Iseult M. Wilson

The Musculoskeletal Consequences of Breast Reconstruction using the Latissimus Dorsi Muscle for Women following Mastectomy for Breast Cancer: A Critical Review

Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. However, one common, but often ignored, complication following LD flap is shoulder dysfunction. The aim of this critical review was to comprehensively assess the musculoskeletal impact of LD breast reconstruction and evaluate the functional outcome following surgery. Five electronic databases were searched including; Medline, Embase, CINAHL Plus (Cumulative Index to Nursing and Allied Health), PubMed and Web of Science. Databases were searched from 2006 to 2016, and only full text, English language articles were included. Twenty-two observational studies and two surveys were reviewed with sample sizes ranging from six to 206 participants. The majority of studies had small sample sizes and were retrospective in nature. Nevertheless, there is evidence to suggest that there is some degree of weakness and reduced mobility at the shoulder following LD muscle transfer. The literature demonstrates that there is considerable morbidity in the immediate post-operative period with functional recovery varying between studies. The majority of work tends to be limited and often gives conflicting results; therefore, further investigation is required in order to determine underlying factors that contribute to a reduction in function and activities of daily living.

Factors that influence low back pain in people with a stoma.

Purpose: People with a stoma believe that there is a link between their surgery and low back pain (LBP). Aim: To explore factors relating to (i) core stability in people with a stoma and LBP and (ii) biopsychosocial factors related to LBP. Methods: Adults with an ileostomy and LBP (n = 17) completed (i) a range of standardised instruments, (ii) clinical tests and (iii) an ultrasound scan of right and left transversus abdominis (TrA). Results: The findings showed moderate pain and disability: RMDQ: median = 12 (IQR: 9.5–13), EQ-5D health state: mean = 6.9 (±1.75), BPI pain severity: median = 4.5 (IQR: 2.87–5.4). The TrA contraction was less on the operated than the unoperated side and this was linked to less control for BKFO to the operated side, and the presence of a parastomal hernia. Co-morbidities were associated with greater balance problems during the stork test (p < 0.05). Men had more fear avoidance (p < 0.05) on the FABQ regarding physical activity. Discussion: Abdominal function may be altered after stoma surgery leading to reduced ability to perform functional tasks and a possible increased risk of back pain. These results should be viewed with caution due to the small sample size. Implications for Rehabilitation Back pain in people with a stoma is a complex problem including both physical and psychological issues. The ability of transversus abdominis (TrA) to contract efficiently is unclear; however, those with a thinner TrA had poorer balance and core stability (as measured by bent knee fall out). The psychological factors of fear avoidance must be addressed alongside any physical interventions for motor control, muscle strengthening and rehabilitation of function after surgery. This research needs to be repeated with a larger sample due to the small numbers in this exploratory study (n = 17).

Low back pain in people with a stoma: a postal survey.

Purpose. To investigate whether low back pain (LBP) is a problem for people with a stoma. Method. Following ethical approval, a postal questionnaire was sent to the Ileostomy Association of Northern Ireland (n = 402). Results. The response rate was 81.6%. Two hundred ninety three (72.8%) were included in the analysis. The participants fell into three groups: those who never had LBP (n = 102, 34.8%), those who had LBP but not within the last 6 months (n = 26, 8.9%) and those who had LBP within the last 6 months (n = 165, 56.3%). Participants with LBP (n = 165) compared the ease with which they could carry out everyday tasks: ‘before’ and ‘since’ surgery. There was a mean increased difficulty of between 1.75 and 2.26 points across all tasks. The Roland Morris Disability Questionnaire scores ranged from 0 to 24 with 50% having a score of 8/24 or higher. Some participants (n = 76, 46.1%) believed that the stoma surgery was the reason for their back pain, followed by 27.9% (n = 46) blaming weak muscles. Others (53.3%) thought their back pain was worsening. There was a significant rise in the incidence of first episode back pain within a year of surgery. Conclusions. These results suggest that LBP is a problem for people with a stoma.

Do people with an ileostomy have a different back pain experience to those with a colostomy? A postal survey in Northern Ireland

Background. The abdominal muscles play a vital role in lumbar stability. The stoma surgery creates a permanent flaw in the abdominal wall and this may increase the risk of low back pain for people with a stoma. Purpose. To determine whether there was a difference in back pain experience between the two stoma groups: ileostomy and colostomy. Method. A postal questionnaire sent to people in Northern Ireland with an ileostomy or colostomy. Results. Over half (56.7%, n = 417) had back pain in the last 6 months and the primary perceived cause was the stoma surgery. There was a statistically significant deterioration in functional activities in those with back pain when ‘today’ was compared with ‘before surgery’. Those with a colostomy had generally poorer outcomes in respect of pain and disability, than those with an ileostomy. Conclusion. Low back pain in people with a stoma is a real and complex issue, especially as there are significant differences between those with an ileostomy when compared with people with a colostomy. Many factors are likely to contribute to a person developing low back pain, not least, the underlying reason for the surgery and the surgical procedure itself.

Service user involvement in radiotherapy and oncology education; the patient perspective

INTRODUCTION The Health & Care Professions Council (HCPC) recently mandated the integration of the service-user voice into all aspects of allied healthcare education in the UK. However, the potential benefits and harms of this integration to service users are largely unknown. This study aimed to determine service user perspectives on relaying their personal experience of the cancer treatment pathway to students in an undergraduate Radiotherapy and Oncology programme. METHODS A qualitative study was conducted where seven patients led educational sessions with students and were interviewed (1:1) 1 week later using an iterative semi-structured format. RESULTS Unanimously, the primary motivation for participation was the opportunity for patients to tell their unique story to positively influence the future behaviour and understanding of student healthcare professionals. Patients experiencing significant cancer-related psychological trauma reported reacting more emotionally to the experience but also reported particularly positive benefits from their participation, including therapeutic healing. CONCLUSION Findings highlight the array of benefits to service users associated with teaching in allied healthcare education. Post traumatic growth (PTG) may also potentially occur through this type of intervention in certain participants and this warrants further investigation in future studies.

The musculoskeletal consequences of latissmus dorsi breast reconstruction in women following mastectomy for breast cancer

Introduction Current evidence suggests that patients who have latissimus dorsi (LD) breast reconstruction following mastectomy for breast cancer can experience long-term shoulder dysfunction. However, as there is no standardised assessment or follow-up period within the literature, findings are conflicting. This research aimed to investigate the impact on daily living of immediate and delayed LD breast reconstruction in women following mastectomy for breast cancer. Methods Both qualitative and quantitative methods of enquiry were used. A focus group study explored the musculoskeletal consequences of surgery as perceived by the women (n = 15) and their healthcare professionals (n = 11). A questionnaire survey was administered (n = 159), including a range of outcome measures to quantify both the physical and psychosocial impact of LD breast reconstruction. Dyad interviews were also conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman’s perspective and that of her significant other (n = 8). Results The qualitative studies highlighted a lack of preparedness and unrealistic expectations regarding functional recovery among women and their significant others’. Post-surgery it was apparent that women weighed up reduced shoulder function against survival, demonstrating resilience in their approach to coping with this adaptive way of living. The survey identified low to moderate effect on the outcomes assessed (n = 159), however, node removal significantly impacted certain aspects of quality of life (p<0.05) and disability (p = 0.04). Conclusions Breast reconstruction using the LD had an impact on shoulder function and some ADL, which impacted not only on the women but also family and significant others. Despite the functional implications associated with surgery, findings would suggest that shoulder dysfunction is not their main concern. This work identified that women and their significant other require further information to clarify expectation regarding recovery, highlighting the changing priorities of women throughout their journey from diagnosis into long-term recovery.

The extent of playing-related musculoskeletal problems (PRMDs) in the Irish traditional music community. A Survey

BACKGROUND The literature related to playing-related musculoskeletal disorders (PRMDs) primarily includes classical musicians and instrument-specific studies. Previous work by our team identified that PRMDs are an issue for Irish traditional fiddle players; however, the extent of the problem was not known. OBJECTIVE To identify the type and extent of PRMDs in the Irish traditional music population, specifically fiddle players. METHODS A questionnaire was developed and administered to faculty and students related to all Irish traditional music courses in all higher education institutions in Ireland. RESULTS Seven institutions were included. The response rate was 77.5% (n=79 of 102 possible respondents). A fifth of respondents never had a PRMD, 36.7% (n=29) currently had a PRMD, and 34.2% (n=27) had a previous experience of a PRMD. The main symptoms were pain (62%, n=49), stiffness (41.8%, n=33), and tingling (35.4%, n=28). There was a positive association between the development of PRMDs and increased hours of play (p=0.017). CONCLUSIONS PRMDs are a problem for Irish traditional fiddle players, especially during times of intense playing such as festivals.