title: Telehealth system: A randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors.
abstract: BACKGROUND
  The chronicity status of breast cancer survivors suggests a growing need for cancer rehabilitation. Currently, the use of technology is a promising strategy for providing support, as reflected in the emergence of research interest in Web-based interventions in cancer survivorship.
  
  
  METHODS
  A randomized controlled trial was conducted that included a total of 81 participants who had completed adjuvant therapy (except hormone treatment) for stage I to IIIA breast cancer. Participants were randomly assigned to an 8-week Internet-based, tailored exercise program (n = 40) or to a control group (n = 41).The instruments used at baseline, 8 weeks, and 6-month follow-up were the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and its breast cancer module, the Brief Pain Inventory, the handgrip dynamometer, the isometric abdominal test, the back dynamometer, the multiple sit-to-stand test, and the Piper Fatigue Scale.
  
  
  RESULTS
  After the intervention, the telerehabilitation group had significantly improved scores for global health status, physical, role, cognitive functioning, and arm symptoms (all P < .01) as well as pain severity (P = .001) and pain interference (P = .045) compared with the control group. Significant improvements also were observed favoring the telerehabilitation group for affected and nonaffected side handgrip (both P = .006), abdominal, back and lower body strength (all P < .01), and total fatigue (P < .001). These findings were maintained after 6 months of follow-up, except for role functioning, pain severity, and nonaffected side handgrip. Analysis was based on an intention-to-treat principle.
  
  
  CONCLUSIONS
  This program may improve adverse effects and maintain benefits in breast cancer survivors. The results of this study have encouraging implications for cancer care. Cancer 2016;122:3166-74. © 2016 American Cancer Society.
authors.affiliation: Granada Institute for Biomedical Research, University Hospital Complex of Granada/University of Granada, Granada, Spain. noeliagaliano@ugr.es.|Department of Physical Therapy, University of Granada, Granada, Spain. noeliagaliano@ugr.es.
authors.forename: Noelia
authors.initials: N
authors.lastname: Galiano-Castillo
authors.affiliation: Granada Institute for Biomedical Research, University Hospital Complex of Granada/University of Granada, Granada, Spain.|Department of Physical Therapy, University of Granada, Granada, Spain.|Mixed University Sport and Health Institute, Granada, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Cantarero-Villanueva
authors.affiliation: Granada Institute for Biomedical Research, University Hospital Complex of Granada/University of Granada, Granada, Spain.|Department of Physical Therapy, University of Granada, Granada, Spain.|Mixed University Sport and Health Institute, Granada, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Fernández-Lao
authors.affiliation: Department of Physical Therapy, University of Granada, Granada, Spain.|Department of Physical Medicine and Rehabilitation, University Hospital San Cecilio, Granada, Spain.
authors.forename: Angélica
authors.initials: A
authors.lastname: Ariza-García
authors.affiliation: Granada Institute for Biomedical Research, University Hospital Complex of Granada/University of Granada, Granada, Spain.|Mixed University Sport and Health Institute, Granada, Spain.|Department of Nursing, University of Granada, Granada, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Díaz-Rodríguez
authors.affiliation: Radiotherapy Breast Oncology Unit, University Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Del-Moral-Ávila
authors.affiliation: Granada Institute for Biomedical Research, University Hospital Complex of Granada/University of Granada, Granada, Spain.|Department of Physical Therapy, University of Granada, Granada, Spain.|Mixed University Sport and Health Institute, Granada, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Arroyo-Morales
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D016022:Case-Control Studies; D005081:Exercise Therapy; D005221:Fatigue / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D009367:Neoplasm Staging; D010147:Pain Measurement; D011379:Prognosis; D011788:Quality of Life; D017741:Survivors / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods*
keywords: Internet; breast cancer; e-health; exercise; telehealth; telerehabilitation