Reliability and validity of a device to assess distensibility and anisotropy of scar tissue adhesions after mastectomy

status: publishe

Effect of myofascial techniques for treatment of upper limb pain in breast cancer survivors: randomized controlled trial

PURPOSE: Besides pain, myofascial dysfunctions may contribute to the presence of upper limb impairments such as impaired range of motion, decreased strength, lymphedema, and altered postures and kinematics. Therefore, the aim of this study was to investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of upper limb dysfunctions in breast cancer survivors. METHODS: Fifty women treated for a unilateral breast cancer with pain and myofascial dysfunctions at the upper limb region. The intervention group received 12 sessions of myofascial therapy consisting of release techniques on myofascial trigger points and adhesions in addition to a standard physical therapy program for 3 months. The control group received 12 sessions of a placebo intervention in addition to the same standard physical therapy program during the 3 months. Outcome parameters are active shoulder range of motion (inclinometer); arm lymphedema (perimeter); upper limb strength (handheld dynamometer); scapular statics and dynamics (acromion-table and pectoralis minor index, inclinometer); shoulder function (Disability of Shoulder, Arm and Hand questionnaire); and quality of life (Short Form 36). Measures were taken before and after the intervention at 6 and 12 months follow-up. RESULTS: No differences between groups were found for all outcome parameters over the course of 1 year. However, overall beneficial effects of the standard physical therapy program for active shoulder range of motion and shoulder function were found in both groups up to 1 year follow-up. CONCLUSION: Myofascial therapy has no additional beneficial effect for improvement of upper limb function in breast cancer survivors.status: publishe

Identification of Myofascial Trigger Points in Breast Cancer Survivors with Upper Limb Pain: Interrater Reliability

Objective: Despite the increasing awareness of the contribution of myofascial dysfunctions to upper limb pain in breast cancer survivors, reliability of the identification of myofascial trigger points (MTPs) in this population has not yet been investigated. Therefore, the aim of the present study was to investigate the interrater reliability of the identification of MTPs by palpation at the upper limb region in breast cancer survivors with upper limb pain. Design: Interrater reliability study. Setting: University Hospitals Leuven, Belgium. Subjects: Thirty breast cancer survivors with pain at the upper limb region. Methods: Nine muscles (upper trapezius, levator scapulae, infraspinatus, supraspinatus, teres major and minor, subscapularis, pectoralis major, and scalene muscles) at the operated side were examined. The weighted kappa (WK) coefficient and Absolute Agreement with 95% confidence intervals were calculated. Results: Moderate agreement was found for all examined upper limb muscles (WK = 0.41-0.60), except for the trapezius muscle, for which the agreement was almost perfect (WK = 0.83), and the supraspinatus muscle (WK = 0.23), for which the agreement was only fair. Conclusions: For most muscles, moderate interrater reliability for the identification of MTPs by palpation in breast cancer survivors with upper limb pain was found. Therefore, we concluded that the identification of MTPs by palpation may add to the diagnosis of the myofascial pain syndrome in breast cancer survivors.status: publishe

Effect of myofascial techniques for treatment of persistent arm pain after breast cancer treatment: randomized controlled trial

To investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of persistent arm pain after finishing breast cancer treatment.status: publishe

An evaluation tool for myofascial adhesions in patients after breast cancer (MAP-BC evaluation tool): Development and interrater reliability

<div><p>Purpose</p><p>To develop a tool to evaluate myofascial adhesions objectively in patients with breast cancer and to investigate its interrater reliability.</p><p>Methods</p><p>1) Development of the evaluation tool. Literature was searched, experts in the field of myofascial therapy were consulted and pilot testing was performed. 2) Thirty patients (63% had a mastectomy, 37% breast-conserving surgery and 97% radiotherapy) with myofascial adhesions were evaluated using the developed tool by 2 independent raters. The Weighted Kappa (WK) and the intra-class correlation coefficient (ICC) were calculated.</p><p>Results</p><p>1) The evaluation tool for Myofascial Adhesions in Patients with Breast Cancer (MAP-BC evaluation tool) consisted of the assessment of myofascial adhesions at 7 locations: axillary and breast region scars, musculi pectorales region, axilla, frontal chest wall, lateral chest wall and the inframammary fold. At each location the degree of the myofascial adhesion was scored at three levels (skin, superficial and deep) on a 4-points scale (between no adhesions and very stiff adhesions). Additionally, a total score (0–9) was calculated, i.e. the sum of the different levels of each location. 2) Interrater agreement of the different levels separately was moderate for the axillary and mastectomy scar (WK 0.62–0.73) and good for the scar on the breast (WK >0.75). Moderate agreement was reached for almost all levels of the non-scar locations. Interrater reliability of the total scores was the highest for the scars (ICC 0.82–0.99). At non-scar locations good interrater reliability was reached, except for the inframammary fold (ICC = 0.71).</p><p>Conclusions</p><p>The total scores of all locations of the MAP-BC evaluation tool had good to excellent interrater reliability, except for the inframammary fold which only reached moderate reliability.</p></div

Interrater reliability (ICC) between two raters for the total score of myofascial adhesions.

<p>For each anatomical location the prevalence rate of myofascial adhesions is given.</p

Overview of the Weighted Kappa and Absolute Agreement of the different myofascial levels.

<p>The Weighted Kappa (lines), Absolute Agreement (numbers) and their 95% CI for the agreement between two raters on the scoring of the degree of myofascial adhesions for different anatomical locations is given. Per anatomical location the different myofascial levels are given from top to bottom: skin (dotted line)–superficial (full line)–deep (dashed line).</p

Characteristics of the patients of 1) the pilot study and 2) the reliability study.

<p>Characteristics of the patients of 1) the pilot study and 2) the reliability study.</p