Author Names
Joshi, D., Shah S., Shinde, S., Patil S.
Reviewer Name
Erik Furseth SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background: Breast surgery, Axillary Lymph Node Dissection (ALND), radiation and chemotherapy may develop several complications such as axillary web syndrome, frozen shoulder, numbness, shoulder pain and range of motion restriction, lymphostasis, and lymphedema. Up to 77% report sensory disturbance in the breast or arm after breast surgery. These short- and long-term consequences have dramatic impact on physical function and quality of life in this population. Aims: The aim of the study was to determine the effect of neural tissue mobilization on sensory-motor impairments in breast cancer survivors with lymphedema. Subjects and Methods: This study was carried out by analyzing total 100 breast cancer survivor women, with lymphedema aged between 30-65 years of age who had undergone breast surgery mostly lumpectomy along with chemotherapy or radiation therapy. Participants were divided into two groups by random allocation. One group underwent neurodynamic mobilization and the other group conventional physiotherapy.The treatment protocol was given for 6 weeks. Parameters such ROM, pain, lymphedema and sensory-motor impairments were assessed at the baseline before the treatment and 6 weeks after the treatment.Result: The result from this study shows that there is significant improvement (p<0.0001, t-value 4.69) in mTNS of patients undergoing neural tissue mobilization, whereas there was no significant improvement (p=0.05, t-value 1.951) seen in patients undergoing conventional physiotherapy. Conclusion: This study concludes that effect of neural tissue mobilization has significant impact on sensory motor impairments as compared to conventional treatment protocol in breast cancer survivors with lymphedema.Pain and ROM showed similar difference with both the treatment protocols. It was also observed that patients with mild and moderate lymphedema showed significant improvement as compared to patients with severe lymphedema.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Cannot Determine, Not Reported, or Not Applicable
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Cannot Determine, Not Reported, or Not Applicable
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Cannot Determine, Not Reported, or Not Applicable
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
The use of neural tension treatments is significant for those with mild to moderate lymphadema swelling, but there still shows some benefit with severe.
Key Finding #2
The use of neural tissue mobilization has a significant impact on sensory motor impairments when compared to conventional treatment protocols in breast cancer survivors with lymphedema.
Key Finding #3
Pain scores significantly improved with conventional physical therapy as well as neural tissue mobilizations, but there was no significant differences between the two.
Please provide your summary of the paper
The purpose of this study was to determine the effects of neural tissue mobilization of sensory-motor impairments in breast cancer survivors with lymphedema. 100 women who were survivors of breast cancer and had lymphedema, between 30-65 years old, and who had breast surgery along with chemotherapy or radiation therapy. The patients were divided into 2 groups, 1 group that did the neural tissue mobilization technique and the other did conventional physical therapy techniques to treat pain, ROM, lymphedema and sensory-motor impairments. Pain was reported using a 10-point scale to assess their intensity of axillary/shoulder pain. Shoulder flexion and abduction ROM was assessed. Lymphedema was assessed on the effected limb and subsequently compared to the non-affected side. The modified Total Neuropathy Score was used to assess sensory-motor impairments. All impairments were assessed before and after the 6-week interventions. In conclusion to the study, they found a significant difference in both groups for pain level and ROM post intervention. The patients that had mild and moderate lymphedema saw a significant decrease in lymphatic swelling, but the patients with severe swelling still saw some decreases in arm-to-arm measurements.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
The use of neural tissue mobilization should be used in breast cancer survivors as a therapeutic exercise to help reduce pain, increase ROM, and help to decrease lymphedema. Although patients in this study had specific requirements, since the results showed significant increases in many aspects, neurodynamic mobility could be used in a more broad population and monitored for similar effects. The results found could help with patient buy-in, reduce pain to allow for more physical therapy interventions, potentially increasing the patient’s recovery. More research should be done to determine the effects of using neurodynamic treatment in addition to conventional physical therapy to determine if there are greater effects seen when both are done simultaneously.
