title: The effect of prospective monitoring and early physiotherapy intervention on arm morbidity following surgery for breast cancer: a pilot study.
abstract: OBJECTIVE
  Significant arm morbidity is reported following surgery for breast cancer, yet physiotherapy is not commonly part of usual care. This study compared the effect on arm morbidity after surgery for breast cancer of a clinical care pathway including preoperative education, prospective monitoring, and early physiotherapy (experimental group) to that of preoperative education alone (comparison group).
  
  
  METHODS
  A prospective quasi-experimental pretest-posttest, non-equivalent group design compared two clinical sites; Site A (n=41) received the experimental intervention, and Site B (n=31) received the comparison intervention. At baseline (preoperative) and 7 months postoperative, shoulder range of motion (ROM), upper-extremity (UE) strength, UE circumference, pain, UE function, and quality of life were assessed.
  
  
  RESULTS
  The experimental group maintained shoulder flexion ROM at 7 months, whereas the comparison group saw a decrease (mean 1° [SD 9°] vs. -6° [SD 15°], p=0.03). A lower incidence of arm morbidity and better quality of life were observed in the experimental group, but these findings were not statistically significant. Baseline characteristics and surgical approaches differed between the two sites, which may have had an impact on the findings.
  
  
  CONCLUSIONS
  Initial results are promising and support the feasibility of integrating a surveillance approach into follow-up care. This pilot study provides the foundation for a larger, more definitive trial.
authors.affiliation: Fraser Health Authority, Surrey, B.C.
authors.forename: Chiara
authors.initials: C
authors.lastname: Singh
authors.affiliation: Fraser Health Authority, Surrey, B.C.
authors.forename: Mary
authors.initials: M
authors.lastname: De Vera
authors.affiliation: Department of Physical Therapy, University of British Columbia, Vancouver B.C.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Campbell
keywords: breast neoplasms; lymphedema; muscle strength; range of motion; upper extremity