Clarissa Medeiros da Luz

Evidence-based practice in the management of lower limb lymphedema after gynecological cancer

ABSTRACT Purpose: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. Methods: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using “rehabilitation,” “treatment outcome,” “therapeutics,” “clinical protocol,” “gynecologic surgery,” “lower extremity,” “lower limb,” and “lymphedema” as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. Results: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome – decreased volume of the affected limb lymphedema. Conclusions: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.

Urinary Incontinence in Physically Active Young Women: Prevalence and Related Factors

This cross-sectional survey aims to (1) verify the prevalence of urinary incontinence and its impact on the quality of life among nulliparous fit women, and to (2) analyze whether urinary incontinence is influenced by the intensity of the sport (high- vs. low-impact) or by the volume of physical activity (minutes per week) performed. Two hundred forty-five nulliparous women (18-40 years) completed the International Consultation on Incontinence Questionnaire-Short Form, the Kings Health Questionnaire and a questionnaire regarding demographic and training variables. Overall 22.9% of the participants self-reported urinary incontinence, and among them, 60.7% had stress urinary incontinence. Incontinent women demonstrated worse quality of life than continent females (p=0.000). Women practicing high-impact sports presented higher frequency in loss of urine than those practicing low-impact sports (p=0.004). Regardless the intensity of the sport, the volume of exercise showed positive association with the frequency of loss of urine (p=0.005, r=0.475). In conclusion, almost one fourth of the women enrolled in this study reported symptoms of urinary incontinence and worse quality of life than those who were continent. Women who practice high-impact sports or who have higher volume of training should be aware of the symptoms associated with pelvic floor dysfunction, since they seem to predispose to urine leakage.

Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice

Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome.

Upper Limb Functionality and Quality of Life in Women with Five-Year Survival after Breast Cancer Surgery

Objective To evaluate the correlation between upper limb functionality and quality of life in women with five-year survival following breast cancer surgical treatment. The secondary objective was to evaluate the function of the ipsilateral upper limb and the quality of life in relation to the type of surgery and the presence of pain. Methods The Disabilities of Arm, Shoulder and Hand (DASH), and the Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACTB + 4) questionnaires were used to evaluate upper limb function and quality of life respectively. Data distribution was verified by the Shapiro-Wilk test. Pearsons correlation coefficient was used for the parametric variables, and Spearmans rank correlation coefficient was used for the distribution of non-parametric variables. The statistical significance was set at 5% (p < 0.05). Results The study included 30 patients, with a mean age of 51.23 (±8.72) years. The most common complications were: pain (50%), adherence (33.3%), and nerve lesion (20.0%). There was a moderate negative correlation between the instruments DASH and FACTB + 4 (total score), r = -0.634, and a strong negative correlation between the DASH and the FACTB + 4 arm subscale, r = -0.829. The scores of both questionnaires showed significant difference on the manifestation of pain. However, there was no significant difference found when comparing the scores considering the type of surgery performed. Conclusions Five years after surgery, the patients showed regular functionality levels on the ipsilateral upper limb and decreased quality of life, especially in the group manifesting pain.

Efeitos da intervenção fisioterapêutica na amplitude de movimento do ombro e no mapa termográfico de idosas submetidas à cirurgia para tratamento de câncer de mama

A idade e o principal fator de risco para o desenvolvimento do câncer de mama e clinicamente, as mulheres idosas apresentam um processo de reabilitacao mais dificil. Objetivo: Avaliar os efeitos da intervencao fisioterapeutica na amplitude de movimento (ADM) do ombro e no mapa termografico de idosas em pos-operatorio de tratamento do câncer de mama. Metodos: Participaram 10 idosas, submetidas a tratamento cirurgico para câncer de mama. A avaliacao foi feita antes e apos a intervencao atraves do goniometro, para medidas de ADM, e da câmera termografica Eletrophysics PV320T, para identificacao da temperatura da regiao toracica. Utilizou-se o teste Wilcoxon e a correlacao de Spearman, com nivel de significância de 0,05. Resultados: As pacientes apresentaram melhora significativa da amplitude de todos os movimentos do membro comprometido, exceto a rotacao interna. Ao comparar os valores de temperatura da avaliacao com a reavaliacao, houve um aumento da temperatura das regioes toracicas, sendo significativos apenas os valores da mama preservada. Ao comparar a temperatura da regiao preservada com a comprometida na avaliacao, houve diferenca significativa, ja na reavaliacao, ocorreu uma aproximacao destes valores. A correlacao entre o aumento de temperatura e ADM foi significativa para aducao de ambos os membros e rotacao interna do membro preservado, na avaliacao. Conclusao: A intervencao garantiu resolucao ou diminuicao das alteracoes apresentadas no exame fisico, melhora da ADM, aumento da temperatura das regioes toracicas, e correlacao entre aumento da temperatura e ADM de aducao bilateral e rotacao interna do membro preservado na avaliacao inicial180 ABSTRACT Age is the main risk factor for developing breast cancer and clinically, older women have a more difficult rehabilitation process. Objective: The aim of the study was to evaluate the effects of physiotherapy intervention in range of motion (ROM) of shoulder and thermographic map of elderly postoperative treatment of breast cancer. Methods: A total of 10 elderly, undergoing surgery for breast cancer. The evaluation was done before and after the intervention by means of the goniometer for ADM measures and thermographic camera Eletrophysics PV320T, to identify the temperature of the thoracic region. We used the Wilcoxon test and Spearman correlation, with a 0.05 significance level. Results: The patients showed significant improvement in range of all movements of the affected limb, except internal rotation. When comparing the assessment of temperature values with the revaluation, there was an increase in temperature of the thoracic regions, and only significant values preserved breast. By comparing the temperature of the region preserved with compromised in the evaluation, there was a significant difference, since the revaluation, there was an approximation of these values. Conclusion: The correlation between increased temperature and ADM was significant for both members adduction and internal rotation member preserved in the evaluation. Intervention assured resolution or reduction of amendments on physical examination, improved ROM, increased temperature of the thoracic regions, and correlation between temperature increase and ROM bilateral adduction and internal rotation member preserved in the initial evaluation.

Effects of physiotherapeutic intervention on shoulder range of motion and map thermography of elderlies submitted to surgery for breast cancer treatment

A idade e o principal fator de risco para o desenvolvimento do câncer de mama e clinicamente, as mulheres idosas apresentam um processo de reabilitacao mais dificil. Objetivo: Avaliar os efeitos da intervencao fisioterapeutica na amplitude de movimento (ADM) do ombro e no mapa termografico de idosas em pos-operatorio de tratamento do câncer de mama. Metodos: Participaram 10 idosas, submetidas a tratamento cirurgico para câncer de mama. A avaliacao foi feita antes e apos a intervencao atraves do goniometro, para medidas de ADM, e da câmera termografica Eletrophysics PV320T, para identificacao da temperatura da regiao toracica. Utilizou-se o teste Wilcoxon e a correlacao de Spearman, com nivel de significância de 0,05. Resultados: As pacientes apresentaram melhora significativa da amplitude de todos os movimentos do membro comprometido, exceto a rotacao interna. Ao comparar os valores de temperatura da avaliacao com a reavaliacao, houve um aumento da temperatura das regioes toracicas, sendo significativos apenas os valores da mama preservada. Ao comparar a temperatura da regiao preservada com a comprometida na avaliacao, houve diferenca significativa, ja na reavaliacao, ocorreu uma aproximacao destes valores. A correlacao entre o aumento de temperatura e ADM foi significativa para aducao de ambos os membros e rotacao interna do membro preservado, na avaliacao. Conclusao: A intervencao garantiu resolucao ou diminuicao das alteracoes apresentadas no exame fisico, melhora da ADM, aumento da temperatura das regioes toracicas, e correlacao entre aumento da temperatura e ADM de aducao bilateral e rotacao interna do membro preservado na avaliacao inicial180 ABSTRACT Age is the main risk factor for developing breast cancer and clinically, older women have a more difficult rehabilitation process. Objective: The aim of the study was to evaluate the effects of physiotherapy intervention in range of motion (ROM) of shoulder and thermographic map of elderly postoperative treatment of breast cancer. Methods: A total of 10 elderly, undergoing surgery for breast cancer. The evaluation was done before and after the intervention by means of the goniometer for ADM measures and thermographic camera Eletrophysics PV320T, to identify the temperature of the thoracic region. We used the Wilcoxon test and Spearman correlation, with a 0.05 significance level. Results: The patients showed significant improvement in range of all movements of the affected limb, except internal rotation. When comparing the assessment of temperature values with the revaluation, there was an increase in temperature of the thoracic regions, and only significant values preserved breast. By comparing the temperature of the region preserved with compromised in the evaluation, there was a significant difference, since the revaluation, there was an approximation of these values. Conclusion: The correlation between increased temperature and ADM was significant for both members adduction and internal rotation member preserved in the evaluation. Intervention assured resolution or reduction of amendments on physical examination, improved ROM, increased temperature of the thoracic regions, and correlation between temperature increase and ROM bilateral adduction and internal rotation member preserved in the initial evaluation.

Intervention effects on shoulder physiotherapeutic range of motion and old map thermography submitted to surgery for breast cancer treatment

A idade e o principal fator de risco para o desenvolvimento do câncer de mama e clinicamente, as mulheres idosas apresentam um processo de reabilitacao mais dificil. Objetivo: Avaliar os efeitos da intervencao fisioterapeutica na amplitude de movimento (ADM) do ombro e no mapa termografico de idosas em pos-operatorio de tratamento do câncer de mama. Metodos: Participaram 10 idosas, submetidas a tratamento cirurgico para câncer de mama. A avaliacao foi feita antes e apos a intervencao atraves do goniometro, para medidas de ADM, e da câmera termografica Eletrophysics PV320T, para identificacao da temperatura da regiao toracica. Utilizou-se o teste Wilcoxon e a correlacao de Spearman, com nivel de significância de 0,05. Resultados: As pacientes apresentaram melhora significativa da amplitude de todos os movimentos do membro comprometido, exceto a rotacao interna. Ao comparar os valores de temperatura da avaliacao com a reavaliacao, houve um aumento da temperatura das regioes toracicas, sendo significativos apenas os valores da mama preservada. Ao comparar a temperatura da regiao preservada com a comprometida na avaliacao, houve diferenca significativa, ja na reavaliacao, ocorreu uma aproximacao destes valores. A correlacao entre o aumento de temperatura e ADM foi significativa para aducao de ambos os membros e rotacao interna do membro preservado, na avaliacao. Conclusao: A intervencao garantiu resolucao ou diminuicao das alteracoes apresentadas no exame fisico, melhora da ADM, aumento da temperatura das regioes toracicas, e correlacao entre aumento da temperatura e ADM de aducao bilateral e rotacao interna do membro preservado na avaliacao inicial180 ABSTRACT Age is the main risk factor for developing breast cancer and clinically, older women have a more difficult rehabilitation process. Objective: The aim of the study was to evaluate the effects of physiotherapy intervention in range of motion (ROM) of shoulder and thermographic map of elderly postoperative treatment of breast cancer. Methods: A total of 10 elderly, undergoing surgery for breast cancer. The evaluation was done before and after the intervention by means of the goniometer for ADM measures and thermographic camera Eletrophysics PV320T, to identify the temperature of the thoracic region. We used the Wilcoxon test and Spearman correlation, with a 0.05 significance level. Results: The patients showed significant improvement in range of all movements of the affected limb, except internal rotation. When comparing the assessment of temperature values with the revaluation, there was an increase in temperature of the thoracic regions, and only significant values preserved breast. By comparing the temperature of the region preserved with compromised in the evaluation, there was a significant difference, since the revaluation, there was an approximation of these values. Conclusion: The correlation between increased temperature and ADM was significant for both members adduction and internal rotation member preserved in the evaluation. Intervention assured resolution or reduction of amendments on physical examination, improved ROM, increased temperature of the thoracic regions, and correlation between temperature increase and ROM bilateral adduction and internal rotation member preserved in the initial evaluation.