title: Manual therapy associated with upper limb exercises vs. exercises alone for shoulder rehabilitation in postoperative breast cancer.
abstract: Our objective was to evaluate the effectiveness of manual therapy (MT) associated with upper limb (UL) exercises in women with impaired shoulder range of motion (ROM) after axillary lymph node dissection (ALND) for breast cancer. A randomized, prospective, blinded clinical trial with 131 women with a ROM  <-  100° for shoulder flexion and/or abduction on the first day postoperatively were evaluated. Sixty-six women were allocated to group exercises and 65 underwent the exercises followed by MT. Shoulder ROM was measured by goniometry, and function was evaluated by the Modified-University of California at Los Angeles Shoulder Rating Scale--the UCLA Scale, in the 1st, 6th, 12th, and 18th month after surgery. The chi-square test was used for the relationship between clinical characteristics and oncological treatment between groups, and ANOVA for repeat measures was used. No difference in recovery of shoulder ROM as well as UL function was observed between groups. Improvement in ROM was gradual from the 1st to the 18th month, and the function achieving a good classification at 18th month. MT associated with exercises did not enhance the results obtained with exercises alone for shoulder ROM and ipsilateral UL function.
authors: Department of Obstetrics and Gynecology-DObGyn, University of Campinas-UNICAMP School of Medicine-SM, Campinas, Brazil. maiteamaral@uol.com.br
authors: Maria Teresa
authors: MT
authors: Pace do Amaral
authors: Mariana Maia
authors: MM
authors: Freire de Oliveira
authors: Néville de Oliveira
authors: Nde O
authors: Ferreira
authors: Renata Vidigal
authors: RV
authors: Guimarães
authors: Luís Otávio
authors: LO
authors: Sarian
authors: Maria Salete Costa
authors: MS
authors: Gurgel
mesh_terms: D000328:Adult; D000368:Aged; D053587:Arthrometry, Articular; D001696:Biomechanical Phenomena; D001938:Brazil; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D026201:Musculoskeletal Manipulations; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome