| Objectives: To explore the effect of rehabilitation exercise program for postoperative patient with breast cancer-related lymphedema on the changes of arm circumference, lymphedema-related symptoms and symptoms distress and the quality of life. Methods: This study is a randomized control trial. Convenient sampling method was used to recruit 68 breast cancer-related lymphedema patients supposed to receive surgery treatment for lymphedema from December 2014 to January 2016. 32 patients were randomized as the intervention group while 36 patients were divided to the control group. 4 patients were ruled out which included one case of patients with upper limb activity obstacle, one case of patients with tumor metastasis, one case of patients change treatment, one case of patients quit midway of this study. Ultimately 64 patients were included in the study, and 31 patients were randomized to the intervention group while 33 patients were divided to the control group. Routine nursing care was given to all of the patients while patients in the intervention group took rehabilitation exercise program in addition. Assessments were carried out in 1 month, 3 months and 6 months after the surgery, including arm circumference measurement, lymphedema symptoms, symptom distress and quality of life. Results:1. Before intervention, the two groups in demographic data have no statistical significance including the age, degree of education, marital status, work status and payment(P>0.05). and the treatment of breast cancer including breast cancer operation?adjuvant therapy and so on also have no statistical significance(P>0.05). There are also no statistical significance between the two groups patients in the severity of lymphedema and the occurrence of erysipelas(P>0.05).2. No significant difference existed at the arm circumference difference between groups before intervention. But intervention group had a smaller arm circumference difference than control group at 1 month(0.42 vs-0.06, Z=-2.367, P=0.018), 3 months(0.36 vs-0.04, Z=-2.251, P=0.024) and 6 months(0.36 vs-0.21, Z=-2.233, P=0.026).3. For the breast cancer-related lymphedema symptoms experience, intervention group had significant more numbers of lymphedema related symptom score than the control group 3 months(10.62±6.40 vs 7.18±5.40, Z=-2.071, P=0.038) after surgery. Intervention group had significant lower score of severity than the control group both 3 months(12.00 vs 6.50, Z=-2.070, P=0.038) and 6 months after surgery(9.00 vs 5.00, Z=-1.977, P=0.046).About lymphedema related symptom distress, intervention group had significant lower score than the control group 6 months after surgery(13.00 vs 6.50, Z=-2.282, P=0.022). Intervention group had a lower score of ?function?(7.00 vs 2.00, Z=-2.342, P=0.019), ?society?(1.00 vs 0.00, Z=-2.878, P=0.004)and ?sleep?(0.00 vs 0.00, Z=-2.114, P=0.035)dimensions as well as a lower score of total symptom experience both 3 month(34.00 vs 16.5, Z=-2.164, P=0.030)and 6 month after surgery(23.00 vs 13.00,Z=-2.324,P=0.020).4. For the quality of life, intervention group had a higher score of the ?physical functioning? dimension before anastomosis(75.00 vs 85.00, Z=-2.059, P=0.040); intervention group had a higher score of the ?vitality? dimension 1 month after surgery(70.00 vs 82.50, Z=-2.084, P=0.037); Intervention group had a higher score of the ?physical functioning? dimension(73.52±15.18 vs 83.27±8.48, t=2.901, P=0.006),?general health? dimension(60.00±23.19 vs 72.73±19.35, t=-2.166, P=0.035), ?vitality? dimension(70.93±16.11 vs 81.00±11.73, t=2.560, P=0.014)and ?Role-Emotional? dimension(66.66 vs 100.00, Z=-2.476, P=0.013) 6 months after surgery; Patients in the intervention group showed greater improvements on total scores of the physiological(246.48±76.33 vs 290.85±69.65, t=2.208, P=0.032) and psychological(280.75±87.35 vs 332.44±60.39, t=-2.497, P=0.016). Conclusion: Providing rehabilitation exercise program for postoperative patients with breast cancer related lymphedema was effective to reduce the lymphedema-related symptoms, the number and severity of lymphedema related symptom, lymphedema related symptom distress, while it also showed a positive impact for improvement of quality of life. |
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