title: Effectiveness of postoperative physical therapy for upper-limb impairments after breast cancer treatment: a systematic review.
abstract: OBJECTIVE
  To systematically review the effectiveness of various postoperative physical therapy modalities and timing of physical therapy after treatment of breast cancer on pain and impaired range of motion (ROM) of the upper limb.
  
  
  METHODS
  We searched the following databases: PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, Physiotherapy Evidence Database, and Cochrane. Articles published until October 2012 were included.
  
  
  METHODS
  Only (pseudo) randomized controlled trials and nonrandomized experimental trials investigating the effectiveness of passive mobilization, manual stretching, myofascial therapy, and/or exercise therapy and timing of physical therapy after treatment for breast cancer are reviewed. Primary outcomes are pain of the upper limb and/or ROM of the shoulder. Secondary outcomes are decreased shoulder strength, arm lymphedema, limitations in activities of daily living, decreased quality of life, and wound drainage volume. Physical therapy modalities had to be started in the first 6 weeks after surgery.
  
  
  METHODS
  Articles were selected by 2 independent researchers in 3 phases and compared for consensus. First the titles were analyzed, and then the selected abstracts and finally the full texts were reviewed.
  
  
  RESULTS
  Eighteen randomized controlled trials were included in the review. Three studies investigated the effect of multifactorial therapy: 2 studies confirmed that the combination of general exercises and stretching is effective for the treatment of impaired ROM another study showed that passive mobilization combined with massage had no beneficial effects on pain and impaired ROM. Fifteen studies investigated the effectiveness of a single physical therapy modality. One study of poor quality found evidence supporting the beneficial effects of passive mobilization. The only study investigating the effect of stretching did not find any beneficial effects. No studies were found about the effectiveness of myofascial therapy in the postoperative phase. Five studies found that active exercises were more effective than no therapy or information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder ROM, whereas 4 studies supported the delay of exercises to avoid prolonged wound healing.
  
  
  CONCLUSIONS
  Multifactorial physical therapy (ie, stretching, exercises) and active exercises were effective to treat postoperative pain and impaired ROM after treatment for breast cancer. High-quality studies are necessary to determine the effectiveness of passive mobilization, stretching, and myofascial therapy as part of the multifactorial treatment. In addition, the appropriate timing and content of the exercise programs need to be further investigated.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Department of Rehabilitation Science and University Hospitals Leuven, University of Leuven, Leuven, Belgium. Electronic address: an.degroef@faber.kuleuven.be.
authors.forename: An
authors.initials: A
authors.lastname: De Groef
authors.affiliation: Department of Physical Medicine and Rehabilitation, Department of Rehabilitation Science and University Hospitals Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Marijke
authors.initials: M
authors.lastname: Van Kampen
authors.affiliation: Department of Physical Medicine and Rehabilitation, Department of Rehabilitation Science and University Hospitals Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Evi
authors.initials: E
authors.lastname: Dieltjens
authors.affiliation: Department of Surgery, Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium; Department of Surgical Oncology, University of Leuven, Leuven, Belgium.
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Christiaens
authors.affiliation: Department of Surgery, Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Neven
authors.affiliation: Department of Physical Medicine and Rehabilitation, Department of Rehabilitation Science and University Hospitals Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Geraerts
authors.affiliation: Department of Physical Medicine and Rehabilitation, Department of Rehabilitation Science and University Hospitals Leuven, University of Leuven, Leuven, Belgium.
authors.forename: Nele
authors.initials: N
authors.lastname: Devoogdt
mesh_terms: D001943:Breast Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010149:Postoperative Pain / Q000628:therapy; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Breast neoplasms; Physical therapy modalities; Rehabilitation; Shoulder pain