title: Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals.
abstract: BACKGROUND
  Despite strides in early detection and management of breast cancer, the primary treatments for this disease continue to result in physical impairments for some of the nearly 3 million people diagnosed annually. Over the past decade, evidence-based clinical practice guidelines (CPGs) have been developed with goals of preventing and ameliorating these impairments. However, translation of these guidelines into clinical practice needs to be accelerated.
  
  
  METHODS
  Relevant health science databases (2001-2011) were searched to identify CPGs on breast cancer rehabilitation for the following impairments: upper extremity restrictions, lymphedema, pain, fatigue, chemotherapy-induced peripheral neuropathy, treatment-related cardiotoxicity, bone health, and weight management.
  
  
  RESULTS
  Recommendations from 19 relevant CPGs were first summarized by impairment within tables; commonalities across guidelines, within each impairment, were then synthesized within the article. The CPGs were rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II); wide variability was noted in rigor of development, clarity of presentation, and stakeholder involvement. The most rigorous and comprehensive of those rated was the adult cancer pain guideline from the Scottish Intercollegiate Guidelines Network.
  
  
  CONCLUSIONS
  Based on a large body of evidence published in recent years, including randomized trials and systematic reviews, there is an urgent need for updating the guidelines on upper extremity musculoskeletal impairments and lymphedema. Furthermore, additional research is needed to provide an evidence base for developing rehabilitation guidelines on management of other impairments identified in the prospective surveillance model, eg, arthralgia.
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada. susan.harris@ubc.ca
authors.forename: Susan R
authors.initials: SR
authors.lastname: Harris
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Campbell
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNeely
mesh_terms: D000328:Adult; D000368:Aged; D000570:American Cancer Society; D001943:Breast Neoplasms / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D003226:Congresses as Topic; D042241:Early Diagnosis; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology / Q000534:rehabilitation*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000534:rehabilitation*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome