Scaffidi, M., Vulpiani, M.C., Vetrano, M., Conforti, F., Marchetti, M.R., Bonifacino, A., . . . Ferretti, A. (2012). Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. European Journal of Physical and Rehabilitation Medicine, 48, 601–611.

To clinically evaluate upper ipilateral limb function and the impact of certain post-surgical consequences arising after invasive or breast-conserving surgery for early breast cancer, by intervening, or not intervening, with an early rehabilitation program

Group A received reoperative information verbally; did not begin physiotherapy during hospitalization. Group B received preoperative information in written form; treated by a dedicated physiotherapist during hospitalization from the day following surgery until the hospital discharge. One physiotherapy session per day, with each session lasting for 30–40 minutes. The exercises were initially focused on deep breathing, relaxation, stretching of the neck muscles, and then on elevation, abduction, external and internal rotation of the shoulder, flexion and extension of the elbows in a neutral position. The patients were instructed on how to position their shoulder-arm in bed and how to carry out exercises at home after discharge. The patients were given an exhaustive brochure containing pictures and explanations of the exercises to carry out at home. All patients were assessed at 15–30, 60, and 180 days after surgery. 

SITE:  Single site  

SETTING TYPE:  Inpatient  

LOCATION: Rome, Italy

PHASE OF CARE: Transition phase after active treatment

Two-group cohort comparison

• Shoulder-arm mobility, upper limb function, presence of lymphedema, prescription of outpatient physiotherapy
• Constant and Murley Score for mobility
• Arm circumference measures

Although no differences were identified between two groups in the outcome assessment, statistically significant differences (p <  0.05), in favor of Group B, were encountered at the 180-day follow-up visit, including shoulder-arm mobility, upper limb function (p < 0.001), and presence of lymphedema (p = 0.036).

The early assisted mobilization (beginning on the first postoperative day) and home rehabilitation, in conjunction with written information on precautionary hygienic measures to observe, play a crucial role in reducing the occurrence of postoperative side-effects of the upper limb.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias(sample characteristics)
• Other limitations/explanation: limited follow-up duration, retrospective first follow-up visit in Group A

The study findings suggest that nurses should be aware of early rehabilitation (e.g., early assisted mobilization right after the surgery) and home exercises rehabilitation as well as written/educational information may play a critical role to prevent postoperative side-effects in patients with breast cancer. Studies with rigorous design are warranted to further evaluate the study intervention.