Claire Davies

Breast Cancer EDGE Task Force Outcomes Clinical Measures of Strength and Muscular Endurance: A Systematic Review

Background: Muscular strength deficits are a common morbidity following treatment for breast cancer. Accurate assessment of strength and muscular endurance following breast cancer treatments is essential in identifying deficits and planning rehabilitation strategies. Purpose: The purpose of this systematic review was to identify strength and muscular endurance outcome measures for use with women treated for breast cancer that possess strong psychometric properties and are clinically useful. Methods: Multiple electronic databases were searched between February and June 2013. Included studies of tools used to assess strength and muscular endurance met the following criteria: reported psychometric properties, clinically feasible methods, adults (preferably female), and published in the English language. Each outcome measure was reviewed independently and rated by two reviewers separately. A single Cancer EDGE Task Force Outcome Measure Rating Form was completed for each category of strength or endurance assessment, and a recommendation was made using the 4‐point Breast Cancer EDGE Task Force Rating Scale. Results: Of the original 874 articles found, 22 were included in this review. Hand Grip Strength and Hand Held Dynamometry were rated 3, recommended for clinical use. Manual muscle test and one repetition maximum were rated 2B, unable to recommend at this time. Muscular endurance testing was rated 2A, unable to recommend at this time. Conclusions: Utilizing objective dynamometry for hand grip and muscle strength testing provides precise measurement to assess baseline status and monitor change among women treated for breast cancer.

Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association

Abstract The Oncology Section of the American Physical Therapy Association (APTA) developed a clinical practice guideline to aid the clinician in diagnosing secondary upper quadrant cancer-related lymphedema. Following a systematic review of published studies and a structured appraisal process, recommendations were written to guide the physical therapist and other health care clinicians in the diagnostic process. Overall clinical practice recommendations were formulated based on the evidence for each diagnostic method and were assigned a grade based on the strength of the evidence for different patient presentations and clinical utility. In an effort to maximize clinical applicability, recommendations were based on the characteristics as to the location and stage of a patients upper quadrant lymphedema.

Oncology Section EDGE Task Force on Prostate Cancer Outcomes: A Systematic Review of Clinical Measures of Strength and Muscular Endurance

Background: Strength deficits are a common morbidity following treatment for prostate cancer. Accurate assessment of strength and muscular endurance following prostate cancer treatments is essential to identify deficits and plan rehabilitation. Purpose: To identify strength and muscular endurance outcome measures that possess strong psychometric properties and are clinically useful for examination of men treated for prostate cancer. Methods: Multiple electronic databases were searched for articles published after 1995. Studies of tools used to assess strength and muscular endurance were included if they reported psychometric properties, were clinically feasible methods, performed on adults, and published in the English language. Each outcome measure was independently reviewed and rated by two reviewers. A single Cancer EDGE Task Force Outcome Measure Rating Form was completed for each category of strength or endurance assessment, and a recommendation was made using the 4‐point Cancer EDGE Task Force Rating Scale. Results: Of the original 683 articles found, 30 were included in this review. Hand‐grip strength and hand‐held dynamometry were rated 3, recommended for clinical use. One repetition maximum was rated 2A, unable to recommend at this time but the measure has been used in research on individuals with prostate cancer. Manual muscle testing was rated 2B, unable to recommend at this time due to lack of psychometric support, and muscular endurance testing was not recommended (1). Conclusions: Utilizing objective dynamometry for hand grip and muscle strength testing provides precise measurement to assess baseline status and monitor change among men treated for prostate cancer.

The Baptist Health Nurse Retention Questionnaire: A Methodological Study, Part 1

OBJECTIVE The purposes of this study were to develop and test the Baptist Health Nurse Retention Questionnaire (BHNRQ) and examine the importance of nurse retention factors. BACKGROUND Multiple factors, including increasing patient acuity levels, have led to concerns regarding nurse retention. An understanding of current factors related to retention is limited. METHODS To establish the psychometric properties of the BHNRQ, data were collected from 279 bedside nurses at a 391-bed, Magnet® redesignated community hospital. A principal component analysis was conducted to determine the subscale structure of the BHNRQ. Additional analyses were conducted related to content validity and test-retest reliability. RESULTS The results of the principal components analysis revealed 3 subscales: nursing practice, management, and staffing. Analyses demonstrate that the BHNRQ is a reliable and valid instrument for measuring nurse retention factors. CONCLUSION The BHNRQ was found to be a clinically useful instrument for measuring important factors related to nurse retention.

Astym therapy improves function and range of motion following mastectomy

Hypersensitive scar tissue formation along the incision line and drain site is a common side effect following mastectomy. If this scar tissue is not addressed, it can lead to decreased flexibility and function in the involved upper quadrant. Astym® treatment is a new approach to soft tissue injuries, and is evidenced in animal studies to promote the healing and regeneration of soft tissues. It has also been found to reduce pain and increase function in people with soft tissue dysfunction. The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. Handheld instrumentation is applied topically to locate and treat the underlying dysfunctional soft tissue through specific protocols for the application of particular pressures and shear forces. The purpose of this study was to examine the effects of Astym treatment on activities of daily living in women who had undergone a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, following a mastectomy, evaluated five outcome measures pre- and post-Astym treatment. All five measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active range of motion of shoulder flexion; and active range of motion of abduction were also measured and all demonstrated significant changes. In this study, Astym treatment improved active range of motion in the involved quadrant and also improved function in patients following a mastectomy.

Test-retest and Internal Consistency of the Disability of Arm, Shoulder and Hand (DASH) Outcome Measure in Assessing Functional Status among Breast Cancer Survivors with Lymphedema

Background: The Disability of Arm, Shoulder and Hand (DASH) outcome measure is a self‐report questionnaire that can be used with breast cancer survivors (BCS) to measure physical, social and psychological functioning of the upper limb. The internal consistency of the DASH outcome measure has been demonstrated in BCS but there is limited psychometric support for use of the DASH with BCS with lymphedema. Purpose: The purpose of this study was to determine test‐retest reliability and internal consistency for the use of the DASH among BCS with lymphedema. Methods: Following Institutional Review Board approval, test‐retest reliability was evaluated as follows: participants completed the DASH outcome measure at the initial physical therapy evaluation and again 2‐3 hours later by telephone interview (n=19). In order to test internal consistency of the DASH among BCS with lymphedema, a retrospective chart review of DASH scores (n=144) was conducted in a hospitalbased outpatient physical therapy facility. Coefficients reflecting internal consistency were calculated at initial evaluation (n = 144), 30 day re‐evaluation (n=44) and discharge (n=59). Results: Strong test re‐test reliability (ICC=0.97) and internal consistency (&agr;= 0.97, 0.92, and 0.98) were established. Conclusions: The DASH is a reliable measure of upper extremity function among BCS with lymphedema.

Oncology Section EDGE Task Force on Breast Cancer Outcomes: A Systematic Review of Outcome Measures for Functional Mobility

Background: Breast cancer treatments in women with breast cancer often result in physical impairments that lead to activity limitations and participation restrictions. These limitations and restrictions manifest in impaired functional mobility skills that may impact survivorship. Thus, evaluation of functional mobility is an important part of survivorship care. Purpose: To identify functional mobility outcome measures that possess strong psychometric properties and are clinically useful for examination of women treated for breast cancer. Methods: Multiple electronic databases were searched for articles published after 1995. Studies were included if they reported psychometric properties, used clinically feasible methods, were performed on adults, and published in the English language. Each outcome measure was independently evaluated and rated by two reviewers. A single Cancer EDGE Task Force Outcome Measure Rating Form was completed for each category of functional mobility, and a recommendation was made using the 4‐point Cancer EDGE Task Force Rating Scale. Results: Of the original 819 articles found, 211 were included in this review. A total of 11 measures are recommended for clinical use: the Timed Up and Go; the 2‐Minute, 6‐Minute, and 12‐Minute Walk Tests; 10‐Meter Walk; 5 Times Sit to Stand; Short Performance Physical Battery; Physical Battery for Patients with Cancer; Functional Independence Measure (FIM); Assessment of Life Habits; and Activity Measure for Post‐acute Care. Conclusions: Many tools are available to assess upper extremity and overall functional mobility skills in women treated for breast cancer. There are currently no tools recommended that assess community participation.

BREAST CANCER EDGE TASK FORCE OUTCOMES: Assessment Measures of Secondary Lymphedema in Breast Cancer Survivors

Background: The Breast Cancer EDGE Task Force reviewed the published evidence on assessment techniques to clinically measure breast cancer related lymphedema (BCRL). In order to identify lymphedema in a timely manner and to objectively document response to interventions, physical therapists need valid and reliable assessment tools. To date, there are several assessment tools used by physical therapists; however, the advantages and disadvantages of each tool and which tool(s) is most appropriate is not well known. Breast cancer related lymphedema assessment tools include: circumferential measurement (CM), water displacement, bioelectrical impedance spectroscopy (BIS), perometry, tonometry, and self‐report tools. Purpose: The purpose was to identify specific assessment techniques or tools that could be recommended for use in clinical practice to measure upper extremity secondary lymphedema in breast cancer survivors (BCS). Methods: A systematic literature review was used to appraise the evidence supporting the psychometric properties and clinical utility of assessment techniques in BCS with secondary lymphedema in the upper extremity. Results: Circumferential measurement, water displacement, and BIS received a recommendation of 4 (highly recommended), due to good reliability, validity, and clinical utility. Tonometry, perometry, the Lymphedema Breast Cancer Questionnaire (LBCQ) self‐report tool and the Visual Analog Scale, received a recommendation of 2A, unable to recommend at this time due to limited evidence available and/or clinical utility. Conclusion: Breast Cancer EDGE Task Force recommends CM, water displacement, and BIS as routine physical therapy assessment tools for early detection of BCRL and/or to document response to interventions. Perometry is not recommended at this time due to poor clinical utility. Further research is needed to determine psychometric properties for tonometry, the LBCQ, and the Visual Analog Scale. Research is also needed to standardize the diagnostic criteria for each assessment tool to detect early onset of BCRL.

Oncology Section Task Force on Breast Cancer Outcomes: Shoulder and Glenohumeral Outcome Measures

Background: Oncology Section Breast Cancer EDGE Task Force subgroup for shoulder/glenohumeral outcomes reviewed the published evidence on assessment techniques for range of motion (ROM), muscle length, and glenohumeral joint accessory motion. The purpose was to identify outcomes that could be recommended for use when examining women with a history of breast cancer. Methods: A systematic review of the literature was used to appraise the evidence supporting the psychometric properties and clinical utility of selected outcomes in survivors of breast cancer. Results: Passive goniometry demonstrated superior psychometric properties over active ROM. Muscle length tests were not specifically studied in the patient population with breast cancer. Regarding accessory motion assessment, no information for the patient population with breast cancer was found. Conclusion: Of the shoulder/glenohumeral impairment outcomes included in this study, only passive ROM can be highly recommended as it demonstrated good psychometric properties and has been used in patients with breast cancer.

The Importance of Factors Related to Nurse Retention: Using the Baptist Health Nurse Retention Questionnaire, Part 2.

OBJECTIVE The purpose of this study was to examine the importance of factors related to nurse retention. BACKGROUND Retaining nurses within the healthcare system is a challenge for hospital administrators. Understanding factors important to nurse retention is essential. METHODS Responses of nurses (n = 279) to the Baptist Health Nurse Retention Questionnaire (BHNRQ) at a 391-bed Magnet® redesignated community hospital were analyzed to explore differences in importance scores of bedside nurses. RESULTS The results demonstrate that each of the 12 items on the BHNRQ was moderately to highly important. A multivariate analysis of variance based on generation, degree, unit, and experience revealed no significant differences on subscale scores (nursing practice, management, and staffing). Themes derived from the comment section on the BHNRQ were consistent with quantitative findings. CONCLUSION Clinical and managerial competence, engagement with their employees, and presence on the unit are keys to retaining a satisfied nursing workforce.