Mary Insana Fisher

Effects of Yoga on Arm Volume among Women with Breast Cancer Related Lymphedema: A Pilot Study

Lymphedema affects 3-58% of survivors of breast cancer and can result in upper extremity impairments. Exercise can be beneficial in managing lymphedema. Yoga practice has been minimally studied for its effects on breast cancer related lymphedema (BCRL). The purpose of this study was to determine the effect of yoga on arm volume, quality of life (QOL), self-reported arm function, and hand grip strength in women with BCRL. Six women with BCRL participated in modified Hatha yoga 3×/week for 8 weeks. Compression sleeves were worn during yoga sessions. Arm volume, QOL, self-reported arm function, and hand grip strength were measured at baseline, half-way, and at the conclusion of yoga practice. Arm volume significantly decreased from baseline (2423.3 ml ± 597.2) to final measures (2370.8 ml ± 577.2) (p = .02). No significant changes in QOL (p = .12), self-reported arm function (p = .34), or hand grip strength (p = .26) were found. Yoga may be beneficial in the management of lymphedema.

Oncology Section Task Force on Breast Cancer Outcomes: An Introduction to the EDGE Task Force and Clinical Measures of Upper Extremity Function

&NA; With the proliferation of outcome measures in the literature, many of which lack documentation of sufficient psychometric properties to justify use, it is difficult to document patient change or demonstrate effectiveness of interventions. The goal of the Section on Researchs EDGE (Evaluation Database to Guide Effectiveness) Task Force is to facilitate identification of valid and reliable tests and measures that reflect clinically important outcomes and are responsive to change for standard use across selected patient groups. This paper lays the groundwork for understanding the work of the Oncology Sections Breast Cancer EDGE Task Force on clinical measures of shoulder function including range of motion and muscle length, upper extremity function, and scapular position and movement, as reported in the 3 papers that follow.

The Power Of Empowerment: An ICF-Based Model to Improve Self-Efficacy and Upper Extremity Function of Survivors of Breast Cancer

&NA; Breast cancer is one of the most frequently diagnosed cancers among women. Breast cancer treatments often negatively impact the function of the arm, and quality of life and upper extremity function does not always return to a prediagnosis level. Survivors of breast cancer may also experience feelings of diminished self‐efficacy related to functional deficits resulting from their physical limitations. The International Classification of Functioning (ICF) provides a framework for rehabilitation practitioners to address physical and psychological impairments, activity limitations, and participation restrictions. Patient outcomes may be improved by fostering self‐efficacy through empowerment. This paper explores how the ICF model and theories of self‐efficacy and empowerment can interact to promote improved rehabilitation outcomes for women who have survived breast cancer. A model for the role of rehabilitation practitioners to enhance self‐efficacy through empowerment in order to minimize participation restrictions resulting from upper extremity morbidities is proposed.

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.

Oncology Section Task Force on Breast Cancer Outcomes: Scapular Assessment

Background: Functional deficits and changes in scapular mechanics following breast cancer (BC) treatments have been documented. Scapular assessment is important when examining the shoulder in survivors of breast cancer to document the need for or effectiveness of physical therapy intervention. The Oncology Section Task Force on Breast Cancer Outcomes sought to identify scapular examination tools that can be recommended for routine use in individuals treated for BC. Methods: A systematic review of the literature on scapular measures was conducted. Relevant studies were examined for psychometric properties and clinical usefulness. Each method was given a recommendation score based on the Breast Cancer EDGE (Evidence Database to Guide Effectiveness) criteria. Results: Only Dynamic Motion Assessment was recommended for clinical use. The remaining tools lacked either good psychometric properties or clinical usefulness. Conclusions: Measurement of scapular motion remains a challenge and reliable and valid measures must precede further research into scapular problems among survivors of breast cancer.

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.

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 Rehabilitation: Clinical Examination and Outcomes Assessment

Breast cancer is the most commonly diagnosed cancer in women in the United States. The treatment for breast cancer occurs along a protracted time period and includes many different disease treatment modalities. These treatments carry with them a large number of side effects that negatively impact function in both the short-term and long-term. It is necessary for rehabilitation providers to interface with patients being treated for breast cancer throughout the continuum of care so that interval assessments can be conducted to identify emerging impairments and alleviate disability. In order to achieve this, the rehabilitation provider must have an understanding of the clinical measurement tools best suited for examination and assessment of breast cancer-related impairments and disability. This article aims to provide a comprehensive overview of the evidence supporting the use of various clinical measurement tools for the breast cancer population and highlights the implementation of rehabilitation examination and assessment along the continuum of disease treatment.