| 저자 |
Seung-Hwan Jung1*, Ju-Hyun Kim1, Dae-Won Gwak2, Jae-Gyeong Jeong1, Min-Gyu Lim2, Yang-Soo Lee1, Tae-Du Jung2, Eun-Hee Park2† |
Background
The latissimus dorsi (LD) flap, which leads to deteriorate upper limb functions and daily living activities, is one of breast reconstruction techniques in breast cancer survivors. Our previous study revealed functional disability of upper limb persisted over a year after surgery. In this study, we investigated individualized exercise program on upper limb after LD flap reconstruction to improve shoulder function and quality of life in breast cancer survivors.
Methods
Unilateral breast cancer patients whom were to be operated on mastectomy with immediately autologous LD flap reconstruction surgery from 2016 to 2019 were recruited. Patients with previous breast cancer surgery or other previous orthopedic shoulder problems were excluded. Total 56 patients were included and compared to the previous study, control group (n=31). We evaluated range of movement(ROM) in shoulder before the surgery(T0), after 2 weeks(T1), 6 weeks(T2), 3 months(T3), 6 months(T4) and 12 months(T5) from the surgery. Furthermore, we evaluated disability using Quick-disabilities of arm, shoulder and hand(DASH), and quality of life using 36-Item Short-Form Health Survey(SF-36) at T0, T3, T4, and T5. Our rehabilitation team educated individualized stretching and strengthening program (Fig. 1) in upper limb at each time points and encouraged them to perform exercises at home. All statistical analyses were performed using SPSS 23.0 (SPSS Inc., Chicago, IL, USA).
Results
There were no significant differences of clinical characteristics such as lymph node dissection, chemotherapy, radiotherapy or hormone therapy, ROM, DASH, SF-36 scores at T0 between two groups. For both of the group, all ROM in shoulder decreased at T1, while flexion and abduction significantly decreased compared to T0 (Fig. 2). There were significant increases in internal rotation at T1, T2, and T5 and external rotation at T1, T2, T3, T4 and T5 in the education group compared to the control group (P<0.05, Fig. 2).
There was significant differences in DASH scores and time interaction effects between two groups (F = 4.161, p = 0.017). However, in post hoc, the changes of DASH scores were not significantly different between two groups (Fig. 3). In addition, there were significant differences in physical role functioning scores of SF-36 and time interaction effects between two groups (F = 6.676, p = 0.002). In post hoc, the physical role functioning scores were elevated in the education group compared to the control group (t = -2.865, p = 0.006) at T3 (Fig. 4).
Conclusion
Our study showed that functional disability and range of motion impaired immediately at 2 weeks after surgery until 1 year after surgery. However, there were significant less impaired in flexion and abduction in the education group compared to the control group. The individualized exercise on upper limb after LD flap reconstruction would be effective to recover shoulder function and physical role function in daily life.
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Post LD flap reconstruction exercise education program.
Range of motion at four direction, † : There shows significant decrease in range of motion compared to preoperative measurement in both groups, p<0.05. * : significantly different in inter-group comparison, p<0.05.
(A) Quick DASH questionnaire. There shows significant improvement in DASH score compared to preoperative measurement in both groups, F = 4.161, p = 0.017. (B) Physical role functioning of SF-36 There shows significant improvement in DASH score compared to preoperative measurement in both groups, especially on T3 time points (p=0.006).
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