| Objective:This study investigated the muscular strength and reduction in function of upper limbs affected by breast cancer related-lymphedema(BCRL)and explored the effect of resistance training on the rehabilitation of these patients.Methods:This study was a randomized control trial.Sixty six patients with breast cancer-related lymphedema due to receive complex decongestive therapy(CDT)were recruited to the study in the lymphedema outpatient clinic of Jiangsu Cancer Hospital from December 2017 to February 2019.Thirty three patients were randomly allocated to the intervention group while the remaining 33 were placed in the control group,although 5 were found to be ineligible to participate.Finally,61 patients participated in the study,of which 30 were in the intervention group and 31 were in the control group.Both groups received complex decongestive therapy,exercising with multi-layer compression bandaging or wearing a pressure cuff.The control group received regular guidance in functional exercise,while patients in the intervention group undertook a 24-week program of progressive resistance training.Assessments were conducted at baseline and after 2,12 and 24 weeks,in which arm circumference,range of motion in the shoulder,grip strength were measured,patients being scored using the Quick-DASH outcome measure and adjusted Constant-Murley score.Results:1.Prior to intervention,the two groups were not significantly different in terms of demographic details(P>0.05),including age,BMI,cultural,marital or work status,salary,monthly average household income,place of residence,diagnosis,stage of cancer,premenstrual menopause,surgical procedure,postoperative complications,adjuvant treatment after breast cancer surgery,history of lymphedema,duration after breast cancer surgery to the development of lymphedema,whether the dominant hand was affected,whether grip strength was reduced,lymphedema contributor,vasculitis,axillary reticulum syndrome,the stage,progression and treatment of lymphedema.2.There was no significant difference in arm circumference between the two groups at baseline(control group vs intervention group=13.24:1±12.11 cm vs 12.82±7.06 cm,t=0.165,P?0.869).The mean difference in the circumference of the upper limbs gradually increased,differences that were statistically significant after 2,12 and 24 weeks(P=0.019,0.018 and 0.005,respectively).Differences in arm circumference between the two groups were compared using repeated measures analysis of variance at different time points.There was no interaction between the time and grouping factors(P=0.125).As time passed,arm circumference in the two groups gradually decreased,the greatest decline being at 2 weeks,beginning to rise at 12 weeks.After 24 weeks,arm circumference did not exceed that at baseline.Mean arm circumference in the intervention group was smaller in every case than those in the control group.3.A reduction in grip strength was observed in 47.0%of patients.There was no significant difference between the two groups in grip strength of the affected arm at baseline(control group vs intervention group=17.63±6.36 kg vs 17.1 9±6.92 kg,t=0.274,P=0.785).There was also no statistical difference in the unaffected arm(control vs intervention group?20.863±5.82 kg vs 20.72±6.85 kg,t?0.090,P?0.928).After 24 weeks,there was an interaction between the time and grouping factors.There was a statistical difference in the influence of grouping on the grip strength of the affected arm(F time × group?10.999,P<0.001),while there was no significant difference in grip in the unaffected hand(F time × group=2.597,P?0.062).4.There was no significant difference between the two groups at baseline in forward flexion of the arm(control vs intervention group=149.450° vs 15 1.3°),abduction(control vs intervention group=151.5° vs 152.3?)or extension(control vs intervention group?53.85° vs 53.3°).Repeated measures of analysis of variance were used to compare differences in the range of motion of the shoulder.There was no interaction between the time and grouping factors(P>0.05).As time passed,the range of flexion,and maximum abduction and extension improved gradually.5.There was no statistical difference in the adjusted Constant-Murley score between the two groups at baseline(control vs intervention group?65 vs 66,Z=-0.246,P?0.886)or after 24 weeks(control group vs intervention group?70 vs 72,Z?-0.960,P=0.337).Adjusted Constant-Murley scores of the two groups at 24 weeks were statistically different from those measured at baseline(P<0.0001).6.Quick-DASH scores of the two groups were not statistically different at baseline,and neither were the scores of the control group before and after treatment(P>0.05).Scores of the two groups at 24 weeks(control vs intervention group=35.88±21.58 vs 24.03±21.58,t?2.554,P=0.01 3)and the bef'ore-and-after scores in the intervention group were significantly different(before vs after scores=40.47±24.30 vs 24.03±21.58,t?5.872,P<0.001).Conclusions1.Breast cancer related-lymphedema patients exhibited reduced grip strength,with the strength in the affected arm clearly weaker than that of the unaffected hand.No abnormalities of shoulder joint motion in BCRL patients was found,while they exhibited moderate limb dysfunction.2.Resistance training was found to significantly enhance the muscular strength of the upper limbs,and the change in strength of the affected arm was greater than that of the unaffected side.Such training significantly improved upper limb function of patients and promoted rehabilitation of the affected arm without exacerbating the severity of lymphedema in patients,possibly maintaining the benefit of complex decongestion therapy to a certain extent. |
PDF Full Text Request