Online pain neuroscience education and graded exposure to movement in breast cancer survivors: protocol of a randomized controlled trial.

Introduction: Cancer-related chronic pain is an important sequelae that damages the quality of life of breast cancer survivors. Pain neuroscience education and graded exposure to movement are therapeutic tools that have been shown to be effective in the management of chronic pain in other populations. However, there are no previous studies that combine them after breast cancer. Objective: To evaluate the effectiveness of an online physiotherapy focused-person program which combines pain neuroscience education and graded exposure to movement for quality of life improvement in breast cancer survivors. Methodology: This protocol is a randomized controlled trial with a sample size of 40 breast cancer survivors with pain in the last 6 months. Participants will be allocated to the experimental or control group using a fixed size block randomization method. The evaluator and statistician will be blinded to participant allocation. Participants in the experimental group will receive a 12-week intervention based on pain neuroscience education and therapeutic yoga as a graded exposure to movement exercise; participants in the control group will continue with their usual cancer-related symptoms care. Both groups will receive an education booklet. The main outcome will be quality of life, measured by the Functional Assessment of Cancer Therapy - Breast (FACT-B+4); secondary, four outcomes related to pain experience (catastrophising, self-efficacy, kinesiophobia and fear-avoidance behaviors) will be also assessed. All variables will be assessed by two blinded evaluators at four timepoints. A mixed-model analyses of variance ANOVA (2 × 4) will be used to study the effects of the treatment on the dependent variables. All statistical tests will be performed considering a confidence interval of 95%. SPSS program will be used for the data analysis. Discussion: This research is expected to contribute to breast cancer rehabilitation field. The proposed intervention is also expected to improve self-care skills related to chronic pain and to empower women regarding the management of their symptoms and quality of life.Clinical trial registration: https://clinicaltrials.gov/, NCT04965909.

Yoga-based interventions may reduce anxiety symptoms in anxiety disorders and depression symptoms in depressive disorders: a systematic review with meta-analysis and meta-regression.

OBJECTIVE: To summarise the effect of mind-body exercises on anxiety and depression symptoms in adults with anxiety or depressive disorders. DESIGN: Systematic review with meta-analysis and meta-regression. DATA SOURCES: Five electronic databases were searched from inception to July 2022. Manual searches were conducted to explore clinical trial protocols, secondary analyses of clinical trials and related systematic reviews. ELIGIBILITY CRITERIA: Randomised clinical trials evaluating qigong, tai chi or yoga styles with anxiety or depression symptoms as the outcomes were included. No intervention, waitlist or active controls were considered as control groups. The risk of bias and the certainty of the evidence were assessed. Meta-analyses, meta-regressions and sensitivity analyses were performed. RESULTS: 23 studies, comprising 22 different samples (n=1420), were included. Overall, meta-analyses showed yoga interventions were superior to controls in reducing anxiety symptoms in anxiety disorders. Furthermore, yoga-based interventions decreased depression symptoms in depressive disorders after conducting sensitivity analyses. No differences between groups were found in the rest of the comparisons. However, the certainty of the evidence was judged as very low for all outcomes due to concerns of high risk of bias, indirectness of the evidence, inconsistency and imprecision of the results. In addition, there was marked heterogeneity among yoga-based interventions and self-reported tools used to evaluate the outcomes of interest. CONCLUSION: Although yoga-based interventions may help to improve mental health in adults diagnosed with anxiety or depressive disorders, methodological improvements are needed to advance the quality of clinical trials in this field. PROSPERO REGISTRATION NUMBER: CRD42022347673.

Mind-body practices for cancer-related symptoms management: an overview of systematic reviews including one hundred twenty-nine meta-analyses.

PURPOSE: Mind-body practices such as qigong, tai chi, or yoga combine physical movements, deep breathing, and meditation techniques aiming to improve how people self-care. Our purpose was to develop an overview of systematic reviews to summarize the available evidence on the effectiveness of mind-body practices for cancer-related symptoms management. METHODS: CINAHL, Embase, PsycINFO, PubMed, and the Cochrane Library were used to search systematic reviews with meta-analysis from inception until March 2022. Cancer-related symptoms such as fatigue, pain, psychological measures, and overall quality of life were chosen as outcomes of interest. The methodological quality of each systematic review was assessed using AMSTAR 2. Citation matrices were developed, and the corrected covered area was calculated to explore the potential primary study overlap. RESULTS: A total of 38 systematic reviews comprising 134 distinct primary studies and 129 separate meta-analyses were included. The items of AMSTAR 2 regarding the review protocol, the reasons to choose a specific research design, and the provision of a list of studies that justify their exclusion were scarcely performed. The primary study overlap was moderate for qigong trials and high for both tai chi and yoga trials. Mainly, we found that qigong showed promising effects to reduce fatigue. Tai chi produced positive effects in reducing anxiety. Yoga improved anxiety, depression, distress, stress, and overall quality of life. Finally, the effects of mind-body practices on pain were inconsistent. CONCLUSIONS: Qigong, tai chi, and yoga could be effective approaches to relief cancer-related symptoms in adults with different cancer diagnoses.

Translation, Cross-Cultural Adaptation and Validation of the Myofascial Adhesions for Patients after Breast Cancer (MAP-BC) Evaluation Tool: Spanish Version.

(1) Background: The Myofascial Adhesions for Patients after Breast Cancer (MAP-BC) evaluation tool is a quantitative measure for the evaluation of tissue adhesions in breast cancer patients. The aims of this study were to create a Spanish version of the MAP-BC and to test its convergent validity and responsiveness. (2) Methods: Translation and cross-cultural adaptation were performed in five phases according to international guidelines. For the analysis of the convergent validity and responsiveness, a sample of 77 patients after breast cancer surgery were analysed at two timepoints (T1: immediately after the stitches were taken out; T2: one month after surgery). The COSMIN (Consensus-based Standards for the selection of health status Measurement Instruments) guidelines and checklist were used to verify the whole adaptation and validation process. (3) Results: Translation and cross-cultural adaptation of the original English version resulted in an easily understandable Spanish version of the tool. A moderate convergent validity (r = 0.438) with the Patient and Observer Scar Assessment (POSAS) at T1 and a strong correlation at T2 (r = 0.816) were observed. A moderate standardised response mean (0.45) and effect size (0.63) were also observed. (4) Conclusions: The MAP-BC Spanish version is a useful tool that could be incorporated into the evaluation of scars and surrounding tissues in breast cancer patients. It has shown a moderate convergent validity and responsiveness.

Preliminary Study on the Effect of an Early Physical Therapy Intervention after Sentinel Lymph Node Biopsy: A Multicenter Non-Randomized Controlled Trial.

Selective sentinel lymph node biopsy (SLNB) represents a minimally invasive surgery in patients with breast cancer. The purpose of this study was to explore the possible effect of an early physiotherapy intervention for the recovery of the upper limb and the surgical scars after SLNB in comparison with usual care. A total of 40 patients were enrolled in either the control group (n = 20) or the experimental group (n = 20). The intervention group performed an early physiotherapy program based on functional exercises, scar manual therapy, and educational tips. The control group received usual care. Shoulder range of motion (ROM), grip strength, upper limb pain and disability (SPADI), scar recovery (POSAS), myofascial adhesions (MAP-BC), quality of life (EORTCQLA-BR-23) and the presence of axillary web syndrome (AWS) and lymphoedema were assessed at baseline and immediately after intervention. A follow-up period of 6 months was performed for lymphoedema surveillance. Between groups significant differences in favor of the intervention were found for ROM (r = 0.43), grip strength (r = 0.32), SPADI (d = 0.45), POSAS (d = 1.28), MAP-BC (d = 1.82) and EORTCQLQ-BR 23 general function subscale (d = 0.37) (p < 0.05 for all variables). Our results suggest that an early physical therapy program seems to be more effective than usual care in women after SLNB. However, results should be interpreted with caution and future randomized trial with a larger sample size is needed.

Early Physical Rehabilitation after Sentinel Lymph Node Biopsy in Breast Cancer: Is It Feasible and Safe?

The primary purpose of this research was to investigate the feasibility and safety of delivering an early supervised physical therapy intervention to women after sentinel lymph node biopsy (SLNB); furthermore, we aimed to provide explorative data on its effects. This was a single-site feasibility study. Pre- and post-evaluation was conducted from baseline to follow-up at 6 months. Primary outcomes were participant recruitment, participant retention, compliance with the intervention, and safety. Secondary outcomes were shoulder range of motion, handgrip strength, upper limb pain and disability, scar recovery, quality of life, and the incidence of axillary web syndrome (AWS) and/or lymphoedema. A total of 43 participants (mean age 55.37 years) completed the trial and the follow-up period. A total of 91% of women who met the inclusion criteria agreed to participate, and the adherence rate was 80%. No adverse events were reported. Incidence of AWS was 9.3%, and there was no incidence of lymphoedema at 6 months. Our results support that this intervention is feasible and safe. The results presented in this study also provide preliminary evidence for the use of a rehabilitation program as a supportive intervention after SLNB, but future research on effectiveness is needed.