Summary
Background
Upper limb impairments are common in women following surgery for breast cancer. Range
of movement (ROM) exercises are commonly prescribed, but the optimal timing to begin
these exercises is not clear. The aim of this systematic review and meta-analysis
was to evaluate the effectiveness of early ROM exercises (Early ROM) compared to delayed
ROM exercises (Delayed ROM) or usual care (UC) in reducing common complications in
women following breast cancer surgery
Methods
Cochrane Central Register of Controlled Trials, Pubmed, EMBASE, CINAHL, and PEDro
were searched from date of inception until the 15th of February 2021, to identify randomised controlled trials which compared Early ROM
to either Delayed ROM or UC in women following surgery for breast cancer. Outcomes
included shoulder range, wound outcomes and lymphoedema incidence. Risk of bias was
evaluated with the PEDro scale. Data analysis was conducted in R (version 3.6.0),
with a priori sensitivity analyses conducted for studies with low risk of bias and
published after the year 2000
Findings
Of the 703 articles retrieved, 20 trials (2442 participants) were eligible for inclusion.
There were few differences between groups in ROM, except for flexion ROM when more
recent evidence was considered. Total drainage time and haematoma incidence were significantly
higher in the Early ROM group compared to Delayed ROM (WMD 1·2 days [95%CI 0·7,1·7],
and RR 1·6 [95%CI 1·1,2·3], respectively). When considering more recent evidence,
there were no differences between groups for these outcomes. There were no differences
between groups in other wound outcomes. Lymphoedema incidence was higher in the Early
ROM group compared to Delayed ROM in the short-term only (RR 3·7 [95% CI 1·3;10·9]),
and there was no difference when compared to UC. The quality of evidence using the
GRADE approach was generally low to very low
Interpretation
This review found that when considering more contemporary evidence, the timing of
exercise may influence ROM, but not wound outcomes. Further research is recommended
to understand the effect on lymphoedema incidence
Funding
No funding was sought for this review
Registration
A protocol for this systematic review was posted on the Open Science Framework prior
to commencement (DOI: 10.17605/OSF.IO/Q5FHS).
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Article Info
Publication History
Accepted:
June 17,
2022
Received:
January 10,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc.
