaluating the effect of compression and its acceptance by the patient. Therefore, the aims of this study were to construct a questionnaire evaluating the effect of compression and its acceptance by the patient, that is, the Dutch ICC Compression Questionnaire (ICC-CQ), to investigate its reliability and validity, and to translate it into English. Methods and Results: Eleven experts in applying compression and 51 Dutch patients with experience of using compression were involved in the construction process. One part of the ICC-CQ has to be completed by the patient and evaluates seven domains. The other part has to be completed by the health care provider and comprises three domains. Reliability and validity of the final version was investigated in a new group of 79 Dutch-speaking patients with lymphedema or chronic venous disease, wearing compression garments (N = 52) or bandages (N = 27). Except for one domain, the Intraclass Correlation Coefficients for test-rest/interrater reliability ranged from 0.55 to 0.93. Cronbach's alpha for internal consistency ranged from 0.71 to 0.97. Eighty-nine percent of the patients fully understood the questionnaire indicating good face validity, and 87% found it complete indicating good content validity. Construct validity was considered good since 10 out of 11 hypotheses were accepted. Conclusion: The ICC-CQ is the first reliable and valid questionnaire evaluating different kinds of compression and the experience by patients with lymphedema or chronic venous disease.

Can the CutiScan CS 100® measure anisotropy and viscoelasticity in scar tissue after mastectomy? A reliability and validity study.

BACKGROUND: Scars have different biomechanical characteristics, including anisotropy and viscoelasticity compared to healthy skin. To assess these characteristics, the CutiScan CS 100® can be used. The aim of the present study is to investigate reliability and validity of this device in breast cancer patients. MATERIALS AND METHODS: Thirty female patients, with scar adhesions following mastectomy were assessed with the CutiScan CS 100® . Maximal distensibility (pixels) (V1), after-suction return rate (pixels) (V2), and their ratio (%) (V3) at three points on and around the scar were assessed as measures of viscoelasticity. For intra- and interrater reliabilities, the intra-class correlation coefficient (ICC) and its 95% confidence intervals were calculated. The standard error of measurement (SEM) was calculated to interpret reproducibility of these measurements. To investigate criterion validity of the measurement of anisotropy, measurements in the direction of healthy skin were compared with measurements in the direction of the scar, using a paired t-test. RESULTS: V1, V2, and V3 show poor to moderate intrarater reliability (ICC 0.00-0.72) and interrater reliability (ICC 0.00-0.53). The maximum displacement (V1) on the measurement point above the scar shows the best reliability (ICC 0.33-0.72). The SEM is about the same for all parameters at all three points. The paired sample t-test showed a significant difference (p < 0.05) between V1 in the direction towards the scar versus the measurement towards healthy tissue, on the point below the scar. CONCLUSION: These first reliability and validity results of the CutiScan CS 100® for measuring anisotropy and viscoelasticity in scar tissue adhesions after mastectomy seem promising. Further research is needed addressing the limitations of the present study design.

Physical activity levels after low anterior resection for rectal cancer: one-year follow-up.

BACKGROUND: Overall survival rates after rectal cancer have increased. Therefore, functional outcomes rightly deserve more interest. The aims of this study were to assess progression in total, sports, occupational and household physical activity levels of rectal cancer survivors, from preoperatively to 12 months after surgery/stoma closure and to explore predictive factors. METHODS: Multi-center prospective study with 125 patients who underwent low anterior resection for rectal cancer. The Flemish Physical Activity Computerized Questionnaire was completed concerning all physical activity levels at baseline (past preoperative year) and at 1, 4, 6 and 12 months after surgery/stoma closure. At these timepoints, questionnaires (LARS-/ COREFO-questionnaire) regarding bowel symptoms were also filled out. Results were analyzed using linear mixed models for repeated measures. RESULTS: Total physical activity levels up to 12 months remained significantly lower than preoperative. Occupational and sports physical activity levels remained significantly lower until 6 and 4 months postoperative, respectively. Predictive factors for decreased physical activity levels at a specific timepoint were: younger age and no stoma (total physical activity, 1 month), low/mid rectal tumor, no stoma, non-employed status (total, 4 months), higher COREFO-scores (occupational, 4 months) and non-employed status (total, 12 months). At all timepoints, lower COREFO-scores were associated with higher total physical activity levels; male gender and lower educational levels with higher occupational levels; younger age, normal BMI, employed status and adjuvant therapy with higher sports levels; and female gender, lower educational level and unemployed status with higher household levels. CONCLUSIONS: One year after rectal cancer treatment, total physical activity levels were still not recovered. Rectal cancer patients, especially those at risk for decreased physical activity levels and with major bowel complaints, should be identified and guided to increase their activities. TRIAL REGISTRATION: This trial has been registered at Netherlands Trial Register ( NTR6383 , 23/01/2017).

Effectiveness of perioperative pain science education on pain, psychological factors and physical functioning: A systematic review.

OBJECTIVE: To synthesize the evidence on the effectiveness of pain science education on pain, psychological factors and physical functioning in adults who underwent surgery. DATA SOURCES: A systematic literature search of English articles using PubMed/Medline, Embase, Web of Science Core Collection, and Cochrane Library. REVIEW METHODS: The search strategy was constructed as follows: (((pain) AND (education)) OR (pain education)) AND (surgery). Only controlled quantitative studies in adults reporting outcome(s) on pain, psychological factors and/or physical functioning were included. Risk of bias was assessed using the Cochrane risk of bias tools. P-values and corresponding effect sizes for interaction-effect (time × group) portrayed the difference in change over time between groups were of interest. The last search was conducted on February 28, 2021. RESULTS: Nine papers (n = 1078) were deemed eligible for this review. Two randomized controlled trials showed significant interaction effects. Breast cancer patients who had received one preoperative pain science education session showed a significant increase in postoperative pain compared to controls (P-value = 0.0394). Furthermore, psychological factors (pain catastrophizing and kinesiophobia) decreased in participants who had received pain science education before total knee arthroplasty, while this was not the case in the control group (P-value < 0.001, ƞ2p:0.11). CONCLUSIONS: Overall, pain science education did not result in any significant postoperative effects on pain, psychological factors and/or physical functioning compared to controls. There is currently no strong evidence for the implementation of pain science education in the perioperative period.Registration number: PROSPERO: ID 161267, registration number CRD42020161267.

Body perception disturbances in women with pregnancy-related lumbopelvic pain and their role in the persistence of pain postpartum.

BACKGROUND: Lumbopelvic pain (LPP) is common during pregnancy and can have long-lasting negative consequences in terms of disability and reduced quality of life. Therefore, it is crucial to identify women at risk of having pregnancy-related LPP after childbirth. This study aimed to investigate the association between body perception, pain intensity, and disability in women with pregnancy-related LPP during late pregnancy and postpartum, and to study whether a disturbed body perception during late pregnancy predicted having postpartum LPP. METHODS: A prospective cohort study in 130 primiparous women (median age = 30 years) was performed. Pain intensity, disability, and lumbopelvic body perception during the last month of pregnancy and 6 weeks postpartum were assessed with the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, and Fremantle Back Awareness Questionnaire, respectively. Having pregnancy-related LPP was defined as an NPRS score ≥ 1/10. At both timepoints, women were categorized into three groups; pain-free, LPP with low disability, and LPP with high disability (based on Oswestry Disability Index scores). At each timepoint, body perception was compared between groups, and correlations between body perception, pain intensity, and disability were evaluated in women with LPP by using non-parametric tests. Logistic regression analysis was used to determine whether body perception during the last month of pregnancy predicted the presence of LPP 6 weeks postpartum. RESULTS: Women with LPP at the end of pregnancy, and 6 weeks postpartum reported a more disturbed body perception compared to pain-free women (p ≤ 0.005). Greater body perception disturbance correlated with higher pain intensity (σ = 0.266, p = 0.008) and disability (σ = 0.472, p < 0.001) during late pregnancy, and with pain intensity 6 weeks postpartum (σ = 0.403, p = 0.015). A disturbed body perception during late pregnancy nearly significantly predicted having postpartum LPP (Odds Ratio = 1.231, p = 0.052). CONCLUSIONS: Body perception disturbance was greater in women experiencing LPP during late pregnancy and postpartum compared to pain-free women, and correlated with pain intensity and disability. Though non-significant (p = 0.052), the results of the regression analysis suggest that greater body perception disturbance during late pregnancy might predict having LPP postpartum. However, future studies should follow up on this.

Randomised controlled trial to assess efficacy of pelvic floor muscle training on bowel symptoms after low anterior resection for rectal cancer: study protocol.

INTRODUCTION: Radical surgery after a total mesorectal excision (TME) for rectal cancer often results in a significant decrease in the patient's quality of life, due to functional problems such as bowel, urinary and sexual dysfunction. The effect of pelvic floor muscle training (PFMT) on these symptoms has been scarcely investigated. We hypothesise that the proportion of successful patients will be significantly higher in the intervention group, receiving 12 weeks of PFMT, compared with the control group without treatment. The primary outcome of this trial is the severity of bowel symptoms, measured through the Low Anterior Resection Syndrome questionnaire, 4 months after TME or stoma closure. Secondary outcomes are related to other bowel and urinary symptoms, sexual function, physical activity and quality of life. METHODS AND ANALYSIS: This research protocol describes a multicentre single blind prospective, randomised controlled trial. Since January 2017, patients treated for rectal cancer (n=120) are recruited after TME in three Belgian centres. One month following surgery or, in case of a temporary ileostomy, 1 month after stoma closure, patients are randomly assigned to the intervention group (n=60) or to the control group (n=60). The assessments concern the preoperative period and 1, 4, 6, 12 and 24 months postoperatively. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the local Ethical Committee of the University Hospitals Leuven (s59761) and positive advice from the others centres has been obtained. Dissemination of the results will be accomplished via guidelines and (non-)scientific literature for professionals as well as organisation of patient symposia. TRIAL REGISTRATION NUMBER: NTR6383.

The effectiveness of Botulinum Toxin A for treatment of upper limb impairments and dysfunctions in breast cancer survivors: A randomised controlled trial.

OBJECTIVE: To examine the effectiveness of a single Botulinum Toxin A (BTX-A) infiltration in the pectoralis major muscle, in addition to a standard physical therapy (PT) programme on upper limb impairments and dysfunctions after breast cancer treatment. METHODS: Fifty breast cancer patients with persistent pain 3 months after finishing treatment participated in a double-blinded randomised controlled trial. The intervention group received a single BTX-A infiltration. The control group received a placebo (saline) infiltration. Within one week after the infiltration, all patients attended an individual PT programme (12 sessions) during the first 3 months. Outcome parameters were active shoulder range of motion, upper limb strength, scapular statics and shoulder function. Measures were taken before the intervention, at 1, 3 (i.e. after the intervention) and 6 months follow-up. RESULTS: No differences between groups were found for all outcome parameters over the course of 6 months. However, overall beneficial effects of the PT for active forward flexion shoulder range of motion and shoulder function were found in both groups. CONCLUSION: A single Botulinum Toxin A (BTX-A) infiltration in the pectoralis major muscle, in addition to a PT programme cannot be recommended to treat upper limb impairments and dysfunctions after breast cancer treatment.

Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial.

QUESTION: What are the short-term and long-term preventive effects of manual lymph drainage (MLD), when used in addition to information and exercise therapy, on the development of lymphoedema after axillary dissection for breast cancer? DESIGN: Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Adults undergoing unilateral dissection for breast cancer were recruited, with 79 allocated to the experimental group and 81 to the control group. INTERVENTION: The experimental group received guidelines about prevention of lymphoedema, exercise therapy and MLD. The control group received the same guidelines and exercise therapy, but no MLD. The interventions in both groups were delivered for 6 months. OUTCOME MEASURES: The primary outcome was cumulative incidence of arm lymphoedema defined in four ways (≥200ml,≥2cm,≥5%, and≥10% increase), which represent the difference in arm volume or circumference between the affected and healthy sides compared with the difference before surgery. Secondary outcomes included point prevalence of lymphoedema, change in arm volume difference, shoulder range of movement, quality of life and function. RESULTS: Incidence rates were comparable between experimental and control groups at all follow-up measurements. Sixty months after surgery, the cumulative incidence rate for the≥200ml definition was 35% for the experimental group versus 29% for the control group (RR 0.89, 95% CI 0.51 to 1.54, p=0.45); for the≥2cm definition 35% versus 38% (RR 0.93, 95% CI 0.59 to 1.45, p=0.73); for the≥5% definition 68% versus 53% (RR 1.28, 95% CI 0.97 to 1.69, p=0.08) and for the≥10% definition 28% versus 24% (RR 1.18, 95% CI 0.66 to 2.10, p=0.57). The secondary outcomes were comparable between the groups at most assessment points. CONCLUSION: Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the short and long term. TRIAL REGISTRATION: Netherlands Trial Register NTR 1055. [Devoogdt N, Geraerts I, Van Kampen M, De Vrieze T, Vos L, Neven P, Vergote I, Christiaens M-R, Thomis S, De Groef A (2018) Manual lymph drainage may not have a preventive effect on the development of breast cancer-related lymphoedema in the long term: a randomised trial. Journal of Physiotherapy 64: 245-254].

Unraveling Self-Reported Signs of Central Sensitization in Breast Cancer Survivors with Upper Limb Pain: Prevalence Rate and Contributing Factors.

BACKGROUND: Hypersensitivity of the central nervous system to environmental and chemical stimuli is a clinical feature of central sensitization mechanisms that can be assessed with the central sensitization inventory (CSI). OBJECTIVE: The aim was to determine prevalence rate of this feature and explore the treatment-, patient-, pain-, and psychosocial-related variables associated with the degree of self-reported signs of central sensitization, assessed with the CSI (0-100), in breast cancer survivors at long-term. STUDY DESIGN: Cross-sectional study. SETTING: University Hospitals, Leuven, Belgium. METHODS: One hundred and forty-six women with persistent pain, more than one year after breast cancer surgery, were included. The following factors were analyzed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy, and trastuzumab); 2) patient's related variables (age and body mass index); 3) pain-related variables (pain intensity, pain quality, primary hyperalgesia, and index of widespread pain); and 4) psychosocial variables (the degree of pain catastrophizing and vigilance and awareness to pain). The dependent variable was degree of central sensitization measured with the CSI. Additionally, a stepwise regression was performed. RESULTS: Fifty-five (38%) patients reported signs of central sensitization measured with the CSI (i.e., > 40/100). From multivariable analysis, it appears that more severe pain quality and higher levels of pain catastrophizing contribute to a higher degree of central sensitization. The stepwise regression revealed that up to 24% of variance of the CSI can be explained by these factors. LIMITATIONS: A selection bias may be present since patients were all recruited from a larger cohort participating in clinical trials on the effectiveness of physical therapy after breast cancer treatment. CONCLUSION: Signs of central sensitization cannot be neglected in breast cancer survivors at long term. More severe pain quality and pain catastrophizing contribute to higher levels of central sensitization in this population. KEY WORDS: Breast neoplasm, pain, central sensitization mechanisms, central sensitization inventory.

Physical activity levels after treatment for breast cancer: Two-year follow-up.

OBJECTIVES: Breast cancer treatment can have a considerable large and prolonged impact on activity levels of breast cancer survivors. Therefore, the aim of the present study was to investigate the change in total physical activity level and occupational, sport and household activity levels of breast cancer survivors from preoperatively up to 24 months after breast cancer surgery. Additionally, predictive factors for this change were investigated. METHODS: Patients with primary breast cancer (n = 267) filled in the Flemish Physical Activity Computerized Questionnaire (FPACQ) before surgery and 1, 3, 6, 12 and 24 months after surgery. Patient-, disease- and treatment-related factors were analyzed as predictive factors for change in physical activity. RESULTS: Two years after surgery, all activity levels (total, occupational, sport and household) were still significantly lower compared to preoperative values. After the first 12 months, no significant improvements were seen for none of the activity levels, except for the occupational activity. CONCLUSIONS: Two years after breast cancer surgery, physical activity levels are still significantly lower compared to pre-operative values. Based on this limited recovery, it seems important to monitor physical activity levels in breast cancer patients and advice these patients to stay active after surgery and return to pre-operative activity levels in the long term as well. This study indicates the importance of long term monitoring and subsequently coaching of physical activity after breast cancer surgery.

Identification of Myofascial Trigger Points in Breast Cancer Survivors with Upper Limb Pain: Interrater Reliability.

Objective: Despite the increasing awareness of the contribution of myofascial dysfunctions to upper limb pain in breast cancer survivors, reliability of the identification of myofascial trigger points (MTPs) in this population has not yet been investigated. Therefore, the aim of the present study was to investigate the interrater reliability of the identification of MTPs by palpation at the upper limb region in breast cancer survivors with upper limb pain. Design: Interrater reliability study. Setting: University Hospitals Leuven, Belgium. Subjects: Thirty breast cancer survivors with pain at the upper limb region. Methods: Nine muscles (upper trapezius, levator scapulae, infraspinatus, supraspinatus, teres major and minor, subscapularis, pectoralis major, and scalene muscles) at the operated side were examined. The weighted kappa (WK) coefficient and Absolute Agreement with 95% confidence intervals were calculated. Results: Moderate agreement was found for all examined upper limb muscles (WK = 0.41-0.60), except for the trapezius muscle, for which the agreement was almost perfect (WK = 0.83), and the supraspinatus muscle (WK = 0.23), for which the agreement was only fair. Conclusions: For most muscles, moderate interrater reliability for the identification of MTPs by palpation in breast cancer survivors with upper limb pain was found. Therefore, we concluded that the identification of MTPs by palpation may add to the diagnosis of the myofascial pain syndrome in breast cancer survivors.