Cinar, N., Seckin, U., Keskin, D., Bodur, H., Bozkurt, B., & Cengiz, O. (2008). The effectiveness of early rehabilitation in patients with modified radical mastectomy. Cancer Nursing, 31(2), 160–165.

To evaluate the effects of the early onset rehabilitation program on shoulder mobility, functional capacity, lymphedema, and postoperative complications in patients who had modified radical mastectomy

Patients were randomly assigned to either the treatment group (n = 27) or home exercise program group (n = 30). In the treatment group, specific shoulder-hand-elbow range-of-motion exercises were performed under the supervision of a physiotherapist until the drains were out, then participants followed a physiotherapy program for eight weeks. In the home exercise program group, patients received a form that demonstrated how to perform the exercises by themselves after removal of the drains. Each exercise was taught by a physiotherapist until the exercise was performed properly. Both groups were informed about skin care and other issues that they should pay attention to during daily living activities. Each patient was assessed preoperatively and then postoperatively on the fifth day and one, three, and six months after by another physiotherapist who was blinded to the groups of the patients.

• The sample size consisted of 57 female patients with 27 in the intervention group and 30 in the comparison group.
• Patients were about 50 years of age.

The setting was a single site in Turkey that included inpatient and outpatient.

The study used a randomized controlled trial design.

• Circumferential measurements were used to assess lymphedema.
• Range of motion of the operation-side shoulder joint was measured by Myrin goniometry while the patients were sitting in a chair.
• A functional questionnaire was used.

There were statistically significant time-related changes in all range-of-motion measurements and functional questionnaire scores in both groups. The differences over time in flexion, abduction, and adduction movements were significantly better in the treatment group compared with the home exercise program group  (p < 0.01, p < 0.001, p < 0.005, respectively). The mean range of flexion and abduction returned to almost preoperative values more quickly in the treatment group compared with the home exercise program group. The recovery of upper-extremity functional questionnaire score was also significantly better in the treatment group compared with the home exercise program group  (p < 0.05). There was no statistically significant variance in circumferential difference between the groups.

Early rehabilitation started on the first postoperative day did not have an adverse effect on local infection, hematoma, and seroma formation and did not cause an increase in duration and amount of lymphatic drainage.

• The sample was small (N < 100).
• The follow-up time for the late effect of breast cancer treatment, lymphedema, was shorter (only six months).

Nurses and clinicians should remember to refer patients with breast cancer to a rehabilitation specialist. During the postoperative period, patients should be closely monitored to increase their adaptation and compliance to an early onset exercise program.