title: Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial.
abstract: OBJECTIVE
  To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer.
  
  
  METHODS
  Randomised, single blinded, clinical trial.
  
  
  METHODS
  University hospital in Alcalá de Henares, Madrid, Spain.
  
  
  METHODS
  120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007.
  
  
  METHODS
  The early physiotherapy group was treated by a physiotherapist with a physiotherapy programme including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only.
  
  
  METHODS
  Incidence of clinically significant secondary lymphoedema (>2 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm).
  
  
  RESULTS
  116 women completed the one year follow-up. Of these, 18 developed secondary lymphoedema (16%): 14 in the control group (25%) and four in the intervention group (7%). The difference was significant (P=0.01); risk ratio 0.28 (95% confidence interval 0.10 to 0.79). A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group (intervention/control, hazard ratio 0.26, 95% confidence interval 0.09 to 0.79).
  
  
  CONCLUSIONS
  Early physiotherapy could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes.
  
  
  BACKGROUND
  Current controlled trials ISRCTN95870846.
authors.affiliation: Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain. maria.torres@uah.es
authors.forename: María
authors.initials: M
authors.lastname: Torres Lacomba
authors.forename: María José
authors.initials: MJ
authors.lastname: Yuste Sánchez
authors.forename: Alvaro
authors.initials: A
authors.lastname: Zapico Goñi
authors.forename: David
authors.initials: D
authors.lastname: Prieto Merino
authors.forename: Orlando
authors.initials: O
authors.lastname: Mayoral del Moral
authors.forename: Ester
authors.initials: E
authors.lastname: Cerezo Téllez
authors.forename: Elena
authors.initials: E
authors.lastname: Minayo Mogollón
mesh_terms: D001132:Arm; D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000517:prevention & control*; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000517:prevention & control*; D016037:Single-Blind Method; D016896:Treatment Outcome