The Evidence-Based Research Of Early Functional Exercise Program For Postoperative Breast Cancer Patients

Background Breast cancer is one of the most common tumors in women.Surgery is the most important method for breast cancer patients,but various surgical methods,especially axillary lymph node dissection will destroy the lateral limb muscle tissue,blood circulation and lymphatic circulation,which in turn cause the arm and shoulder dysfunction,or even appear lymphedema,muscle stiffness,affecting the patients' daily life seriously.Early postoperative functional exercise plays an important role in reducing the incidence of postoperative complications.At present,there is no evidence-based early postoperative functional exercise program for breast cancer patients,which can provide scientific and standardized guidance for clinical staff and patients.Therefore,we should construct the evidence-based early postoperative functional exercise program for breast cancer patients.Objective To establish the initial construction of evidence-based “Early postoperative breast cancer functional exercise program”,we used in-depth analysis to know and evaluate the existing problems,experience and recommendations of clinical experts about the implementation of early postoperative functional exercise of breast cancer,the best evidence and related evidence-based resources,combined with two rounds of Delphi expert inquiry.Methods Semi-structured in-depth interviews were conducted to understand and analyze clinical experts' experiences and suggestions on early postoperative functional exercise in breast cancer.We also integrated systematic reviews,meta analysis and related evidence-based resources to get the best evidence to build the first draft of functional exercise program.Two rounds of Delphic expert inquiry method were adopted to revise the first draft plan and determine the early functional exercise program.Results1.Semi-structured personal in-depth interviews with 14 clinical specialists from breast surgery department and general surgery department at four tertiary hospitals in Anhui province.The results indicated that patients had deficient knowledge and negative attitude toward functional exercise.Medical staff' s views on functional exercise were not uniform and lacked evidence-based functional exercise.2.The Chinese and English databases were searched comprehensively and systematically,and strictly screening,extraction and quality evaluation of the literatures that met the inclusion criteria was carried out.Finally,14 randomized controlled trials were conducted,and the quality of the literatures were medium or above.The included literatures were categorized and meta-analyzed.Compared with late shoulder activity,early shoulder activity can improve shoulder mobility of patients partly,which can reduce the incidence of postoperative short-term lymphedema and increase the risk of subcutaneous fluid of breast cancer patients,but can not effect the incidence rate of skin flap necrosis,and the affect on the quality of life is still uncertain.The above results can provide strong evidence for construction of postoperative functional exercise programs.3.A comprehensive and systematic search of databases and guide websites wereintegrated into 4 guidelines,9 systematic reviews and 7 related evidence-based resources.According to the evidence recommended:(1)Early functional exercise should follow the principle step by step,under the guidance of professionals,especially nurses,combine the paper guidance materials for structural guidance.(2)Preoperative assessment should be carried out on both sides of the upper limb function(including limb joint mobility,arm circumference),1 to 2 days after surgery to keep the shoulder still,the fingers,wrists,elbow movements;(3)It is controversial that when to exercise shoulder activities,so professionals should weigh the pros and cons and according to the patients' situation(eg,drainage,wound healing,subcutaneous fluid,etc.)to guide them with shoulder joint activity carefully.If the patient has the effect factors of wound healing and drainage,we can postpone functional exercise a week(9 to 10 days after operation).During the period,we can instruct patients to exercise elbow flexion outreach,shoulder flexion abduction pronation,hair comb,wall climbing exercises,but do not carry shoulder activities across the head;When the drainage tube is removed,the intensity of the shoulder joint can be gradually increased after the wound healing,and the activity across the head can be carried out.(4)It is recommended that progressive functional exercise can be carried out under painless condition,from 3 min a time to5~10 min a time in the exercise of large joints(such as the shoulder joint),can be extended to 20~30 min a time,2 to 3 times a day.(5)The main evaluation indicators of functional exercise were range of motion,incidence of lymphedema,upper limb muscle strength,quality of life,pain and so on.4.Using two rounds of expert consultation,22 experts revised the draft of “early functional exercise program for postoperative breast cancer”.Conclusion Through qualitative research,best evidence integration and Delphi expert consultation,we constructed a scientific and standardized early postoperative functional exercise program for breast cancer including applicable objects,educators,evaluation indicators,functional exercise methods and frequency.The program is based on evidence and provides scientific guidance for clinical medical staff and patients.