A prospective model of care for breast cancer rehabilitation: function.
ABSTRACT A significant proportion of adult breast cancer survivors experience deficits in function and restriction in participation in life roles that may remain many years after diagnosis. Function is a complex construct that takes into account the interactions between an individual, their health condition, and the social and personal context in which they live. Research to date on limitations in activities of daily living, upper extremity function, and functional capacity in breast cancer survivors illustrates the need for prospective measurement of function using measures that are sensitive to the unique issues of breast cancer survivors and the need for the development of effective rehabilitation interventions to improve function. Limitations in function have a significant impact on quality of life, but less is known about the implications on return to work and survival, as well as the impact of other comorbidities and aging on the function limitations in breast cancer survivors. This review provides a rationale for the integration of measures of function into breast cancer care to more fully appreciate the functional limitations associated with breast cancer diagnosis and treatment and to aid in the development of better rehabilitation care for breast cancer survivors.
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ABSTRACT: Question: What are typical values of physical function for women diagnosed with breast cancer and how do these compare to normative data? Design: Systematic review with meta-analysis. Participants: Women diagnosed with breast cancer who were before, during or after treatment. Outcome measures: Physical function was divided into three categories: aerobic capacity, upper and lower extremity muscular fitness, and mobility. Measures of aerobic capacity included field tests (6-minute walk test, 12-minute walk tests, Rockport 1-mile test, and 2-km walk time) and submaximal/maximal exercise tests on a treadmill or cycle ergometer. Measures of upper and lower extremity muscular fitness included grip strength, one repetition maximum (bench, chest or leg press), muscle endurance tests, and chair stands. The only measure of mobility was the Timed Up and Go test. Results: Of the 1978 studies identified, 85 were eligible for inclusion. Wide ranges of values were reported, reflecting the range of ages, disease severity, treatment type and time since treatment of participants. Aerobic fitness values were generally below average, although 6-minute walk time was closer to population norms. Upper and lower extremity strength was lower than population norms for women who were currently receiving cancer treatment. Lower extremity strength was above population norms for women who had completed treatment. Conclusion: Aerobic capacity and upper extremity strength in women diagnosed with breast cancer are generally lower than population norms. Assessment of values for lower extremity strength is less conclusive. As more research is published, expected values for sub-groups by age, treatment, and co-morbidities should be developed. [Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K Campbell KL (2014) Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review.Journal of Physiotherapy60: 189–200]Journal of physiotherapy 11/2014; · 2.89 Impact Factor
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ABSTRACT: Purpose/Objective: Our goal was to explore the effects of lymphedema on long-term adjustment among breast cancer survivors, in terms of functioning in important life environments. Research Method/Design: Limb volume measurements and psychosocial survey data were collected from women shortly after undergoing surgical intervention for breast cancer and annually thereafter. A subset of these women were selected for the current study because they had preoperative limb volume measurement data, which is best suited to determine presence and severity of lymphedema. Our final sample of 61 women had both the arm measurements (preoperative and 5-year) and survey data (baseline and 5-year) needed for this study, which comprises a secondary cross-sectional analysis of longitudinal data. A correlational approach was used to explore associations among lymphedema (presence, severity, and whether the participant met the criteria for lymphedema at any assessment point since their treatment for breast cancer) and outcome variables (physical functioning, vocational functioning, social functioning, domestic functioning, and sexual functioning). Results: Each of the three measures of lymphedema was significantly correlated with domestic functioning, but not with functioning in other common environments. Conclusions/Implications: Long-term breast cancer survivors are at risk for developing secondary conditions, such as lymphedema, to which they must learn to adjust and adapt. Lymphedema may increase risk for compromised functioning in everyday environments, a problem which lies at the heart of rehabilitation. Breast cancer survivorship, therefore, fits well within the scope of a rehabilitation framework. (PsycINFO Database Record (c) 2013 APA, all rights reserved).Rehabilitation Psychology 11/2013; 58(4):342-9. · 1.91 Impact Factor
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ABSTRACT: The purpose of this study was to construct a clinical instrument to measure functioning in breast cancer survivors using the International Classification of Functioning, Disability and Health (ICF) categories for body functions, activity and participation, and environmental factors, based on a Rasch analysis. Items were generated from the brief ICF core set for breast cancer and in-depth interviews from eight oncologists. Psychometric properties were evaluated in 158 female Korean patients with breast cancer using Rasch analysis, such as fit of the ICF categories, targeting between the ICF categories and a person's abilities, unidimensionality, and reliability. The Rasch refinement led to a change from the original 43-item, 5-level scale to a 30-item, 3- or 4-level scale. Rasch reliabilities were 0.89 (body function scale), 0.96 (activity and participation scale), and 0.93 (environmental scale). The item-difficulty hierarchy was stable across age (<50 or ≥50 years) and had no non-fitting items or gaps (all information weighted fit (infit)/outlier sensitive fit (outfit) mean square error of 0.7-1.3, n = 140). The Brief Core Set Breast Cancer Questionnaire for Screening is a reliable and valid 30-item questionnaire based on the brief ICF core set. It allows measurement of functioning as a unidimensional construct in patients with breast cancer.Supportive Care in Cancer 05/2014; · 2.09 Impact Factor