Disorders Of Upper Extremity Research Articles

WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP): Factor Analysis and Internal Consistency

ObjectiveTo test a 17-item questionnaire, the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP), for dimensionality of the items (factor analysis) and internal consistency. DesignCross-sectional study. SettingOutpatient clinic. ParticipantsA consecutive sample of patients (N=150) consisting of all new referral patients (either from a general physician or other hospital) who visited the orthopedic outpatient clinic because of an upper extremity musculoskeletal disorder. InterventionsNot applicable. Main Outcome MeasuresNumber and dimensionality of the factors in the WORQ-UP.Results: Four factors with eigenvalues (EVs) >1.0 were found. The factors were named exertion, dexterity, tools & equipment, and mobility. The EVs of the factors were, respectively, 5.78, 2.38, 1.81, and 1.24. The factors together explained 65.9% of the variance. The Cronbach alpha values for these factors were, respectively, .88, .74, .87, and .66. ConclusionsThe 17 items of the WORQ-UP resemble 4 factors—exertion, dexterity, tools & equipment, and mobility—with a good internal consistency.

Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review.

The EuroQol-5 Dimension (EQ-5D) is the most widely used generic instrument to measure quality of life (QoL), yet its application in upper extremity orthopaedics as well as its measurement properties remain largely undefined. We implemented a systematic literature review to provide an overview of the application of EQ-5D in patients with upper extremity disorders and analyse its measurement properties. We searched Medline, EMBASE, Cochrane and Scopus databases for clinical studies including orthopaedic patients with surgical interventions of the upper extremity who completed the EQ-5D. For all included studies, the use of EQ-5D and quantitative QoL data were described. Validation studies of EQ-5D were assessed according to COSMIN guidelines and standard measurement properties were examined. Twenty-three studies were included in the review, 19 of which investigated patients with an intervention carried out at the shoulder region. In 15 studies, EQ-5D assessed QoL as the primary outcome. Utility index scores in non-trauma patients generally improved postoperatively, whereas trauma patients did not regain their recalled pre-injury QoL levels. EQ-5D measurement properties were reported in three articles on proximal humerus fractures and carpal tunnel syndrome. Positive ratings were seen for construct validity (Spearman correlation coefficient ≥ 0.70 with the Short Form (SF)-12 or SF-6D health surveys) and reliability (intraclass correlation coefficient ≥ 0.77) with intermediate responsiveness (standardised response means: 0.5-0.9). However, ceiling effects were identified with 16-48% of the patients scoring the maximum QoL. The methodological quality of the three articles varied from fair to good. For surgical interventions of the upper extremity, EQ-5D was mostly applied to assess QoL as a primary outcome in patients with shoulder disorders. Investigations of the measurement properties were rare, but indicate good reliability and validity as well as moderate responsiveness in patients with upper extremity conditions.

Chronic Health Risks in Commercial Fishermen: A Cross-Sectional Analysis from a Small Rural Fishing Village in Alaska

ABSTRACTObjectives: The purpose of this study is to evaluate chronic health risks before and during the fishing season in a sample of commercial fishermen, addressing the NIOSH priority of Total Worker HealthTM.Methods: Gillnet license holders in Cordova, Alaska (n = 607) were contacted to participate in a preseason survey (March 2015) assessing health behaviors. A mid-season survey (July 2015) was also conducted. Physical exams and additional assessments were performed on a subset of these fishermen.Results: Sixty-six fishermen participated in the preseason survey and 38 participated in the mid-season survey. The study population was overwhelmingly white males with an average age of 49. The average BMI was 27 with 70% of the participants overweight or obese. Nearly 80% of the sample considered their health good or better. Participants reported longer working hours, less sleep, and less aerobic exercise during the fishing season (P < .05). FitBitTM monitoring (n = 8) confirmed less sleep and fewer steps during fishing season. In one exam (n = 20), 80% of participants showed measured hearing loss at 4 kz (conversation range), and 70% had one or more upper extremity disorders, including 40% with rotator cuff tendonitis.Conclusions: The prevalence of hearing loss, upper extremity disorders, and sleep apnea risk factors were higher than in the general population both before and during the fishing season. Occupational factors including exposure to noise, the upper extremity demands of gillnetting, and long working hours while fishing exacerbate these chronic health conditions. Health promotion programs targeted toward these conditions may present opportunities for improving total worker health.

Seasonal Variation in the Prevalence of Common Orthopaedic Upper Extremity Conditions

Introduction Seasonal variation in disease processes and injuries have been reported, but it is unclear if this variation exists in upper extremity disorders. The goal of this study is to characterize seasonal and weather variations in common upper extremity orthopaedic conditions. Methods This cross-sectional study reviewed 68,943 consecutive, new patient visits from January 2010 to September 2015 for carpal tunnel syndrome (CTS), trigger finger (TF), DeQuervain's tenosynovitis (DeQ), lateral epicondylitis (LE), hand arthritis (OA), and distal radius fractures (DRF). Presentation rates for each condition were compared across month, season, and various weather parameters. Results DRF, OA, and LE had a higher rate of presentation in the winter compared with all other seasons ( p < 0.001). TF and DeQ showed no statistically significant seasonal differences. Higher barometric pressures were associated with higher rates of all of the diagnoses. Higher humidity was associated with lower rates of CTS, TF, DeQ, LE, and DRF ( p < 0.001). There was no significant association between temperature levels or amount of precipitation. Discussion Although the precise mechanism remains unclear, there does appear to be an impact of winter, increased barometric pressure, and higher humidity on presentation rates. Further studies are needed to determine more conclusively why this occurs. Level of Evidence Level IV, cross-sectional study.

The responsiveness of the PROMIS instruments and the qDASH in an upper extremity population

BackgroundThis study evaluated the responsiveness of several PROMIS patient-reported outcome measures in patients with hand and upper extremity disorders and provided comparisons with the qDASH instrument.MethodsThe PROMIS Upper Extremity computer adaptive test (UE CAT) v1.2, the PROMIS Physical Function (PF) CAT v1.2, the PROMIS Pain Interference (PI) CAT v1.1 and the qDASH were administered to patients presenting to an orthopaedic hand clinic during the years 2014–2016, along with anchor questions. The responsiveness of these instruments was assessed using anchor based methods. Changes in functional outcomes were evaluated by paired-sample t-test, effect size, and standardized response mean.ResultsThere were a total of 255 patients (131 females and 124 males) with an average age of 50.75 years (SD = 15.84) included in our study. Based on the change and no change scores, there were three instances (PI at 3 months, PI >3 months, and qDASH >3 months follow-ups) where scores differed between those experiencing clinically meaningful change versus no clinically meaningful change. Effect sizes for the responsiveness of all instruments were large and ranged from 0.80–1.48. All four instruments demonstrated high responsiveness, with a standardized response mean ranging from 1.05 to 1.63.ConclusionThe PROMIS UE CAT, PF CAT, PI CAT, and qDASH are responsive to patient-reported functional change in the hand and upper extremity patient population.

ACCUMULATIVE REPETITIVE STRAIN INJURY AMONG BUSINESS PROCESS OUTSOURCING EMPLOYEES: A SURVEY STUDY

Objective: Computer overuse syndrome or repetitive strain injury is the most common problem among the people in all age groups. Several studies have found the adverse effect of using computers for a long duration. In the modern tech-savvy world, usage of computers is something unavoidable. The objective of this survey study is to find out the accumulative repetitive strain injury among the business process outsourcing employees.Methods: This study was conducted in different business process outsourcings in Noida, and a convenient sampling method was used to collect data through Neck Pain Disability Index (NPDI) and disabilities of the arm, shoulder and hand (DASH) questionnaire. The study comprised of total 230 subjects.Results: The mean and standard deviation (SD) of NPDI score was found to be 32.12 and 11.26, respectively, whereas the mean and SD for DASH score was 24.34 and 7.44, respectively. The Chi-square value for NPDI and DASH was found to be 263.043 and 139.461. The study shows that upper extremity pain is a common problem in employees working in the IT sector. The employees showed high rates of computer use–associated with upper extremity musculoskeletal symptoms and symptom-related functional limitation.Conclusion: The findings of the study suggest a need to begin to evaluate interventions and to reduce the risks of developing computer overuse syndrome such as developing upper extremity symptoms, disability, and disorders among employees working in the IT sector who use computers for more than 40 hrs/week. Intervention to reduce symptoms should include effective training in work rest patterns, good-working postures coupled with availability of appropriate equipment.

Development of a novel WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP)

PurposeThe aim of this study is to develop a patient-reported outcome measure (PROM) that identifies work-related limitations among patients with upper extremity musculoskeletal disorders in order to enhance work-directed care in daily orthopaedic practice, and to assess its content validity.MethodsThe questionnaire was developed following the evaluation of existing PROMs and consensus within the research team. The content validity was assessed in three steps: (1) one on one interviews with patients (n = 14) were held to discuss the clarity and possible adaptation of items; (2) experts from the field (physiotherapists, insurance physicians, occupational health physicians, rehabilitation physicians and orthopaedic surgeons) were approached to participate in an interview to discuss the clarity, relevance and missing items; (3) patients (n = 12) were interviewed one on one to discuss the final version.ResultsThe first version of the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP) consisted of 18 items based on the criteria: exertion, dexterity, handling tools & equipment, and mobility. According to patients (n = 14), 44% of the items were not easy enough to understand. Twenty-one experts [10 men, mean age 46 (SD = 8.5) and mean years of experience 16 (SD = 9.9)] participated in the interviews and adaptations were made. The final version of the WORQ-UP consisted of 17 items, all easy enough to understand according to patients (n = 12).ConclusionsA PROM specific for work-related limitations in patients with upper extremity musculoskeletal disorders was developed. According to patients and experts, it has sufficient content validity. The WORQ-UP can be used to assist in enhancing communication among healthcare workers to improve work-directed care and to evaluate effects of treatment on limitations at work.

The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis

Patients who receive workers' compensation often display worse surgical results, such as prolonged pain or reduced functional ability. The outcomes of surgery can be assessed using a variety of surveys, assessments, and measurements. It is unknown whether the confounding effect differs based on how results are measured. The aim of this study was to determine whether these variations exist. A search of full-length articles published between January 1, 1995, and December 31, 2015, was conducted using 3 online databases. The authors performed a systematic review and meta-analysis using unique inclusion criteria for each. A total of 101 articles were included in the systematic review; 62 of them were retained for the meta-analysis. In the systematic review, 70 percent of studies found that patients receiving workers' compensation had significantly worse postoperative results than uncompensated patients, whereas only 42 percent of studies that measured preoperative versus postoperative improvement were influenced by workers' compensation. The meta-analysis found that uncompensated patients were more likely to experience improvement after surgery than patients receiving workers' compensation (summary OR, 3.17; 95 percent CI, 2.47 to 4.08). A subgroup analysis demonstrated that functional measures, such as grip strength or nonunion, were least affected by workers' compensation, compared with other outcome measures such as patient-reported outcomes questionnaires or time off work. Potential bias introduced by workers' compensation can be mitigated by evaluating surgical treatment of work-related upper extremity disorders using preoperative versus postoperative improvement or functional measures.

Experts' perspective on a definition for delayed return-to-work after surgery for nontraumatic upper extremity disorders: Recommendations and implications

Study DesignDescriptive study. IntroductionA delayed return to work (RTW) is often associated with poorer outcomes after a workplace injury but is ill defined. Purpose of the StudyTo define delayed RTW after surgery for nontraumatic upper extremity conditions. MethodsExperts were consulted to define delayed RTW and whether a universal time point can determine the transition from early to delayed RTW. ResultsForty-two experts defined a delayed RTW as either a worker not returning to preinjury (or similar) work within the expected time frame (45%); not returning to any type of work (36%); or recovering slower than expected (12%). Two-thirds of experts believed that universal time points to delineate delayed RTW should be avoided. DiscussionMultiple factors complicate a uniform definition of delayed RTW. ConclusionDefining delayed RTW should be individualized with due consideration to the type of work. Time-based cutoffs for outcome measurement may not be appropriate with continuous measures more appropriate in research. Level of EvidenceDecision analysis V.

Upper extremity disorders in heavy industry workers in Greece.

AIMTo investigate the disability due to musculoskeletal disorders of the upper extremities in heavy industry workers.METHODSThe population under study consisted of 802 employees, both white- and blue-collar, working in a shipyard industry in Athens, Greece. Data were collected through the distribution of questionnaires and the recording of individual and job-related characteristics during the period 2006-2009. The questionnaires used were the Quick Disabilities of the Arm, Shoulder and Hand (QD) Outcome Measure, the Work Ability Index (WAI) and the Short-Form-36 (SF-36) Health Survey. The QD was divided into three parameters - movement restrictions in everyday activities, work and sports/music activities - and the SF-36 into two items, physical and emotional. Multiple linear regression analysis was performed by means of the SPSS v.22 for Windows Statistical Package.RESULTSThe answers given by the participants for the QD did not reveal great discomfort regarding the execution of manual tasks, with the majority of the participants scoring under 5%, meaning no disability. After conducting multiple linear regression, age revealed a positive association with the parameter of restrictions in everyday activities (b = 0.64, P = 0.000). Basic education showed a statistically significant association regarding restrictions during leisure activities, with b = 2.140 (P = 0.029) for compulsory education graduates. WAI’s final score displayed negative charging in the regression analysis of all three parameters, with b = -0.142 (P = 0.0), b = -0.099 (P = 0.055) and b = -0.376 (P = 0.001) respectively, while the physical and emotional components of SF-36 associated with movement restrictions only in daily activities and work. The participants’ specialty made no statistically significant associations with any of the three parameters of the QD.CONCLUSIONIncreased musculoskeletal disorders of the upper extremity are associated with older age, lower basic education and physical and mental/emotional health and reduced working ability.

Qualitative Evaluation of Digital Hand X-rays Is Not a Reliable Method to Assess Bone Mineral Density.

The gold standard for evaluating bone mineral density is dual energy x-ray absorptiometry (DEXA). Prior studies have shown poor reliability using analog wrist X-rays in diagnosing osteoporosis. Our goal was to investigate if there was improved diagnostic value to visual assessment of digital hand X-rays in osteoporosis screening. We hypothesized that similar to analog counterparts, digital hand X-rays have poor correlation and reliability in determining bone mineral density (BMD) relative to DEXA. We prospectively evaluated female patients older than 65 years who presented to our hand clinic with digital hand and wrist X-rays as part of their evaluation over six months. Patients who had a fracture and were without DEXA scans within the past two years were excluded. Five fellowship-trained hand surgeons, blinded to DEXA T-scores, evaluated the x-rays over two assessments separated by four weeks and classified them as osteoporotic, osteopenic, or normal BMD. Accuracy relative to DEXA T-score, interobserver and intraobserver rates were calculated. Thirty four patients met the inclusion criteria and a total of 340 x-rays reviews were performed. The assessments were correct in 169 cases (49%) as compared to the DEXA T-scores. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) reflecting a fair agreement. The first and second assessment for all five physicians was 0.46 (range 0.19-0.78) reflecting a moderate agreement. Grouping osteoporosis and osteopenia together compared to normal, the accuracy, interobserver and intraobserver rates increased to 63%, 0.42 and 0.54 respectively. Abnormally low BMD is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy relative to DEXA scan and only fair agreement in diagnosing osteoporosis using visual assessments of digital x-rays.

Validation of the shoulder36 for the activities of daily living with shoulder disorders.

[Purpose] The Shoulder36 (V 1. 3) is a regional questionnaire in Japan that has not been validated as a functional evaluation of the shoulder via a thorough comparison with other questionnaires (e.g., QuickDASH). The purpose of this study was to test the reliability, validity, and responsiveness of the Shoulder36 (V 1. 3). [Subjects and Methods] A series of 46 patients with upper extremity disorders completed the Shoulder36 (V 1. 3) and the QuickDASH Japanese version (QuickDASH-JSSH). The reliability of the Shoulder36 was assessed for consistency and validity. The correlation coefficients between the Shoulder36 (V 1. 3) and the QuickDASH-JSSH were obtained. [Results] The total of the Cronbach’s alpha coefficients for the Shoulder36 (V 1. 3) was 0.98. The intraclass correlation coefficients for the six domains of the Shoulder36 (V 1. 3) were similarly high, ranging from 0.81 to 0.94. The correlations between the six domains of the Shoulder36 (V 1. 3) and the three domains of the QuickDASH subscales ranged from −0.43 to −0.78. [Conclusion] The Shoulder36 (V 1. 3) was able to evaluate the relationship between activities of daily living and shoulder joint function with the same degree of accuracy but in more detail than QuickDASH-JSSH. Therefore, it should prove to be a valuable asset in physiotherapy plans and have multiple research applications.

Ergonomic evaluation of an alternative tool for cake decorating

AimCake decorating involves several hand intensive steps with high grip force during the application of icing. The purpose of this laboratory study was to evaluate forearm muscle activity, discomfort, productivity, and usability of an alternative tool for cake decorating compared to decorating with the traditional piping bag. MethodsParticipants (n = 17) performed 2 h of cake decorating tasks using the two tools. Subjective hand and arm fatigue, usability, upper extremity posture, and muscle activity from three forearm muscles were assessed for each tool. Outcome measures were evaluated using the Wilcoxon Signed Rank test and the paired t-test. ResultsLess fatigue was reported in the dominant hand (p = 0.001), forearm (p = 0.003) and shoulder (p = 0.02) for the alternative tool when compared to the piping bag. Average median (APDF 50%) and peak (APDF 90%) muscle activity was significantly less for the alternative tool across all three forearm muscles. The alternative tool significantly reduced grip force, an important risk factor for distal upper extremity pain and disorders. Participants rated usability of the alternative tool superior for refill and comfort but the traditional method was rated better for accuracy, stability, positioning and control. ConclusionsThe alternative tool was associated with less dominant arm fatigue, muscle activity, and grip force when compared with the piping bag. However, the alternative tool did not receive the best overall usability rating due to problems with accuracy and overflow, especially with smaller decorating tips. Recommendations were made for addressing these problems with the alternative tool.

Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand: A Systematic Review.

Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.

Predictors of Disability and Quality of Life With an Upper-Extremity Peripheral Nerve Disorder.

We sought to understand the wide range of problems that patients with upper-extremity peripheral nerve disorders experience and to identify predictors of disability and quality of life (QOL). Data from standardized assessments of disability and QOL, physical examination results, and intake surveys from 627 patients were analyzed using descriptive and inferential statistics. We compared results between groups and built multivariate models measuring disability, work disability, and physical and mental QOL. The sample demonstrated substantial disability and even greater work disability, which both closely correlated with poorer QOL. Work status was integral in predicting disability. Common predictors across models included problems with sleep and intimate relationships, deficits in work and household performance, and higher pain. To decrease disability and improve QOL, occupational therapy practitioners should help patients with upper-extremity peripheral nerve disorders identify strategies to maintain meaningful work and household roles, intimate relationships, and sleep, while continuing to address pain.

The Correlation Between a Numerical Rating Scale of Patient Satisfaction With Current Management of an Upper Extremity Disorder and a General Measure of Satisfaction With the Medical Visit.

Background: Patient satisfaction is used as an indicator of quality of care, but the measures currently available are lengthy and cumbersome and may not be feasible in orthopedic surgical practices. We set out to assess the relationship between the Medical Interview Satisfaction Scale (MISS-21) and a numerical rating scale (NRS) of patient satisfaction with current management of an orthopedic upper extremity condition. Methods: In this cross-sectional study, 86 patients from the practices of 2 hand surgeons were included during an initial or follow-up visit. Questionnaires assessing demographics, upper extremity specific disability, pain during rest and activity, satisfaction with the medical visits (MISS-21), and satisfaction with current management of an orthopedic upper extremity condition (NRS satisfaction) were completed. Results: Eighty-six patients completed all questionnaires. A small correlation of .21 (P = .050) was found between the MISS-21 and the NRS satisfaction. In bivariate analysis, NRS pain at rest and during activity had small correlations with the MISS-21 (-.29, P = .05 and -.23, P = .034) and with NRS satisfaction (-.27, P = .011 and -0.27, P = 0.012). Quick Disability of Arm, Shoulder and Hand (QuickDASH) had a small correlation with NRS satisfaction (-0.023, P ≤ 0.001), but did not correlate with MISS-21. Conclusions: Although there is small overlap about the 2 satisfaction measures, a complex patient satisfaction questionnaire consisting of multiple facets of patient satisfaction like MISS-21 is not replaceable by 1 simple NRS patient satisfaction question.

Multifactor association of job, individual and psychosocial factors in prevalence of distal upper extremity disorders and quantification of job physical exposure

The objective of this study was to develop a multifactor model of job, individual and psychosocial factors in prevalence of distal upper extremity musculoskeletal disorders (DUE MSDs); and quantify job physical exposure to establish safe exposure limits. The study sample comprised of 525 workers who were part of a large prospective cohort study and represented a broad array of industrial practices and a wide range of job physical exposure. Only baseline data was considered for the analysis in the study. Workers underwent laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current DUE MSDs. All workers' jobs were individually measured for job physical exposure factors and videotaped. Binomial logistic regression was used to develop and test the multifactor association and quantification of job physical exposure for safe exposure limits. Results indicated that work-related DUE MSDs are multifactor in nature and are significantly affected by specific factors of (1) job physical exposure - percentage duration of exertion (PDOE), workers' subjective ratings of perceived effort or intensity of exertion (IOE) (using Borg CR-10), hand activity level measured by the American conference of Governmental Industrial Hygienists (ACGIH) threshold limit value for hand activity level (TLV for HAL), and presence of 2-point pinch grasps; (2) individual factors - female gender, diabetes, higher body mass index (BMI), and past and current smokers; (3) psychosocial factors - neither likely/unlikely or very unlikely to take up the current job again, divorced/separated, and presence of family problems. Quantification of job physical exposure indicated that prevalence of work-related DUE MSDs significantly increases with efforts per minute (Eff/min) >8 (OR = 1.69, p = 0.006) and woker's perceived effort based on Borg rating for IOE at the end of the shift >3 (OR = 2.46, p < 0.001). Further studies should be conducted to validate these safe exposure limit criteria.

Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study

The aim was to examine whether texting on a mobile phone is a risk factor for musculoskeletal disorders in the neck and upper extremities in a population of young adults.In a longitudinal population-based cohort study with Swedish young adults (aged 20–24 years) data were collected via a web-based questionnaire at baseline (n = 7092) and after one and five years. Cross-sectional associations were found between text messaging and reported ongoing symptoms in neck and upper extremities (odds ratios, ORs 1.3–2.0). Among symptom-free at baseline prospective associations were only found between text messaging and new cases of reported symptoms in the hand/fingers (OR 2.0) at one year follow up. Among those with symptoms at baseline prospective associations were found between text messaging and maintained pain in neck/upper back (OR 1.6). The results imply mostly short-term effects, and to a lesser extent, long-term effects on musculoskeletal disorders in neck and upper extremities.

Effectiveness of Pilates-based exercises on upper extremity disorders related with breast cancer treatment

Breast cancer treatment causes upper extremity (UE) impairments. This study aims to assess the efficacy of Pilates-based exercises (PE) in comparison with combined exercise (CE) and home exercise (HE) groups, in the rehabilitation of UE disorders related with breast cancer treatment. Fifty-five patients were randomly allocated to PE, CE (consisting of strengthening, stretching and range of motion [ROM] exercises) and HE groups (consisting of CE group exercises). Pain (using visual analogue scale), ROM (using digital goniometer), muscle strength (using dynamometer and pinch gauge), functional status (using Constant-Murley scale and Disabilities of the Arm, Shoulder and Hand scale) were evaluated before and after intervention. For data analyses (using spss 21 version), one-way ANOVA, paired samples t-test and Kruskal-Wallis test were performed (p≤.05 was considered statistically significant). The data obtained in this study revealed significant improvements in almost all the parameters measured in the PE and CE groups, and some improvements were superior to HE group. PE seemed to have resulted similar improvements in pain, muscle strength and functional status when compared to CE group. Therefore, PE seems to be an effective method of rehabilitation of patients with UE disorders related with breast cancer treatment, and might be considered for use as an alternative to CE in this population.

Review of Therapeutic Exercise for Upper Lymphedema Patients Following Mastectomy

PURPOSE: The purpose of this review was to summarize some of traditional and recent rehabilitation exercise program to provide basic data and effective treatment guidelines that are applicable to evidence-based clinical practice. METHODS: The abnormal accumulation of tissue proteins due to lymphedema causes the lack of muscle flexibility and weakness, which subsequently causes limitations in performing exercises. However, exercise therapy, which is recommended as a combination therapy, not only overlooks the accompaniment of upper-extremity exercise disorders by the nature of breast cancer, but also does not take into account the pain occurring during exercises. Thus, we reviewed previous studies as many as on therapeutic exercise in upper- limb lymphedema patient at MEDLINE, PubMed, KISS, and RISS. RESULTS: We introduced brief etiology on upper limb lymphedema following mastectomy in breast cancer with general symptoms and characteristics. We also summarized detail therapeutic exercise programs on the exercise intensity, frequency, and time to suggest effective treatment guidelines. CONCLUSIONS: The appropriate exercise rehabilitation programs are effective to recovery from upperlimb lymphedema, and beside it resulted in elevation of functional abilities.