The Effect of Physical Therapy Interventions on Arm Morbidity in Breast Cancer: A Systematic Review of Randomized Controlled Trials

Background : Arm morbidity can impair function after breast cancer treatment. Physical therapy, including exercise and manual therapy, may reduce its incidence and progression. This systematic review assesses the effect and evidence quality for commonly used physical therapy interventions on arm morbidity in adults with nonmetastatic breast cancer from the early postoperative phase through adjuvant and post-primary therapy. Methods : CINAHL, Medline (Ovid), and EMBASE were searched from inception to August 7, 2024. Randomized controlled trials were included if they delivered physical therapy for ≥3 weeks to adults during or after nonmetastatic breast cancer treatment and reported arm morbidity outcomes (ie, upper extremity function, pain, shoulder range of motion, strength, and/or lymphedema incidence/progression). Data on participants, interventions, and outcomes were extracted and synthesized qualitatively. Evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework, and risk of bias was assessed using the Cochrane Risk of Bias Tool 1.0. Results: Fifty-seven trials met the inclusion criteria. Interventions most frequently included progressive exercise programs, stretching, and manual therapy, often initiated within 6 weeks postoperatively. Most trials demonstrated benefits in shoulder range of motion (58%), while fewer reported improvements in upper extremity function (49%), pain (46%), upper extremity strength (38%), or lymphedema (38%). Only 23% of trials evaluated arm morbidity as a primary outcome. Conclusion : Physical therapy may reduce incidence and progression of arm morbidity after breast cancer treatment, but evidence quality is generally low. High-quality trials with larger samples, standardized outcome reporting, and better adherence tracking are needed to guide practice.