Breast Cancer Clinical Trial
Official title:
The Effect of Complex Decongestive Physiotherapy on Sensory Parameters in Breast Cancer Related Lymphedema Patients
The aim of this study was to determine the effect of complex decongestive physiotherapy in women with unilateral breast cancer-related lymphedema on sensory parameters.
Although there are a limited number of studies in the literature on disorders of sensory
functions seen after breast cancer treatments, sensory disorders that may be seen in
lymphedema associated with breast cancer were evaluated in only 2 studies published in 1979
and 2006. Although these studies are not sufficient in terms of study design, they only
include Semmes-Weinstein monofilaments and two-point discrimination tests and hand
evaluations. Ganel et al. Reported that approximately 50% of the patients they included in
the study found that varying degrees of lymphedema developed in the upper extremity, and the
median nerve compression in the brachial plexus and carpal tunnel was significantly higher in
these patients. They did not find a direct correlation with radiotherapy in patients with
nerve compression. They therefore stated that nerve compression may be associated with
lymphedema or fibroblast infiltration. According to this study, lymphedema may also be a risk
factor in post mastectomy problems such as brachial plexus and carpal tunnel syndrome. Greve
et al. reported that lymphedema may cause a decrease in sensory functions in patients who
were evaluated with monofilaments in their studies on the effect of lymphedema on sensory
functions after mastectomy (Ganel 1979, Greeve 2006).
Complex Decongestive Physiotherapy was developed by Földi in the 1980s in Germany to reduce
limb volume, preserve skin health, lymph transport stimulation and reabsorption of residual
interstitial proteins. Complex Decongestive Physiotherapy is a treatment method consisting of
four main elements and two phases. The four main elements of the first phase of complex
decongestive physiotherapy; includes manual lymphatic drainage, skin care, compression
therapy and remedial exercises. After the edema is reduced, phase II is passed. This phase
includes self-drainage, skin care, personalized compression socks and remedial exercises. In
lymphedema, protein-rich fluid accumulates in the subcutaneous tissue for a long time,
disrupting natural skin elasticity over time. With Complex Decongestive Physiotherapy, edema
reduction up to 65% can be achieved, functional loss, fibrotic changes, and cosmetic
problems, which are the secondary problems caused by lymphedema, can be observed.
Increased interstitial fluid in lymphedema associated with breast cancer can cause local
sensory loss due to compression of peripheral nerves. Dermal thickness increase due to
lymphedema and biomechanical changes in viscoelasticity can cause various changes on sensory
functions. Therefore, quantitative evaluation of the sensory system can be an effective
method to determine the injury risk factor of the lymphedema region in the event of an
existing sensory dysfunction. However, although the effects of Complex Decongestive
Physiotherapy on edema reduction, skin thickness and elasticity are mentioned, its effect on
sensory functions is unknown.
Complex Decongestive Physiotherapy will be applied to patients for a total of 3 weeks, 5 days
a week within the scope of this study.
The assessments will be performed before treatment and at the end of three weeks treatment
period.
A detailed story will be taken from the patients first. The lymphedema diagnoses of the
patients will be confirmed by ultrasonographic imaging method. Imaging will be performed
using a 5-12 MHz linear probe (Logiq P5, GE, Wisconsin, USA) on the upper extremity. Dermis
and subcutaneous soft tissue thicknesses; It will be measured using plenty of gel, using
images without applying any pressure - with the help of the device's automatic calculation
feature after marking.
The severity of lymphedema between the two extremities will be assessed by environmental
measurement.
Semmes-Weinstein Monofilament Test: It will be applied 10 cm distal to the elbow joint of the
volar surface in the forearm. The measurement will start with the lightest monofilament and
proceed to the monofilament that the patient feels. Each monofilament will be applied to a
spot three times in a row.
Two Point Discrimination Test: This test is a non-invasive test commonly used in sensory
evaluation. It is done by randomly touching one or two points. If 7 of the 10 answers given
by the patient are correct, the answer is considered correct. If the answer is not correct,
the difference between the two ends of the esthesiometer is increased by 1, 2 or 5 mm
depending on the expected state of sensory loss. The test continues until you reach the
correct answer. If the correct answer cannot be obtained even at 15 mm, the test is
terminated.
The pressure pain threshold will be evaluated with 'J tech Algometer Commander' by giving
pressure from both the upper extremity to 10 cm distal from the volar surface of the elbow
joint until the patient feels minimal pain. Pressure will be applied vertically with the 1
cm2 head of the device and patients will be asked to say 'yes' whenever they feel
uncomfortable with the pressure applied. The measurement will be repeated 3 times, and the
pressure pain threshold will be calculated by taking the arithmetic average of these three
trials.
Hot / Cold Sensory Test: The sense of warm / cold will be evaluated with test tubes
containing hot and cold liquid. The cold tube will be filled with water at 10 °C and the hot
tube at 40 °C. When the patient's eyes are closed, these tubes will be touched to the skin
surface 10 cm distal to the volar face elbow joint in a random order, and the patient will be
asked to express that the water in the tube is hot or cold.
Vibration Sensation Measurement: The vibration sensation will be measured from the lateral
epicondyle in the upper extremity by diapason. Diapason is a small U-shaped tool made of
steel that vibrates at a certain height when vibrated.
Lymphedema Life Impact Scale: Weiss et al. The validity and reliability of the questionnaire
developed by Orhan et al. made by. Lymphedema life impact scale consists of 18 questions and
has physical, psychological and functional subtitles. '0'; no influence, '4'; It is scored
between the minimum '0' and the maximum '72' score with a 5-stage Likert-type scale in the
form of severe influence. As the score increases, the state of influence worsens.
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