Scapular and shoulder exercises for improving shoulder function and preventing secondary lymphedema following breast cancer surgery – a randomised clinical trial protocol

Introduction The most prevalent cancer among women worldwide is breast cancer. Those diagnosed with breast cancer usually undergo modified radical mastectomy (MRM) or breast-conserving therapy (BCT). The excision of lymph nodes is likely to result in secondary lymphedema. As there are not many indian studies on preventing secondary lymphedema through upper limb exercises after breast cancer surgery, the present study investigated the effect of scapular and shoulder muscle strengthening exercises in preventing the development of upper limb lymphedema following breast cancer surgery. Subjects and Methods In this single-blinded, randomised clinical trial, 58 participants will be randomised to receive conventional physiotherapy or conventional physiotherapy along with shoulder and scapular muscle strengthening exercises (four sessions per day) for 24 weeks following MRM or BCT surgery. The primary outcome variables include shoulder and scapular muscle strength, shoulder range of motion, upper limb circumference, volumetry, shoulder pain, and disability. The secondary outcome variable is quality of life assessment. Results Outcome variables will be evaluated by a blinded assessor at baseline (second postoperative day) and three, six, 12, 16, and 24 weeks after surgery. A mixed model analysis of variance (ANoVA) will be used to analyse the data for all outcomes. Furthermore, an intention-to-treat analysis will be used, and missing data will be handled with multiple imputations. Conclusions Strengthening exercises following breast cancer surgery, if found effective, can be used in breast cancer rehabilitation protocols to improve shoulder function and prevent secondary lymphedema.