Best evidence based practice Physical Therapy for shoulder ... · Morbidity, Shoulder, Arm, Thoracic spine, Cervical spine, Axillary Web, Syndrome, Myofascial, Evidence Oncologiedagen

Best evidence based practice Physical

Therapy for shoulder mobility

dysfunction in breast cancer patients

or survivors

Systematische literatuurstudie

Best evidence based practice Physical

Therapy for shoulder mobility dysfunction in breast cancer patients or survivors

Wouter Hoelen MSc. Oncologie en Lymfologie en Manueel Therapie

– President Casley Smith International

– Therapeutisch Centrum de Berekuyl

– European College of Lymphoedema

– Voormalig voorzitter NVFL

Brenda Goedhart MSc. Oncologie en Lymfologie

– Alexander Monro Borstkankerziekenhuis

– Helen Dowling Instituut

– Medicort Fysiotherapie

– Pro Education- NCOI

– NVFL: Herontwikkeling BCPO en Domeinbeschrijving Oncologie Fysiotherapeut

Prof. Dr. J. Nijs , Prof. P. Van Wilgen, Prof. F. Struyf, Prof. Dr. M. Meeus

Oncologiedagen 2014 , the Netherlands

Inhoud

1. Achtergrond

2. Doel

3. Methode

4. Resultaten

5. Conclusie

6. Discussie


Achtergrond

Borstkanker: 29,6% (IKNL 2013)

Incidentie: vrouwen 1: 8 (IKNL 2013)

Overleving: 86% 5 jr (IKNL 2013)

Restklachten: 1: 3 (Devoogdt et al. 2010, Quilan et al.(50%) 2009, Ceville et al.

2007, Rutgers et al. 2014)

- Pijn (Devoogdt et al. 2003 , Hack et al. 1999) : Radboud, paininmotion Group

- Spierzwakte (Sato and Kuroda 2008 (8-35%))

- Lymfoedeem (Rutgers et al. 2014 AMAROS (40-15%))

- Afname mobiliteit (Devoogd, AMAROS, Sato and Kuroda 30-35%)


Subvragen?

Fysiotherapeut

Algemene mobiliteitbeperking:

- Oefenen en rekken

Oncologisch of oedeemfysiotherapeut:

Specifieke mobiliteitbeperking:

- Oefenen en rekken?

- Startmoment?

- Duur van FT interventie?


Doel

• Fysiotherapeuten

– Beleid fysiotherapeutische nazorg optimaliseren

– Preventie secundaire problematiek

• Verpleegkundigen

– Informeren incidentie arm-,schouderdysfunctie

– Inzicht in preventie secundaire problematiek

– Nazorg mogelijkheden


Methode

Databases: PubMed en Web of Knowledge (2000 -2013)

Filters: Human, English, RCT

MeSH: Breast neoplasms AND/OR Physical Therapy

Modalities AND/OR Exercises AND/OR Shoulder AND/OR

Range of Motion articular

KEY WORDS: Breast cancer, Physiotherapy, Treatment,

Morbidity, Shoulder, Arm, Thoracic spine, Cervical spine, Axillary

Web, Syndrome, Myofascial, Evidence


Methode


Inclusie: 323 studies

Exclusie titel en abstract: 292 studies

- Populatie

- Interventie

- Resultaten

- Taal

- Studie soort

- Publicatie datum

Volledige tekst evaluatie: 31 studies

- Interventie

- Resultaten

- Publicatie datum

Inclusie: 10 studies

Reasons:

Population

Intervention

Outcome

Language

No RCT

Resultaten


Studies

Items 1

2

3

4

5

6

7

8

9

10

PEDRO- score

Level of evidence

S. A. Lee et al, 2010

+ - + - + + - - + + 6/10 A2

O. Cho et al, 2006

+ - + - - - - - + + 4/10 B

M. T. Pace do Amaral et al, 2012

+ - + - - + - - + + 5/10 B

M. C. Lauridsen, et al, 2000

+ - - - - - - - + + 3/10 B

M. K. McClure et al, 2010

+ + - - - + - - + + 5/10 B

R. C. Box et al, 2002

+ - - - - + + - + - 4/10 B

C.H.G.Beurskens et al, 2007

+ + + - - + + - + + 7/10 B

l. Ferreira de Rezende et al, 2006

+ - + - - - - - + - 3/10 B

S. L. Kilbreath et al, 2012

+ + + - - + + + + + 8/10 B

T. S. Lee et al, 2007

+ + + - - + + + + + 8/10 B


Auteur, Year N PT intervention

Start

Intervention

Medical BrCa

R. C. Box et al,

2002

N=65

3month: IG= PMCP (MEx)

CG= I (Ex)

2 week PO

C.H.G.Beurskens

et al, 2007

N=30

3mnd: IG(9x)= MEx + M + I

CG= I (Ex)

2 week PO

l. Ferreira de

Rezende et al,

2006,

N=60

6wk: IG1= MEx. 40min.

IG2=Free Shoulder movements

48 hour PO

M. T. Pace do

Amaral et al,

2012

N=131

1month: IG1= MT + UL.MEx. 45min.

G2=MUL.Ex

3 days PO

S. L. Kilbreath et

al, 2012

N=160

8wk: IG= MEx + Pass.M + H

CG=I

4-6 week PO

T. S. Lee et al,

2007

N=61

6wk: IG= Pass.M + H

CG=I + control skin

2-3 week PO


Auteur, Year N PT intervention

Start Intervention

Medical BrCa

S. A. Lee et

al, 2010

N=32

8wk : IG1= ST MEx / IG2= General MEx

+40min + C + H

CG= Hist. I

After treatment

O. Cho et al,

2006

N=65

10wk: IG= REHAB prog. 90 min. MEx + P +

H

CG= -

After treatment

0-2 year PO

M. C.

Lauridsen,

et al, 2000

N=59

10wk: IG1= Group MEx + Swim

IG2.= Individ. Treatm. + MEx

1-4 year PO

M. K.

McClure et

al, 2010

N=32

5w: IG= MEx + 60min+ V+ F+ Ms + GD + H

3Months

CG= I

After treatment

Resultaten

Groep 1: 6 RCT’s

- 48 hrs - 6 wk PO

Groep 2: 4 RCT’s

• 6 wk - 4 jr PO


Resultaten groep 1

Casley-Smith International 2013 Netherlands congress

Auteur

Year

Measure 0-10wk 10-20wk 20-30wk 30-

260wk

Sign.

R. C. Box Myrin

Gonio

1mo

CG↑; Abd 0,05

3mo

IG↑

Abd 0,05

x

24mo

IG↑ Abd

0,01

IG↑

3+24mo

CG↑

1mo

C.H.G.

Beurskens

Dig.Inc.

3mo IG↑

Flx. 0.003 +

Abd. 0,005

6mo

IG↑;Flx. 0.007

+ Abd. 0.010

IG ↑

l. Ferreira

de Rezende

Gonio

4wk IG1↑; Flx 0,00391

Abd 0,0322

6wk IG1↑; Flx 0.0087 +

Ext 0.0447+Abd 0.0077 +

Extrot 0.0403

IG ↑

M. T. Pace

do Amaral

Gonio

x

x x

S. L.

Kilbreath

Dig. Inc. 8wk

IG↑; Flx 0,01 + Abd 0,05

6mo IG↑;

HExt 0,03 Abd

0,003

IG ↑

T. S. Lee Dig. Inc. x x

Resultaten groep 2


Auteur

Year

Measure Follow up

T0-10wk

10-20wk

20-

30wk

30-

260wk

Sign.

S. A. Lee

et al

Gonio

8wk

IG2↑; Abd 0,041 +

Introt 0,026 + HAbd

0,027

IG2 ↑

O. Cho

et al

Gonio 10wk

IG↑; Ext. 0,000 + Abd

0,011 + Extrot 0,006

Introt. 0,000

IG ↑

M. C.

Lauridsen

et al

Gonio

x

M. K.

McClure

et al

Gonio

x

3mo

IG↑;TotSH 0,034

+ Introt. 0,022

IG ↑

Uitdaging

Heterogeniteit studie samples

- ALND

- Mastectomie +/-

- Radiotherapie en/of

- Chemotherapie en/of

- Hormoontherapie

Heterogeniteit - Startmoment

- Inhoud

- Duur

- Follow up

Interventie groep versus interventie/controle groep


Conclusie

Groep 1

Start: 6 wk - 4 jr PO

Multidisciplinair FT;

REHAB programma + H

Duur: 8 wk, 1-2xwk

Groep 2

Start: 4 - 6 wk PO

Monodisciplinair FT;

Multiple Oef. + Passieve

mob + H

Duur: 8 wk, 1-2xwk


Dank voor uw aandacht!


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http://www.cancer.org/AboutUs/GlobalHealth/global-economic-cost-of-cancer-report












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Vragen?

Oncologiedagen 2014, the Netherlands

Discussie

• Vraagstelling: Best evidence based practice

Physical Therapy for shoulder mobility dysfunction

in breast cancer patients or survivors

• Conclusie en aanbeveling:

Verwijst u door of niet en waarom?


Documents

Best evidence based practice Physical Therapy for shoulder ... · Morbidity, Shoulder, Arm, Thoracic spine, Cervical spine, Axillary Web, Syndrome, Myofascial, Evidence Oncologiedagen