The experience of physiotherapy on shoulder pain following treatment for breast cancer

Abstract

Background: Following treatment for breast cancer patients may experience some musculoskeletal complications. Shoulder pain is considered to be one of the most common musculoskeletal complications to arise following surgery, chemotherapy, radiotherapy or other adjunctive treatments. This often manifests as restricted range of motion (ROM), stiffness, weakness and joint dysfunction, affecting patients' physical well-being and quality of life. The current literature supports the effectiveness of physiotherapy using outcome measures. This research question aimed to take a different approach, considering the experience of the patient with physiotherapy for shoulder pain following treatment for breast cancer. Research question: Which physiotherapeutic intervention, or combination of interventions is most effective in the treatment/management of shoulder pain following breast cancer treatment, based on patient experience. This question was formulated using a PEO framework: (Population) Females who have undergone treatment for breast cancer and suffer from shoulder pain as a result of the oncological treatment, (Experience) Experience of these patients, (Outcome) Reduction of shoulder pain following physiotherapeutic intervention. Search method: A comprehensive search of literature using six databases was conducted using the keywords from the PEO question together with the relevant synonyms. From the large number of results generated limiters were applied to narrow the search, duplicates were removed and the remaining articles were further scrutinised through a set of inclusion and exclusion criteria, in accordance with the PRISMA framework (2020). This led to the selection of the five key articles, three qualitative descriptive studies and two non-randomised control trials. These were critically appraised using both the CASP qualitative checklist (2018) and the MMAT (2018) due to the mixed-method nature of the study. Results: The most effective physiotherapeutic intervention used in the management of shoulder pain following treatment for breast cancer is guided exercise. While the main aim was to determine the efficacy of different physiotherapeutic interventions based on the patient experience, there was little to no mention of any other intervention apart from exercise under the guidance of a physiotherapist. Conclusions: The findings suggest that exercise is of paramount importance when addressing shoulder pain following breast cancer treatment. However, patients expressed the preference of having a physiotherapist to demonstrate the exercises, follow-up and liaise with other members of the multidisciplinary team to ensure a comprehensive patient-centred rehabilitation experience. Recommendations: The findings of this study led to recommendations for clinical practice, education and the development of research. Physiotherapists working in the oncological field should receive the adequate training and possibly implement some standardisation of shoulder exercises as in the PROSPER programme (2022). Patients need to be educated to mitigate kinesiophobia. Communication of the MDT must be improved and finally future research should explore alternative interventions beyond exercise, including the integration of VR and mHealth technologies.