Background and Objective
The limited range of motion (ROM) of the shoulder occur often after receiving breast cancer surgery, which may be due to post-operative pain, stiffness of shoulder girdle muscle, and etc. Due to limited ROM, the patients may suffer difficulty in activities of daily lives, and quality of life may be reduced. UINCARE Home® (Uincare Co.) is software manufactured in Korea, which uses infrared, kinect camera and motion capture technology to track 3D motion of the patients' articulation. Using this augmented reality (AR) technology, the patients are able to receive home-based exercise program with feedback of their motion. The objective of the study was to examine the effect of hospital-home linkage short-term rehabilitation therapy using real-time interactive digital healthcare system (UINCARE Home®) in post-operative patients with breast cancer.
Method
This was prospective pilot study, and 20 breast cancer patients who underwent wide local excision-axillary lymph node dissection (ALND) or modified radical mastectomy were recruited to receive home-based exercise program with UINCARE Home® for 12 weeks. Those with post-operative day not exceeding 8 weeks and those with limited ROM of the affected shoulder (flexion <160° or abduction <160°) were enrolled. Those with bilateral breast cancer surgery history, and those with underlying shoulder pain or limited ROM before the surgery were excluded. Those with communication difficulty and general deconditioning were also excluded. Enrolled patients were administered with home-based exercise program with UINCARE Home®.
Primary outcome of this study was the ROM of affected shoulder measured at enrollment, 4, 8, and 12 weeks after enrollment. Secondary outcome of this study was pain of affected shoulder measured with numerical rating scale (NRS), functional outcome (Quick-DASH), and quality of life (FACT-B and EQ-5D-5L Index), which were also measured at enrollment, 4, 8, and 12 weeks after enrollment.
Results
Total 18 patients were available for final analysis. The mean age was 45.1-year-old, and none of them suffered from diabetes or hypertension. 5 patients (27.7%) underwent ALND, and 9 patients (50%) received surgery at right arm. 8 patients (44.4%) received chemotherapy, and none received radiotherapy.
As for active ROM, forward flexion, abduction, internal rotation and external rotation showed significant improvement (Figure 1). As for passive ROM, all the measurements showed significant improvement except external rotation (Figure 1). NRS, Quick-DASH, FACT-B, EQ-5D-5L Index showed significant improvement from baseline to 12 weeks (Figure 2).
Conclusion
Home-base exercise program with AR system may improve limited ROM of affected shoulder in breast cancer patients. Further study comparing UINCARE Home® with conventional hands-on therapy with more participants is needed to clarify this result.
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Figure 1. Passive and Active Range of motion of Affected Shoulder from baseline to 12-weeks
Figure2. NRS, Quick-DASH, FACT-B, EQ-5D-5L Index from baseline to 12 weeks
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