Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial
Identifieur interne : 000717 ( Pmc/Curation ); précédent : 000716; suivant : 000718Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial
Auteurs : María Torres Lacomba [Espagne] ; María José Yuste Sánchez [Espagne] ; Álvaro Zapico Go I [Espagne] ; David Prieto Merino [Royaume-Uni] ; Orlando Mayoral Del Moral [Espagne] ; Ester Cerezo Téllez [Espagne] ; Elena Minayo Mogoll N [Espagne]Source :
- The BMJ [ 0959-8138 ] ; 2010.
Abstract
Url:
DOI: 10.1136/bmj.b5396
PubMed: 20068255
PubMed Central: 2806631
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial</title><author><name sortKey="Torres Lacomba, Maria" sort="Torres Lacomba, Maria" uniqKey="Torres Lacomba M" first="María" last="Torres Lacomba">María Torres Lacomba</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Yuste Sanchez, Maria Jose" sort="Yuste Sanchez, Maria Jose" uniqKey="Yuste Sanchez M" first="María José" last="Yuste Sánchez">María José Yuste Sánchez</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Zapico Go I, Alvaro" sort="Zapico Go I, Alvaro" uniqKey="Zapico Go I A" first="Álvaro" last="Zapico Go I">Álvaro Zapico Go I</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation><affiliation wicri:level="3"><nlm:aff id="aff2">Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid</nlm:aff><country>Espagne</country><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName><wicri:orgArea>Príncipe de Asturias University Hospital, Alcalá de Henares</wicri:orgArea></affiliation></author><author><name sortKey="Prieto Merino, David" sort="Prieto Merino, David" uniqKey="Prieto Merino D" first="David" last="Prieto Merino">David Prieto Merino</name><affiliation wicri:level="3"><nlm:aff id="aff3">Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine</wicri:orgArea></affiliation></author><author><name sortKey="Mayoral Del Moral, Orlando" sort="Mayoral Del Moral, Orlando" uniqKey="Mayoral Del Moral O" first="Orlando" last="Mayoral Del Moral">Orlando Mayoral Del Moral</name><affiliation wicri:level="1"><nlm:aff id="aff4">Physiotherapy Department, Provincial Hospital, Toledo, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, Provincial Hospital, Toledo</wicri:regionArea></affiliation></author><author><name sortKey="Cerezo Tellez, Ester" sort="Cerezo Tellez, Ester" uniqKey="Cerezo Tellez E" first="Ester" last="Cerezo Téllez">Ester Cerezo Téllez</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Minayo Mogoll N, Elena" sort="Minayo Mogoll N, Elena" uniqKey="Minayo Mogoll N E" first="Elena" last="Minayo Mogoll N">Elena Minayo Mogoll N</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20068255</idno><idno type="pmc">2806631</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806631</idno><idno type="RBID">PMC:2806631</idno><idno type="doi">10.1136/bmj.b5396</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000717</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000717</idno><idno type="wicri:Area/Pmc/Curation">000717</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000717</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial</title><author><name sortKey="Torres Lacomba, Maria" sort="Torres Lacomba, Maria" uniqKey="Torres Lacomba M" first="María" last="Torres Lacomba">María Torres Lacomba</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Yuste Sanchez, Maria Jose" sort="Yuste Sanchez, Maria Jose" uniqKey="Yuste Sanchez M" first="María José" last="Yuste Sánchez">María José Yuste Sánchez</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Zapico Go I, Alvaro" sort="Zapico Go I, Alvaro" uniqKey="Zapico Go I A" first="Álvaro" last="Zapico Go I">Álvaro Zapico Go I</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation><affiliation wicri:level="3"><nlm:aff id="aff2">Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid</nlm:aff><country>Espagne</country><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName><wicri:orgArea>Príncipe de Asturias University Hospital, Alcalá de Henares</wicri:orgArea></affiliation></author><author><name sortKey="Prieto Merino, David" sort="Prieto Merino, David" uniqKey="Prieto Merino D" first="David" last="Prieto Merino">David Prieto Merino</name><affiliation wicri:level="3"><nlm:aff id="aff3">Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London</nlm:aff><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><wicri:orgArea>Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine</wicri:orgArea></affiliation></author><author><name sortKey="Mayoral Del Moral, Orlando" sort="Mayoral Del Moral, Orlando" uniqKey="Mayoral Del Moral O" first="Orlando" last="Mayoral Del Moral">Orlando Mayoral Del Moral</name><affiliation wicri:level="1"><nlm:aff id="aff4">Physiotherapy Department, Provincial Hospital, Toledo, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, Provincial Hospital, Toledo</wicri:regionArea></affiliation></author><author><name sortKey="Cerezo Tellez, Ester" sort="Cerezo Tellez, Ester" uniqKey="Cerezo Tellez E" first="Ester" last="Cerezo Téllez">Ester Cerezo Téllez</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author><author><name sortKey="Minayo Mogoll N, Elena" sort="Minayo Mogoll N, Elena" uniqKey="Minayo Mogoll N E" first="Elena" last="Minayo Mogoll N">Elena Minayo Mogoll N</name><affiliation wicri:level="1"><nlm:aff id="aff1">Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid</wicri:regionArea></affiliation></author></analytic><series><title level="j">The BMJ</title><idno type="ISSN">0959-8138</idno><idno type="eISSN">1756-1833</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><bold>Objective</bold> To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer.</p><p><bold>Design</bold> Randomised, single blinded, clinical trial.</p><p><bold>Setting</bold> University hospital in Alcalá de Henares, Madrid, Spain.</p><p><bold>Participants</bold> 120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007.</p><p><bold>Intervention</bold> The early physiotherapy group was treated by a physiotherapist with a physiotherapy programme including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only.</p><p><bold>Main outcome measure</bold> Incidence of clinically significant secondary lymphoedema (>2 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm).</p><p><bold>Results</bold> 116 women completed the one year follow-up. Of these, 18 developed secondary lymphoedema (16%): 14 in the control group (25%) and four in the intervention group (7%). The difference was significant (P=0.01); risk ratio 0.28 (95% confidence interval 0.10 to 0.79). A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group (intervention/control, hazard ratio 0.26, 95% confidence interval 0.09 to 0.79).</p><p><bold>Conclusion</bold> Early physiotherapy could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes.</p><p><bold>Trial registration</bold> Current controlled trials ISRCTN95870846.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></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">BMJ</journal-id><journal-id journal-id-type="iso-abbrev">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title-group><journal-title>The BMJ</journal-title></journal-title-group><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1756-1833</issn><publisher><publisher-name>BMJ Publishing Group Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20068255</article-id><article-id pub-id-type="pmc">2806631</article-id><article-id pub-id-type="publisher-id">lacm617837</article-id><article-id pub-id-type="doi">10.1136/bmj.b5396</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group><subj-group subj-group-type="hw-coll-titles"><subject>Clinical Trials (Epidemiology)</subject><subject>Immunology (Including Allergy)</subject><subject>Breast Cancer</subject><subject>Physiotherapy</subject><subject>Sports and Exercise Medicine</subject><subject>Surgical Oncology</subject></subj-group></article-categories><title-group><article-title>Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Torres Lacomba</surname><given-names>María</given-names></name><role>professor of physiotherapy</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Yuste Sánchez</surname><given-names>María José</given-names></name><role>professor of physiotherapy</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Zapico Goñi</surname><given-names>Álvaro</given-names></name><role>professor of obstetrics and gynaecology</role><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Prieto Merino</surname><given-names>David</given-names></name><role>lecturer</role><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Mayoral del Moral</surname><given-names>Orlando</given-names></name><role>professor of physiotherapy</role><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Cerezo Téllez</surname><given-names>Ester</given-names></name><role>research fellow</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Minayo Mogollón</surname><given-names>Elena</given-names></name><role>research fellow</role><xref ref-type="aff" rid="aff1">1</xref></contrib><aff id="aff1"><label>1</label>Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain</aff><aff id="aff2"><label>2</label>Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid</aff><aff id="aff3"><label>3</label>Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London</aff><aff id="aff4"><label>4</label>Physiotherapy Department, Provincial Hospital, Toledo, Spain</aff></contrib-group><author-notes><corresp>Correspondence to: M Torres Lacomba <email>maria.torres@uah.es</email></corresp></author-notes><pub-date pub-type="collection"><year>2010</year></pub-date><pub-date pub-type="epub"><day>12</day><month>1</month><year>2010</year></pub-date><volume>340</volume><elocation-id>b5396</elocation-id><history><date date-type="accepted"><day>9</day><month>10</month><year>2009</year></date></history><permissions><copyright-statement>© Torres Lacomba et al 2010</copyright-statement><copyright-year>2010</copyright-year><copyright-holder>Torres Lacomba et al</copyright-holder><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/">http://creativecommons.org/licenses/by-nc/2.0/</ext-link> and <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>.</license-p></license></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="bmj.b5396_default.pdf"></self-uri><abstract><p><bold>Objective</bold> To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer.</p><p><bold>Design</bold> Randomised, single blinded, clinical trial.</p><p><bold>Setting</bold> University hospital in Alcalá de Henares, Madrid, Spain.</p><p><bold>Participants</bold> 120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007.</p><p><bold>Intervention</bold> The early physiotherapy group was treated by a physiotherapist with a physiotherapy programme including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only.</p><p><bold>Main outcome measure</bold> Incidence of clinically significant secondary lymphoedema (>2 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm).</p><p><bold>Results</bold> 116 women completed the one year follow-up. Of these, 18 developed secondary lymphoedema (16%): 14 in the control group (25%) and four in the intervention group (7%). The difference was significant (P=0.01); risk ratio 0.28 (95% confidence interval 0.10 to 0.79). A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group (intervention/control, hazard ratio 0.26, 95% confidence interval 0.09 to 0.79).</p><p><bold>Conclusion</bold> Early physiotherapy could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes.</p><p><bold>Trial registration</bold> Current controlled trials ISRCTN95870846.</p></abstract></article-meta><notes notes-type="data-supplement"><label>Web Extra</label><title>Extra material supplied by the author</title><supplementary-material content-type="local-data"><caption><p>Example of how continuous variables were calculated</p></caption><media xlink:href="lacm617837.wt1_default.pdf"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material><supplementary-material content-type="local-data"><caption><p>Description of change in volume ratio</p></caption><media xlink:href="lacm617837.ww1_default.pdf"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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