title: Multidisciplinary rehabilitation for follow-up of women treated for breast cancer.
abstract: BACKGROUND
  Breast cancer is the most common malignancy in women worldwide. Multidisciplinary rehabilitation aims to improve outcomes for women but the evidence base for its effectiveness is yet to be established.
  
  
  OBJECTIVE
  To assess the effects of organised multidisciplinary rehabilitation during follow-up in women treated for breast cancer.
  
  
  METHODS
  We searched the Cochrane Breast Cancer Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PEDro and LILACS in December 2011.
  
  
  METHODS
  Randomised and controlled clinical trials (RCTs, CCTs, respectively) that compared multidisciplinary rehabilitation with some form of control intervention (such as a lower level or different type of intervention, minimal intervention, waiting list controls or no treatment, interventions given in different settings).
  
  
  METHODS
  The type of data retrieved did not allow for quantitative synthesis and therefore a narrative synthesis was provided. The methodological quality of the included studies was evaluated by three authors using the risk of bias tool.
  
  
  RESULTS
  Two RCTs, including 262 participants, met the inclusion criteria. Both trials scored poorly for methodological quality. There was 'low level' evidence that multidisciplinary rehabilitation produced short-term gains at the levels of impairment (that is range of shoulder movement), psychosocial adjustment and quality of life after breast cancer treatment (up to 12 months). No evidence was available for the longer-term functional outcomes for caregivers or the cost effectiveness of these programmes. It was not possible to suggest the most appropriate frequency and duration of therapy or choice of one type of intervention over another.
  
  
  CONCLUSIONS
  There was 'low level' evidence that multidisciplinary rehabilitation can improve the outcomes of people with breast cancer in terms of functional ability, psychosocial adjustment and participation in social activities. There was no evidence available on functional gain at the level of activity. This review highlights the limitations of RCTs in rehabilitation settings and the need for high-quality trial-based research in this area. Regular evaluation and assessment of breast cancer survivors for rehabilitation is recommended.
authors.affiliation: Department of Rehabilitation Medicine, Royal Melbourne Hospital, Royal Park Campus, Melbourne, Australia. fary.khan@mh.org.au.
authors.forename: Fary
authors.initials: F
authors.lastname: Khan
authors.forename: Bhasker
authors.initials: B
authors.lastname: Amatya
authors.forename: Louisa
authors.initials: L
authors.lastname: Ng
authors.forename: Marina
authors.initials: M
authors.lastname: Demetrios
authors.forename: Nina Y
authors.initials: NY
authors.lastname: Zhang
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
mesh_terms: D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D056910:Republic of Korea; D012785:Shoulder Joint / Q000502:physiology