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

Patients’ characteristics (N = 30).

<p>Mean (SD) and Number (%) are given.</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

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

Schematic overview of the different myofascial levels.

<p>Schematic overview of the different myofascial levels.</p

The different anatomical locations and the description of the myofascial levelsAnatomical location.

<p>The different anatomical locations and the description of the myofascial levelsAnatomical location.</p

Time-deformation curve of the Cutometer.

<p>Time-deformation curve of the Cutometer.</p

For each anatomical location (7) the minimum, maximum, median and interquartile range of the degree of myofascial adhesions is given.

<p>Additionally, prevalence rate of myofascial adhesions at that location is given.</p

Concurrent validity.

<p>Concurrent validity.</p