Do treatment comparisons reflect your circumstances?

What Is Debt Consolidation?

Debt consolidation can be a way to refocus and take back control of your repayments.

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Introducing Earnest Home Loans

We believe the fundamental role of banks and lenders is to help people realize their hopes and dreams. Offering home loans is the necessary next step towards being the lender people deserve.

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O mais novo não é necessariamente melhor

The Effect of Prehabilitation Exercise on Strength and Functioning after Total Knee Arthroplasty in Patients with Osteoarthritis

This blog is a critical appraisal of the following randomized controlled trial:  The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty

Background

Total Knee Arthroplasty (TKA), known as a total knee replacement, are widely performed and very common throughout the globe. In the UK alone there are around 70,000 TKA’s performed each year. Some of these TKA’s are due to inflammatory diseases but most commonly performed for Osteoarthritis (Arthritis Research UK, 2017). Given the popularity of this procedure there is a lack of evidence on pre-habilitation and if there are any benefits of such a program. (McKay, 2017)

The Study

The study was a randomized controlled trial (RCT) in which 54 community-dwelling patients, all scheduled for a unilateral TKA, were recruited from a single orthopaedic office. All patients were above 50 years old and were screened for exclusion criteria for engaging in moderate intensity exercise. The aim of the study was to determine the effects of prehabilitation training on strength and functioning post TKA.

The 54 participants were randomly allocated, 28 to the prehab group and 26 to the control group. The prehab group were asked to participate in at least 3 prehab sessions per week, one under the guidance of research personnel and the other two at home. The prehab group were taught how to conduct each intervention session focusing on resistance, flexibility and step training. This intervention consisted of a 5-minute warm up followed by 9 various lower limb resistance exercises then by a series of various step up exercises and was concluded with stretching and a 5-minute walk.

An outcome measure looking at knee pain using a visual analogue scale (VAS), functional ability, quadriceps strength and strength asymmetry where measured at baseline, 1 week pre and 1 and 3 months post-surgery. The participants where all asked to perform walking distance in 6 minutes, transferring from bed to sitting, negotiating stairs and going from sitting to standing (STS) as many times as they could in 30 seconds.

Results

One week pre surgery the prehab group had significantly increased their STS task whilst the control reported no change in performance and increased pain. At 1 month post-surgery the prehab group still only maintained improved performance in STS tasks whilst the control group had a decrease in 6 minute walking, pain and surgical leg strength and had increased strength asymmetry and non-surgical leg strength. Finally at 3 months post-surgery, the prehab group increased on 3 of the 4 functional tasks, decreased pain and increased strength in both legs whilst the control improved on 2 of the 4 functional tasks, decreased pain but exhibited greater leg length asymmetry.

Pros and Cons

In order to appropriately evaluate the research, understanding-health-research.org will be used as a guideline. Firstly looking at the sample size, there are positive and negatives. The researchers clearly justified the sample size and the recruitment process was to minimise the potential effects of varying surgical techniques and the pre/post-surgical staff and care protocols. However, as mentioned in the study this limits external validity and decreases clinical significance.

The study is a RCT but there is no mention of how the patients were randomly assigned which offers no information to support attempts to eliminate bias. In order to increase internal validity the study mentions that the care staff and health professionals were blinded but again no mention of how this was performed or ensured. The patients themselves were not blinded which possibly means positive expectations of the prehab group may have encouraged participants in the control group to carry out their own exercise (Lewis, 2017).

Throughout the study there was no mention or monitoring of pain medication or how pain was measured, specifically sub-group analysis for male and female participants. This is particularly relevant as pain is said to be more intense in females than males. (Stanford medicine, 2012). Due to possible complications, patient’s pain medication is temporarily stopped before surgery which may have affected the results of the prehab intervention.

One major confounding factor that was noticed during the study was there was no set amount of prehab exercise sessions, these varied from 4 – 23 sessions with only one per week under supervision. Inconsistencies between the prehab training and measuring of functional ability may have affected the results by the change in open/closed chain movements, squat exercises being closed whilst the assessment of quadriceps strength being open chain.

The most significant finding was the improvement of STS in the prehab group. Although this could be down to the similarities the functional task has to the squat exercise done throughout the pre-rehabilitation. This can be supported by the theory of specificity training (LIVESTRONG.COM, 2018).

Conclusion

The study itself supports its original hypothesis but due to several limitations it is unable to have any real clinical significance. Participants not being blinded, number/intensity of prehab sessions, unmonitored consumption of pain medication and the sample size all need to be considered in further studies, along with a longer period of time in order to determine any significant effects and if it is applicable to the wider population.

References

Arthritis Research UK  (2017) Knee replacement surgery. [online] Available at: https://www.arthritisresearchuk.org/arthritis-information/surgery/knee-replacement.aspx [Accessed 13 Dec. 2017].

Lewis S, Warlow CP (2017) How to spot bias and other potential problems in randomised controlled trials. [online] BMJ. Available at: http://jnnp.bmj.com/content/75/2/181 [Accessed 13 Dec. 2017].

LIVESTRONG.COM (2018). What Is Specificity in Exercise? [online] Available at: https://www.livestrong.com/article/548564-what-is-specificity-in-exercise/ [Accessed 3 Jan. 2018].

McKay, C. (2017) Prehabilitation for TKA: Preop and postop benefits. [online] Lower Extremity Review Magazine. Available at: http://lermagazine.com/article/prehabilitation-for-tka-preop-and-postop-benefits [Accessed 13 Dec. 2017].

STANFORD MEDICINE.,( 2012) Women report feeling Pain more Intensely than Men, says study of electronic records [online]. [Viewed 05 January 2018]. Available from: https://med.stanford.edu/news/all-news/2012/01/women-report-feeling-pain-more-intensely-than-men-says-study-of-electronic-records.html

Topp R, Swank AM, Quesada PM, Nyland J, Malkani A (2009). The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty [online] PM R. August;1(8):729-35. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19695525

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The effect of prehabilitation on the range of motion and functional outcomes in patients following total hip or knee arthroplasty

This blog is a critical appraisal of the following randomized controlled trial: The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty

Background

Osteoarthritis is one of the major causes of disability in older adults. It is presenting an increasing financial burden for the National Health in Australia where a study was conducted which featured globally.

Osteoarthritis is usually treated with physiotherapy, exercise and with pharmacology. If those treatments do not provide sufficient results then joint arthroplasty would be the next choice of treatment. Previous studies have shown that patients’ functional ability and pain before the operation are good predictors of how those patients would cope after the surgery. However, extended waiting time before a total knee replacement (TKR) or total hip replacement (THR) can affect their function and may have a domino effect in the future.

Multiple studies have shown a positive improvement in patients’ functional abilities, for example, increased leg strength as well as shortened postoperative recovery time. At present, there is no data available that proves efficacy of prehabilitation in Australian hospital settings.

How was it done

The purpose of this research was to investigate the effects prehabilitation has on quality of life and functional abilities in patients undergoing TKR or THR. Patients were attending twice-weekly group sessions consisting of exercise and education for a period of 3 to a maximum of 4 weeks prior to surgery. This was a prospective randomized controlled trial where only the assessor was blinded, which could affect the final results of the research. Patients were chosen from orthopaedic surgical review clinic. Postoperatively it was ensured that patients had a good understanding of a home exercise program, and health and safety measures were applied. Pain control management was checked with every patient. Patients then attended the CRC group twice weekly. The group was a mixture of pre and post-operative patients and consisted of a maximum of 6 people.

Measures

Primary outcome measures were EQ-5D-3L (European Quality of Life Instrument) and the Patient Specific Functional Scale (PSFS). The EQ-5D is an internationally recognised scale and PSFS is used to measure functional outcomes over a period of time.

There were six secondary outcome measures used. These included:

• active range of movement (AROM) with the use of a goniometer
• ‘Timed Up and Go’ (TUG) test that measures mobility
• length of stay in an acute hospital setting
• length of stay in the Rehabilitation in the Home (RiTH).

Additionally, the proportion of patients requiring inpatient rehabilitation and the frequency of interventions by physiotherapists or occupational therapists were taken into account.

Results

There was a total of 64 participants recruited. Participants were mostly over 60 years old. Both TKR and THR groups had similar joint range, quality of life and physical function. No major differences were found between groups, but trends showed a more positive effect with the group which had undergone a THR. Additionally, there was a substantial improvement in the range of motion in the total knee arthroplasty group. However, these effects did not influence any of the functional tests.

Strengths and weaknesses

The data obtained during the time of the study was of low significance. Even though there were improvements in knee flexion by 13% this had no effect on any of the functional abilities. However, no research was done on the effects of improved knee flexion on quality of life. Both groups achieved more than 90 degrees in range (this is the minimum required to progress to being independent in activities of daily living) (Chiu, Ng, Tang, and Yau, 2002). Further studies are needed to investigate the effects of improved knee flexion on quality of performance in daily activities. The study also found that there was an improvement in EQ-VAS and TUG in patients that underwent prehabilitation before hip arthroplasty, this may also indicate the need for further investigation.

The weakness of the study was that it was targeting the patients who were more likely to be discharged home after the surgery, which meant a healthier cohort of people were chosen, this in effect showed lack of the visible differences in patients discharged from home in comparison to the previous study (Rooks et al, 2006).

The limitation of the study is it was unfunded, the number of therapists treating the patients was small and this could influence blinding. Another limitation was the fact that some of the recruited patients could have access to private health sector and physiotherapy, and this was not measured or controlled by the assessors. The study only focused on a few outcome measures which would not reflect the bigger picture of prehabilitation effects. For example, some other functional tasks were not measured in this research such as stair climbing or sit to stand performance and timed walking tests.

There were few indicators showing improved performance in some tests and knee flexion. Improved knee flexion range has been associated with reduced risk of falls (Shumway-Cook, Brauer and Woolacott, 2000).

Some recent studies have shown improved quality of life and better outcomes. Clearly, more research needs to be done in the prehabilitation effects on postoperative functional abilities.

To achieve better outcomes in future studies the recruitment of the patients should be done more than 4 weeks prior to surgery and number of the exercise classes increased to more than twice weekly. Additionally, the groups of TKR and THR should be assessed separately, and patients that are experiencing much lower levels of performance in activities of functional living should be included in the studies.

References

CAVILL, S., MCKENZIE, K., MUNRO, A., MCKEEVER, J., WHELAN, L., BIGGS, L., SKINNER, E.H., HAINES, T.P., 2016. The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomised trial. Physiotherapy Theory and Practice [online] April, vol. 32, no. 4, pp. 262-270 [viewed 12 January 2018]. Available from: http://dx.doi.org/10.3109/09593985.2016.1138174

CHIU, K.Y., NG, T.P.,YAU, W.P., 2002. Review article: Knee flexion after total knee arthroplasty. Journal of Orthopaedic Surgery [online]. December, vol.10, no 2, pp. 194-202 [viewed online 13 January 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12493934

CRITICAL APPRAISAL SKILLS PROGRAMME (CASP) – MAKING SENSE OF EVIDENCE., 2013. CASP Randomised Controlled Trial Checklist [online]. [Viewed 21 December 2015]. Available from: http://media.wix.com/ugd/dded87_40b9ff0bf53840478331915a8ed8b2fb.pdf

MRC/CSO Social and Public Health Sciences., 2017. Understanding Health Research [online]. viewed 14.January 2018]. Available from: http://www.understandinghealthresearch.org

ROOKS, D.S., HUANG, J., BIERBAUM, B.E., BOLUS, S.A., RUBANO J., CONNOLLY C.E., ALPERT, S., IVERSEN M.D., KATZ J.N., 2006. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis and Rheumatism. October, vol. 15, no. 55, pp. 700-708 [viewed 13 January 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17013852med

SHUMWAY-COOK, A., BALDWIN, M., POLISSAR N.L., GRUBER, W., 1997. Predicting the probability for falls in community – dwelling older adults. Physical Therapy. August, vol. 77, no. 8, pp. 812-819 [viewed online 12 January 2018] Available from: https://trove.nla.gov.au/work/51692403?q&versionId=64632371

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One Woman’s Mission to Save Friends from Student Debt

Meet Samantha Rosenbaum—repeat referral bonus collector and financial hero to her friends.

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6 Things to Look for in a Day Care’s Discipline Policy

The way we discipline our children has a big impact on whom they grow up to be – and the types of parents they become in the future. However, children are spending more of their time at school and daycare centers. The discipline they are receiving in these places shapes their childhood in a major way. When selecting a daycare for your child, it is important to assess their discipline policies.

Here are six things to look out for in a daycare discipline policy:

1. Prevention

Does a daycare center monitor kids to see the initial signs of bad behavior? Most inappropriate actions from young kids are easily spotted. When daycare centers employ preventive methods, they ensure the child understands their behavior is wrong before it becomes a major issue.

2. Consequences

There should be a detailed list of how kids are expected to behave. Parents should have this information before their child enrolls in the daycare center. Moreover, the center should also provide guidance about how children are punished if they break specific rules.

3. Positivity

It is not the job of a daycare center to negatively discipline children, especially for small infractions. If you feel that a daycare center has overly harsh disciplinary policies, you may want to find a better place for your child to spend time. Daycare centers that advocate positivity in response to misbehavior are a much better fit.

4. Time Out

How does the daycare center handle timeouts? Is the time-frame appropriate? Will a teacher talk to the child in the corner before they are reintroduced into the group?

5. Helping a Child

Not every child is the same. Certain children find it easier to interact with others in a big group. Some kids are better equipped to remain calm when they have so many choices and distractions in front of them. Will teachers at the daycare center help a child who is struggling? If the kids are asked to do some activity, but one or two kids are confused on what to do, will teachers help them? Young kids need guidance, not discipline. Finding a daycare center that believes in this philosophy is so important.

6. Communication with Parents

It is vital to enroll your child in a daycare center that believes in open communication with parents. If there is an incident with your child and you only learn about it a month later, it is not good enough. The daycare center must have policies that result in immediate communication with parents when there is a disciplinary or behavioral issue.

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Are the treatments practical in your setting?

Small Changes to Pay Off Your Student Loans Faster

After years of hard work to earn a degree, it can feel like an impossible task to prioritize paying off debt, but it doesn’t have to be.

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Are you very different from the people studied?

Ask Earnest: Money Advice From Our Moms

This Mother's Day, we will all be calling our moms to say thank you for all the good money lessons they shared with us, and recommend you do the same!

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Why Get Pre-Approved for a Mortgage Early

What exactly does pre-approval mean, and how does it affect the home buying process?

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Do the outcomes measured matter to you?

Financial Fitness: Health Advice for Your Wallet

Fitness professionals tend to repeat the same core rules for a healthy lifestyle. But did you realize that many of these core ideas are also great financial health rules?

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Don’t confuse “no evidence of a difference” with “evidence of no difference”

Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care

This blog is a critical appraisal of the following randomized trial: Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care

Background

Cancer related fatigue (CRF) affects 70-80% of cancer patients (Cancer research UK 2016). CRF is different to ‘normal’ fatigue because rest does not ease CRF and it often continues after treatment ends (American Cancer Society 2016). Physiotherapy is of value in the reduction of health problems that cancer can bring, including CRF (CSP 2012). Much research has looked into the use of exercise for patients receiving cancer treatment, however few studies have focused on palliative care. Pyszora et al. (2017) evaluated the use of a physiotherapy programme to reduce CRF in palliative cancer patients.

What did the study do?

Sixty patients from a palliative care department and a hospice met the inclusion criteria. Randomisation into a treatment and control group took place at a ratio of 1:1. One participant from each group died, forming two groups of 29 participants. The treatment group received two weeks of physiotherapy, in 30 minute sessions 3 times weekly. Physiotherapy applied by the same therapist included exercises, myofascial release and proprioceptive neuromuscular facilitation (PNF). The control group for comparison received no physiotherapy input, though normal medication continued for both groups. Primary outcomes were the Brief Fatigue inventory (BFI) and the Edmonton Symptom Assessment Scale (ESAS), measured three times weekly per group. Satisfaction scores (SS) were a secondary outcome in the treatment group only.

What were the results?

Comparing treatment group BFI scores from baseline to end (Wilcoxon test) showed statistically significant differences on all questions of the BFI (p <0.01), indicating decreased fatigue levels.

Comparison of individual ESAS scores from beginning to end of the study showed statistically significant improvements in pain, fatigue, depression, anxiety, drowsiness, well-being and improved appetite (p <0.01) for the treatment group. Comparatively, the control group showed no statistically significant changes.

Treatment group satisfaction at the end of the study was 1.6+/- 0.8 (3 = max, 0 = min).

What were the strengths and weaknesses of the study?

The CASP tool for randomised controlled trials provides the concise and systematic structure for this critical appraisal (CASP 2017).

The study provides a clear aim, population, intervention, comparison and outcomes. It gives justification for the research carried out, and explains the choice of appropriate outcomes. The study only includes patients able to communicate in Polish, therefore research is confined to a smaller population. This lessens applicability of results to the wider population. Each group fell below the sample size calculations outlined, and as a result this study may not be representative.

Randomisation took place using allocation of numbers from an unordered list. Odd and even numbers allocate to either the treatment or control group. The study does not state who carried out this process and no randomisation blinding took place. This leaves potential for randomisation bias because an even or odd number could have been given on purpose.

Further threat to internal validity comes from the distribution of the groups. A control group comprised of 80% females causes groups to be heterogeneous in their makeup. The study states there is no obvious link between gender and results but this potential bias cannot be ruled out.

Using the same therapist to apply all treatment minimises differences between therapists applying techniques differently. Because of the nature of the study, no blinding to treatment took place (patients, therapist or researcher). This poses threat to internal validity as patients or staff could have changed their behaviour to achieve a certain set of results. Providing patients with information about the study means that consent and ethical standards can be met. However, patients may have known what the aims of the study were and the effects of expectation alone may have influenced results. It is unclear whether overall care between the groups is equal as this information is not provided.

A change in medication discontinues participants from the study so that results will not be affected by external factors. However, these results are not included in an intention-to-treat (ITT) analysis to account for this data. Removing the results from the two patients that died may exclude negative data, thus making results less reliable.

SS results state that patients were satisfied with physiotherapy. These mean results, however, show fair spread for the size of scale used (1.6 +/- 0.8 where min. = 0, max. = 3). Comparisons cannot be made between the groups as SS only took place in the treatment group. For this reason, it is difficult to evaluate the clinical significance of these results.

Finally, research states that a reduction of 4 points in ESAS fatigue indicates clinical significance in fatigue reduction (Reddy et al. 2007). ESAS data for the treatment group showed statistically significant reduction in fatigue (6.8 +/- 1.1 vs 4.6 +/- 1.6), however these mean results do not meet this clinical significance.

Conclusion

In conclusion, a physiotherapy programme reduced CRF and other side effects of advanced cancer. This indicates that physiotherapy may be a useful treatment for this patient group, but this trial was too small to have large implications on clinical practice. Larger trials are therefore necessary to increase the reliability and applicability of results.

 

References

AMERICAN CANCER SOCIETY., 2016. What is cancer related fatigue? [online] [viewed 20 December 2017]. Available from: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fatigue/what-is-cancer-related-fatigue.html

CANCER RESEARCH UK., 2016. What is cancer fatigue? [online] [viewed 20 December 2017]. Available from: http://www.cancerresearchuk.org/about-cancer/coping/physically/fatigue/what-is-cancer-fatigue

CASP (2017). CASP Randomised Controlled Trial Checklist [online] [viewed 20 December 2017). Available from: http://www.casp-uk.net/casp-tools-checklists

CSP., 2012. Physiotherapy works: cancer survivorship [online] [viewed 20 December 2017]. Available from: http://www.csp.org.uk/publications/physiotherapy-works-cancer-survivorship

PYSZORA, A., BUDZYNSKI, J., WOJCIK, A., PROKOP, A., KRAJNIK M., 2017. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial. Support care cancer [online]. September, vol. 25, no. 9, pp. 2899-2908 [viewed 20 December 2017]. Available from: https://www.researchgate.net/publication/316992206_Physiotherapy_programme_reduces_fatigue_in_patients_with_advanced_cancer_receiving_palliative_care_randomized_controlled_trial

REDDY, S., BRUERA, E., PACE, E., ZHANG, K., REYES-GIBBY, CC., 2007. Clinically important improvement in the intensity of fatigue in patients with advanced cancer. Journal of Palliative Medicine. November, vol. 10, no. 5, pp. 1068-1075. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17985963

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The Effect of Physiotherapy on Shoulder Function in Patients Surgically Treated for Breast Cancer

This blog is a critical appraisal of the following randomized trial: The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: A randomized study.

Background

Breast cancer is currently the most prevalent cancer among women worldwide with over 50,000 women, within the UK alone, being diagnosed every year (Breast Cancer Now, 2016). The survival rate of women diagnosed with this type of cancer is increasing year on year due to the variety of treatments which can be used.

Research has been undertaken to evaluate the effectiveness of physiotherapy on upper limb function by using control groups, in which one group receives more intensive physiotherapy input. However, much of the research undertaken considers how to minimize breast cancer patients from getting lymphoedema after surgery by using physiotherapy rather than the general effects of upper limb function post-surgery. One study concluded that there was a gap in research undertaken which specifically considered shoulder mobility post-surgery (TENGRUP, I., et al 2000).

What the Study entailed

A total of 139 patients were enrolled within this trial as they met the inclusion requirements. Fourteen patients later dropped out due to various reasons resulting in 125 patients completing the trial. The intervention consisted of the patients being enrolled into either group A or group B. Both groups were offered standard physiotherapy treatment within the ward and were also offered team instructed physiotherapy group sessions which consisted of 12 sessions lasting 60 minutes each, two sessions per week. Group A’s intervention commenced during weeks 6-8 post operation. This differed to group B as their intervention did not commence until 26 weeks post operation. The same two physiotherapists were included to instruct the group exercise sessions and the exercise programme used was specifically constructed for this research. Therefore, no individual therapy was applied.

All patients were seen post-surgery in weeks 6, 12, 26 and 56 by the same physician, therefore increasing reliability of the outcome measure. At these examinations, the patients’ shoulder mobility was assessed by using the Constant Shoulder Score outcome measure. The physician compared the score on the operated arm to the contra lateral arm, so they could gauge a baseline score. All patients were randomised into their group individually by a computer-generated programme and their placing was kept by a third person, who was not part of the trial, in sealed, opaque envelopes.

The results

The results of this study found that there was no difference in shoulder function between groups A and B pre-operatively and at the first follow-up. However, at the second and third follow-up examination, it was found that group A had significantly better shoulder function than those in group B. Nevertheless, at the fourth follow-up, after both groups had commenced the group physiotherapy treatment, once again there was no substantial difference found between the two groups.

Strengths and Weaknesses of this Study

To be able to critically appraise this study effectively, the Understanding Health Research tool for analysing health studies was used.

This study has a clear research question and aims which include covering the aspects of population, intervention, control group and outcome measures. The researchers created a trial protocol prior to starting, which means that the methods could not be changed throughout the study as this could affect the results. This research explains in detail the reasons why some of the patients dropped out of the trial allowing them to be accounted for.

The study states that all patients were randomised individually by a computer-generated programme. These allocations were undertaken by a third-party member who was not part of the trial to try and keep it blinded. However, throughout the study, there is no mention that the patients have been blinded so that they are unaware of which group they are in. It also states that there was unsuccessful blinding of the physiotherapists as they were aware of which patients were in each group. This is a weakness of the study as it allows there to be bias, resulting in the internal validity of this research being compromised.

The results are clearly explained and show that although there were significant differences in shoulder function throughout different stages of the trial. After the fourth follow-up, there was found to be no significant difference between the two groups. However, although all patients received the same physiotherapy treatment by the end of the trial, the patients had varying types of surgical treatment. For example, some had Breast Conserving Therapy (BCT), others a Modified Radical Mastectomy (MRM) and few were also offered Radiation Therapy (RT).  Therefore, the results also concluded that there were differences in shoulder function depending on what surgical intervention had been provided. Other research undertaken has found that surgery such as a mastectomy can result in patients having greater impairments compared to other surgical interventions (EWERTZ., M et al, 2010). Hence, there is a requirement for more research to be done regarding how different types of surgery affect shoulder function after operations.

Conclusion

This study concluded that group instructed physiotherapy sessions help to improve shoulder function in patients who undergo breast cancer surgery. It was found that patients undergoing BCT had better outcomes of improved shoulder mobility than patients undergoing MRM. Therefore, more specific research would need to be undertaken to make the research more reliable for a wider population.

References

Breast Cancer Now., 2016. Breast Cancer Facts [online] [viewed 04 January 2018]. Available from: http://breastcancernow.org/about-breast-cancer/want-to-know-about-breast-cancer/breast-cancer-facts

EWERTZ, I., and JENSEN, A., 2010. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncologica [online]. August, vol. 50, no.2, pp. 187-193. [viewed 04 January 2018]. Available from: http://www.tandfonline.com/doi/full/10.3109/0284186X.2010.533190?src=recsys

LAURIDSEN, M.C., CHRISTIANSEN, P. and HESSOV, I., 2004. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: A randomized study. Acta Oncologica [online]. July, vol. 44, no. 5, pp. 449-457. [viewed 29 December 2017]. Available from: http://www.tandfonline.com/doi/full/10.1080/02841860510029905

TENGRUP, I., TENNYALL-NITTBY, L., CHRISTIANSSON, I., and LAURIN, M., 2000. Arm Morbidity after Breast-conserving Therapy for Breast Cancer. Acta Oncologica [online]. July, vol. 39, no. 3, pp. 393-397. [viewed 03 January 2018]. Available from: https://www.tandfonline.com/doi/abs/10.1080/028418600750013177

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Don’t confuse “statistical significance” with “importance”