The Efficacy of Exercise Therapy in Reducing Shoulder Pain Related to Breast Cancer: A Systematic Review

Abstract

Purpose: Recent research indicates that physiotherapy interventions, such as exercise and manual therapy, may be effective in decreasing the frequency of side effects linked with breast cancer treatment, including fatigue, pain, nausea, and decreased quality of life. This systematic review aims to determine the efficacy of exercise therapy in reducing shoulder pain related to breast cancer treatment and to identify outcome measures that can be used to assess shoulder pain in this population. Methods: A systematic review of the current literature was conducted using portals such as the Physiotherapy Evidence Database (PEDro), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Ovid MEDLINE (1996 to April 2011), and Allied and Complementary Medicine (AMED) (1985 to April 2011). Databases were searched for relevant studies published up to April 2011. Participants in relevant studies were adults (≥18 years of age) with a primary diagnosis of breast cancer at any point during the treatment of their disease. Results: Six articles were independently appraised by two blinded reviewers. Six studies met the inclusion criteria, each analyzing different types of exercise—shoulder/arm/scapular strengthening/stabilization, postural exercises, general exercises and conditioning, shoulder range-of-motion exercises, and lymphedema exercises—with respect to their efficacy in reducing shoulder pain related to breast cancer treatment. Conclusions: Results suggest that exercise targeting shoulder pain related to breast cancer treatment may be effective. However, definitive conclusions cannot be drawn due to the lack of methodological quality and homogeneity of the studies included. Clinicians should use valid outcome measures, such as the visual analogue scale and brief pain inventory, to evaluate the effectiveness of this treatment.

Telehealth system: A randomized controlled trial evaluating the impact of an internet‐based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors

“…Tatham et al reported that different face‐to‐face interventions were effective at reducing shoulder pain after intervention and follow‐up in patients with BC. Our pain‐related results were similar to those reported by Tatham et al using a nonface‐to‐face intervention but targeting the same parameters in general terms. Our findings related to static and dynamic muscle strength variables are in agreement with the literature describing traditional interventions in cancer survivors with regard to both intervention effects and maintenance effects .…”

Clinician's Commentary on Tatham et al.

“…Secondarily, Tatham and colleagues acknowledged inconsistencies with respect to pain outcome measures: four of the six included studies used a visual analogue scale (VAS), one of which also used the Brief Pain Inventory (BPI), while the other two studies relied solely on oral selfreports of pain. 1 Pain is a dynamic experience that may not be adequately captured by a clinician at any one time point. In addition, unidimensional assessments of pain such as VAS may not be effective in identifying different types and origins of pain and may be unable to tease out multiple pain sources.…”

“…Tatham and colleagues' article also recognizes that not all pain outcome measures in common use are able to properly capture, qualify, and/or measure pain in this population. 1 Tatham and colleagues conducted a multi-database search and obtained results from six studies examining patients with breast cancer who underwent physiotherapy intervention, which they reviewed systematically to determine the efficacy of these interventions in reducing shoulder pain. 1 The interventions analyzed in these studies included varying combinations of shoulder/scapular strength and stability exercises, posture education, massage, ROM, general conditioning exercises, and/or lymphedema management.…”

“…1 Tatham and colleagues conducted a multi-database search and obtained results from six studies examining patients with breast cancer who underwent physiotherapy intervention, which they reviewed systematically to determine the efficacy of these interventions in reducing shoulder pain. 1 The interventions analyzed in these studies included varying combinations of shoulder/scapular strength and stability exercises, posture education, massage, ROM, general conditioning exercises, and/or lymphedema management. The studies included in the review were those accessible online in which participants were adults (>18 years old) with a primary diagnosis of breast cancer at any point in treatment and which also met the following criteria: a randomized controlled trial; interventions including any form of exercise or physical activity; and outcome measures that included a measure of shoulder/chest pain, alone or in combination with other outcomes.…”

“…As Tatham and colleagues note, scales such as the BPI may give a more comprehensive view by evaluating both the intensity of the pain and its impact on function and quality of life, as well as accounting for pain trends over time. 1 At the Princess Margaret Cancer Centre, the Edmonton Classification System for Cancer Pain (ECS-CP) is frequently used on the palliative floor because it analyzes not only pain but other symptoms that may cause distress or affect a patient's perception of pain symptoms. 9 Pain is best described as an experience rather than a static symptom, as it moves along a continuum and may be dramatically altered by the surrounding environment.…”