The Effect of a PNF Technique Program after Mastectomy on Lymphedema Patients’ Depression and Anxiety
Identifieur interne : 004118 ( Pmc/Corpus ); précédent : 004117; suivant : 004119The Effect of a PNF Technique Program after Mastectomy on Lymphedema Patients’ Depression and Anxiety
Auteurs : Kyungjin Ha ; Seungjun ChoiSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2014.
Abstract
[Purpose] This study was conducted to examine the effects of exercises applied with PNF techniques performed for 30 minutes per session, three times per week, after receipt of radiation therapy following mastectomy on depression and anxiety in patients diagnosed with lymphedema and to prepare basic data for creation of self-directed exercise programs for lymphedema patients that will enable them to perform exercises within the range of no pain. [Methods] The subjects of this study were 45 patients selected from among those diagnosed with breast cancer who showed lymphedema after anti-cancer therapy following mastectomy. [Results] The Beck depression score changed significantly during the five assessment periods however, there was no significant difference between the treatment groups. Post hoc analyses revealed that there was significant improvement in the Beck depression score from 4 weeks in all three groups. The interaction between group and time was also statistically significant. [Conclusion] In conclusion, PNF techniques helped to improve the depression and anxiety rates. Four weeks after the start of therapy, PNF techniques Depression and anxiety to create a greater degree of decline was on display.
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DOI: 10.1589/jpts.26.1065
PubMed: 25140098
PubMed Central: 4135199
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Effect of a PNF Technique Program after Mastectomy on Lymphedema
Patients’ Depression and Anxiety</title><author><name sortKey="Ha, Kyungjin" sort="Ha, Kyungjin" uniqKey="Ha K" first="Kyungjin" last="Ha">Kyungjin Ha</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Choi, Seungjun" sort="Choi, Seungjun" uniqKey="Choi S" first="Seungjun" last="Choi">Seungjun Choi</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25140098</idno><idno type="pmc">4135199</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135199</idno><idno type="RBID">PMC:4135199</idno><idno type="doi">10.1589/jpts.26.1065</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">004118</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004118</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Effect of a PNF Technique Program after Mastectomy on Lymphedema
Patients’ Depression and Anxiety</title><author><name sortKey="Ha, Kyungjin" sort="Ha, Kyungjin" uniqKey="Ha K" first="Kyungjin" last="Ha">Kyungjin Ha</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Choi, Seungjun" sort="Choi, Seungjun" uniqKey="Choi S" first="Seungjun" last="Choi">Seungjun Choi</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p> [Purpose] This study was conducted to examine the effects of exercises applied with PNF
techniques performed for 30 minutes per session, three times per week, after receipt of
radiation therapy following mastectomy on depression and anxiety in patients diagnosed
with lymphedema and to prepare basic data for creation of self-directed exercise programs
for lymphedema patients that will enable them to perform exercises within the range of no
pain. [Methods] The subjects of this study were 45 patients selected from among those
diagnosed with breast cancer who showed lymphedema after anti-cancer therapy following
mastectomy. [Results] The Beck depression score changed significantly during the five
assessment periods however, there was no significant difference between the treatment
groups. Post hoc analyses revealed that there was significant improvement in the Beck
depression score from 4 weeks in all three groups. The interaction between group and time
was also statistically significant. [Conclusion] In conclusion, PNF techniques helped to
improve the depression and anxiety rates. Four weeks after the start of therapy, PNF
techniques Depression and anxiety to create a greater degree of decline was on
display.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Fairey, As" uniqKey="Fairey A">AS Fairey</name></author><author><name sortKey="Courneya, Ks" uniqKey="Courneya K">KS Courneya</name></author><author><name sortKey="Field, Cj" uniqKey="Field C">CJ Field</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Markes, M" uniqKey="Markes M">M Markes</name></author><author><name sortKey="Brockow, T" uniqKey="Brockow T">T Brockow</name></author><author><name sortKey="Resch, Kl" uniqKey="Resch K">KL Resch</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Partridge, Ah" uniqKey="Partridge A">AH Partridge</name></author><author><name sortKey="Burstein, Hj" uniqKey="Burstein H">HJ Burstein</name></author><author><name sortKey="Winer, Ep" uniqKey="Winer E">EP Winer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Helgeson, Vs" uniqKey="Helgeson V">VS Helgeson</name></author><author><name sortKey="Cohen, S" uniqKey="Cohen S">S Cohen</name></author><author><name sortKey="Schulz, R" uniqKey="Schulz R">R Schulz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mckenzie, Dc" uniqKey="Mckenzie D">DC McKenzie</name></author><author><name sortKey="Kalda, Al" uniqKey="Kalda A">AL Kalda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Courneya, Ks" uniqKey="Courneya K">KS Courneya</name></author><author><name sortKey="Friedenreich, Cm" uniqKey="Friedenreich C">CM Friedenreich</name></author><author><name sortKey="Sela, Ra" uniqKey="Sela R">RA Sela</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chae, Yr" uniqKey="Chae Y">YR Chae</name></author><author><name sortKey="Choe, Ma" uniqKey="Choe M">MA Choe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hwang, Jh" uniqKey="Hwang J">JH Hwang</name></author><author><name sortKey="Chang, Hj" uniqKey="Chang H">HJ Chang</name></author><author><name sortKey="Shim, Yh" uniqKey="Shim Y">YH Shim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Yb" uniqKey="Kim Y">YB Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Prentice, We" uniqKey="Prentice W">WE Prentice</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Prentice, We" uniqKey="Prentice W">WE Prentice</name></author><author><name sortKey="Voight, Mi" uniqKey="Voight M">MI Voight</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yoo, Ys" uniqKey="Yoo Y">YS Yoo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shapiro, Cl" uniqKey="Shapiro C">CL Shapiro</name></author><author><name sortKey="Recht, A" uniqKey="Recht A">A Recht</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Segar, Ml" uniqKey="Segar M">ML Segar</name></author><author><name sortKey="Katch, Vl" uniqKey="Katch V">VL Katch</name></author><author><name sortKey="Roth, Rs" uniqKey="Roth R">RS Roth</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25140098</article-id><article-id pub-id-type="pmc">4135199</article-id><article-id pub-id-type="publisher-id">jpts-2013-530</article-id><article-id pub-id-type="doi">10.1589/jpts.26.1065</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>The Effect of a PNF Technique Program after Mastectomy on Lymphedema
Patients’ Depression and Anxiety</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ha</surname><given-names>Kyungjin</given-names></name><degrees>MS, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Choi</surname><given-names>Seungjun</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><aff id="aff1"><label>1)</label> College of Arts, School of Sports and Health, Kyungsung University, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Seungjun Choi, College of Arts, School of Sports and Health, Kyungsung
University: 309 Suyeong-ro, Nam-gu, Busan 608-736, Republic of Korea. (E-mail: <email xlink:href="choisj@ks.ac.kr">choisj@ks.ac.kr</email>)</corresp></author-notes><pub-date pub-type="epub"><day>30</day><month>7</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>7</month><year>2014</year></pub-date><volume>26</volume><issue>7</issue><fpage>1065</fpage><lpage>1067</lpage><history><date date-type="received"><day>26</day><month>11</month><year>2013</year></date><date date-type="accepted"><day>23</day><month>1</month><year>2014</year></date></history><permissions><copyright-statement>2014©by the Society of Physical Therapy Science</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p> [Purpose] This study was conducted to examine the effects of exercises applied with PNF
techniques performed for 30 minutes per session, three times per week, after receipt of
radiation therapy following mastectomy on depression and anxiety in patients diagnosed
with lymphedema and to prepare basic data for creation of self-directed exercise programs
for lymphedema patients that will enable them to perform exercises within the range of no
pain. [Methods] The subjects of this study were 45 patients selected from among those
diagnosed with breast cancer who showed lymphedema after anti-cancer therapy following
mastectomy. [Results] The Beck depression score changed significantly during the five
assessment periods however, there was no significant difference between the treatment
groups. Post hoc analyses revealed that there was significant improvement in the Beck
depression score from 4 weeks in all three groups. The interaction between group and time
was also statistically significant. [Conclusion] In conclusion, PNF techniques helped to
improve the depression and anxiety rates. Four weeks after the start of therapy, PNF
techniques Depression and anxiety to create a greater degree of decline was on
display.</p></abstract><kwd-group><title>Key words</title><kwd>Lymphedema</kwd><kwd>Depression</kwd><kwd>Anxiety</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>Recently, mastectomies have been most commonly performed in breast cancer patients. After
undergoing a mastectomy, the patients experience lymphedema and sensory changes due to
physical changes along with restriction of the range of motion of the shoulder joints and
upper extremity muscle weakening<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>.
Although treatments such as radiation therapy and anti-cancer therapy are implemented as a
prescription immediately after surgery to reduce recurrence and mortality, these treatments
are reported to greatly affect the quality of life of the patients due to their adverse
effects that cause physical changes<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>.
Radiation therapy and other anti-cancer therapies cause nerve lesions, lymphedema, muscle
pain, headache, weight gain, a sense of fatigue, cognitive disorders, and feelings of
anxiety and depression in patients<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>.</p><p>Concern over rehabilitation treatment and the quality of life after a mastectomy is
discussed as an important issue. Many studies have implemented rehabilitation programs to
resolve physical, emotional, and functional problems experienced after a mastectomy and
psychological issues appearing in return to society<xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>. In addition, rehabilitation of lymphedema patients is achieved
through exercise, which is regarded as the most effective method of restoring their physical
and psychological functions<xref rid="r5" ref-type="bibr">5</xref><sup>)</sup>.</p><p>A previous study reported that lymphedema patient groups that received exercise treatment
in combination with mental treatment showed significantly higher physical indexes and better
depression and anxiety conditions than groups that received only mental treatment and that
exercise performed by lymphedema patients consequently led to not only physical improvement
but also psychological improvement in terms of depression and anxiety<xref rid="r6" ref-type="bibr">6</xref><sup>)</sup>.</p><p>Existing exercise methods for mastectomy patients have been reported to increase the heart
rate by 60–80% through aerobic exercises, and physical changes have been reported<xref rid="r7" ref-type="bibr">7</xref><sup>)</sup>. These exercises were performed with a view
to increasing the patients’ range of joint motion, and many cases where these exercise
caused pain have been reported<xref rid="r8" ref-type="bibr">8</xref><sup>)</sup>.
Meanwhile, Proprioceptive Neuromuscular Facilitation (PNF) exercises, which are patient
self-exercise methods conducted through PNF techniques, require patients to move within
their ability to move without pain<xref rid="r9" ref-type="bibr">9</xref>, <xref rid="r10" ref-type="bibr">10</xref><sup>)</sup>, thereby enabling the patients to perform
exercises with relatively less pain. Therefore, PNF exercises are regarded as an important
element in reducing and preventing injuries due to exercise<xref rid="r9" ref-type="bibr">9</xref>,<xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r11" ref-type="bibr">11</xref><sup>)</sup>. Not many studies have been conducted on the effect of these
exercises within the range of no pain on the depression and psychological variables of
patients.</p><p>Therefore, this study was conducted to examine the effects of exercises applied with PNF
techniques performed for 30 minutes per session, three times per week, after receipt of
radiation therapy following mastectomy on depression and anxiety in patients with lymphedema
and to prepare basic date for creation of self-directed exercise programs for lymphedema
patients that will enable them to perform exercises within the range of no pain.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>The subjects of this study were 45 patients selected from among those who showed lymphedema
after receiving anti-cancer therapy following a mastectomy after being diagnosed with breast
cancer at D University Hospital located in B Metropolitan City. Information on the purposes,
procedures, and risks of the experiment was provided to the recruited participants in the
experiment, and prior written consent was received from the participants.</p><p>In this study, the subjects were divided into three groups and performed exercises for 30
minutes per session, three times per week for 16 weeks, and questionnaire surveys were
conducted every four weeks. The PNF exercises were performed using Rhythmic initiation (RI),
which is a PNF technique, for 10 minutes as warm-up exercises, and main exercises were
performed for 20 minutes using a Combination of Isotonic (CI), Contract-relax, and
Hold-relax techniques. The PNF+ Super Lizer group performed the same warm-up exercises as
those in the PNF group for 10 minutes and was irradiated with light by a Super Lizer during
performance of the main exercises. The PNF+Manual lymph drainage (MLD) group performed the
same warm-up exercises as those in the PNF group for 10 minutes followed by the same main
exercises as those in the PNF group for 10 minutes and received MLD treatment for 10
minutes. Finishing MLD treatment was implemented. In this study, the psychological variables
of the patients were measured using the standard Korean versions of the Beck Anxiety
Inventory (BAI) and Beck Depression Inventory (BDI), which are mental state rating scales
for anxiety and depression respectively. The BAI and BDI are scales consisting of 21
questions and are measuring methods with high reliability and validity that have been the
most widely used since 1961, which is when they were proposed. After rating, the mental
states of the patients and their levels of satisfaction with the different treatment methods
were evaluated using the average values.</p><p>The data collected in this experiment were analyzed with SPSS ver 18.0. The effects of the
treatment methods (PNF, PNF+Super Lizer, PNF+MLD) on the lymphedema patients after
mastectomy were verified by 3 × 2 repeated measures ANOVAs. Post hoc comparisons were
conducted using contrast tests to verify changes over time (before the experiment, at 4, 8,
12, and 16 weeks, and after the experiment). The statistical significance level of this
study was p<0.05.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>General characteristics of the subjects of this study are shown in <xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title> Study patients’ baseline and demographic characteristics</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">PNF+Super<break></break>Lizer<break></break>(n=17)</th><th align="center" rowspan="1" colspan="1">PNF<break></break>(n=17)</th><th align="center" rowspan="1" colspan="1">PNF+MLD<break></break>(n=18)</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age (years)</td><td align="center" rowspan="1" colspan="1">53 ± 1</td><td align="center" rowspan="1" colspan="1">51 ± 1</td><td align="center" valign="top" rowspan="1" colspan="1">53 ± 1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Height (cm)</td><td align="center" rowspan="1" colspan="1">158 ± 1</td><td align="center" rowspan="1" colspan="1">160 ± 1</td><td align="center" rowspan="1" colspan="1">159 ± 1</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Weight (kg)</td><td align="center" rowspan="1" colspan="1">62.3 ± 0.9</td><td align="center" rowspan="1" colspan="1">63.4 ± 1.2</td><td align="center" valign="top" rowspan="1" colspan="1">66.0 ± 1.6</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">BMI (kg/m<sup>2</sup>)</td><td align="center" rowspan="1" colspan="1">24.93 ± 0.41</td><td align="center" valign="top" rowspan="1" colspan="1">24.92 ± 0.46</td><td align="center" valign="top" rowspan="1" colspan="1">26.21 ± 0.63</td></tr></tbody></table><table-wrap-foot><p>A total of 52 participants (PNF+Super Lizer, 17; PNF, 17; PNF+MLD, 18) were included
in the final analysis. In the PNF+Super Lizer group, the mean age and BMI were
53±1 years and 24.93 ± 0.41, respectively.</p></table-wrap-foot></table-wrap>. The Beck depression score changed significantly during the five assessment
periods (p<0.0001); however, there was no significant difference between the treatment
groups (p=0.094). Post hoc analyses revealed that there was a significant improvement in
Beck depression score from 4 weeks in all three groups. The interaction between group and
time was also statistically significant (p=0.035; <xref rid="tbl_002" ref-type="table">Table
2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title> Depression and anxiety after mastectomy at five assessment points by treatment
group (mean ± SEM) (value: mean±SEM)</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" colspan="3" rowspan="1">Group<hr></hr></th></tr><tr><th align="center" rowspan="1" colspan="1">Variable</th><th align="center" rowspan="1" colspan="1">PNF+Super Lizer(n=17)</th><th align="center" rowspan="1" colspan="1">PNF(n=17)</th><th align="center" rowspan="1" colspan="1">PNF+MLD(n=18)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Depression</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Before treatment</td><td align="center" rowspan="1" colspan="1">28.24±1.13a</td><td align="center" rowspan="1" colspan="1">28.29±1.13a</td><td align="center" rowspan="1" colspan="1">28.44±1.10a</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4 wks</td><td align="center" rowspan="1" colspan="1">26.12±1.13b</td><td align="center" rowspan="1" colspan="1">25.06±1.13b</td><td align="center" valign="top" rowspan="1" colspan="1">23.89±1.10b</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">8 wks</td><td align="center" rowspan="1" colspan="1">24.35±1.13c</td><td align="center" rowspan="1" colspan="1">22.77±1.13c</td><td align="center" rowspan="1" colspan="1">19.56±1.10c</td></tr><tr><td align="left" rowspan="1" colspan="1">12 wks</td><td align="center" rowspan="1" colspan="1">21.53±1.13d</td><td align="center" rowspan="1" colspan="1">19.47±1.13d</td><td align="center" valign="top" rowspan="1" colspan="1">17.39±1.10d</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">16 wks</td><td align="center" rowspan="1" colspan="1">17.77±1.13e</td><td align="center" rowspan="1" colspan="1">16.35±1.13e</td><td align="center" rowspan="1" colspan="1">14.28±1.10e</td></tr><tr><td align="left" rowspan="1" colspan="1">Anxiety</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" valign="top" rowspan="1" colspan="1"></td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Before treatment</td><td align="center" rowspan="1" colspan="1">35.77±1.63a</td><td align="center" rowspan="1" colspan="1">32.88±1.63a</td><td align="center" rowspan="1" colspan="1">37.33±1.58a</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">4 wks</td><td align="center" rowspan="1" colspan="1">27.41±1.63b</td><td align="center" rowspan="1" colspan="1">25.35±1.63b</td><td align="center" valign="top" rowspan="1" colspan="1">26.00±1.58b</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">8 wks</td><td align="center" rowspan="1" colspan="1">21.12±1.63c</td><td align="center" rowspan="1" colspan="1">20.77±1.63c</td><td align="center" rowspan="1" colspan="1">21.28±1.58c</td></tr><tr><td align="left" rowspan="1" colspan="1">12 wks</td><td align="center" rowspan="1" colspan="1">15.88±1.63d</td><td align="center" rowspan="1" colspan="1">17.18±1.63d</td><td align="center" valign="top" rowspan="1" colspan="1">15.11±1.58d</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">16 wks</td><td align="center" rowspan="1" colspan="1">12.47±1.63d</td><td align="center" rowspan="1" colspan="1">13.06±1.63e</td><td align="center" rowspan="1" colspan="1">11.94±1.58d</td></tr></tbody></table><table-wrap-foot><p><sup>1</sup> Values are means±SEM, and the Holm-Sidak method was used for multiple
comparisons. Means with different letters are different from each other (p<0.05).
<sup>2</sup> P values are derived from the between-group effect.</p></table-wrap-foot></table-wrap>).</p><p>Regarding the time course changes in Beck depression score in the PNF+Super Lizer, PNF, and
PNF+MLD groups, there were significant decreases in Beck depression score compared with the
previous value at all assessment points, and there were also significant differences between
the PNF+Super Lizer and PNF+MLD groups at 4 and 8 weeks.</p><p>Regarding the time course changes in Beck anxiety score in the PNF+Super Lizer, PNF, and
PNF+MLD groups, there were significant decreases in Beck anxiety score compared with the
previous value at all assessment points; however, there was no significant difference
between the three groups.</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>In this study, the patients’ psychological variables were observed before the PNF,
PNF+Super Lizer, and PNF+MLD treatment methods were applied, at 0, 4, 8, 12, and 16 weeks of
treatment, and after the treatment. Based on the results, PNF+MLD can be considered an
effective treatment for depression in lymphedema patients after mastectomy. The results were
consistent with a previous report indicating that exercise therapy has effects that
significantly improve physical condition and relieve depression and anxiety<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup>.</p><p>This study was conducted with lymphedema patients who wanted rehabilitation treatment.
Therefore, there are limitations in the interpretation of the results because there were
difficulties in setting the control group. However, on reviewing a previous clinical study,
it can be seen that lymphedema patients have limitations in activities and experience
anxiety and depression<xref rid="r13" ref-type="bibr">13</xref><sup>)</sup>. Another study
reported that although anxiety and depression were significantly relieved after performing
aerobic exercises, self-regard was not changed<xref rid="r14" ref-type="bibr">14</xref><sup>)</sup>. However, the aforementioned study reported that patients who
participated in the exercise program showed improvement in psychological variables compared
with patients who did not participate in the exercise program. Examining the effects of
exercises using PNF techniques is considered clinically meaningful. If future studies are
conducted on the motility of lymphedema patients, more significant results could be
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<fpage>107</fpage>–<lpage>113</lpage><pub-id pub-id-type="pmid">9460778</pub-id></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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