Ays Arıkan Donmez, Sevgisun Kapucu. European Journal of Oncology Nursing 31 (2017)

Main findings

• Small sample size with 25 in the intervention group and 27 in the control group.
• The Data Collection Form, Upper Extremity Circumference Measurement was used for the patients in both groups during the first meeting, which was conducted before surgery. Outcome measures were evaluated at the beginning and end of the second, fourth, and sixth weeks of the study. The Disability of Arm, Shoulder, and Hand Questionnaire (DASH) and the visual analog scale (VAS) were also used at the end of the second, fourth, and sixth weeks of the study.
• Circumference measurements for each arm were conducted at the metacarpophalangeal joint (MCP) and every 5 cm, beginning at the wrist and continuing to the anterior axillary line. Baseline measurements were performed in the preoperative period (generally 1 or 2 days before the surgery). Measurements were repeated every two weeks following the same procedure, for the duration of the study.
• SLD was started after the removal of the axillary drains and applied for six weeks. It was conducted before the physical activity program (PAP), for 40 min, twice a week. Patients were also taught to perform SLD, during the procedure, and were asked to perform it on the evening of the day of implementation. A water-based hydrating lotion was used for each patient to facilitate the manoeuvres during SLD and to provide regular skin care. All the movements during lymphatic drainage were repeated five times in each region, using the palm. There was a specific routine provided in this paper.
• First stage (preoperative first day and postoperative third to seventh days): The patients performed deep breathing, ball squeezing, and hand opening and closing exercises, lasting 3e5 min, two times a day on the day before surgery, and within 24 h after surgery. Second stage: This stage was divided into two sections. The patients performed aerobic exercises (walking) lasting a total of 15-20 min in addition to the first-stage exercises, following the removal of the drains (seven to 14 days after surgery). In the second section (postoperative week and afterwards), patients performed stretching exercises (including hand, wrist, arm, and shoulder stretching) in addition to the first-stage exercises and the first section of the second stage. These exercises were continued for 20 min, on average every week, starting from the second week.
• The control group did not receive any intervention except for the usual care (standard preoperative and postoperative care provided their own physicians and the nurses of the department). They were only given information on lymphedema, physical activity, and SLD by the investigators. Additionally, they were followed-up every fortnight for the estimation of outcome measures. What exercises they completed post operatively wasn’t provided in this paper.
• The authors concluded from their results given the potential of physical activity and SLD in the effective prevention, and short and long-term management of BCRL, PAP and SLD can be safely used together to prevent BC treatment-related lymphedema; their positive effects are evident in this study’s patient group.
• The authors also state the present study supports the acceptability, effectiveness and regular implementation of PAP and SLD, in the prevention and management of BCRL. Since the results of this study point to amelioration in both the subjective and objective measures, it is suggested that they be offered to patients at a risk for BCRL, as a nursing intervention, or that patients be educated and encouraged to practice them by themselves.
• This study has a small sample size and it is unclear whether the results shown would have occurred by the implementation of exercise alone or in fact resolved without any intervention. The authors need to be careful with recommending a program that may be unnecessary and in fact burden the individual when an exercise routine that can be progressed past 6 weeks, and has many other benefits, may provide better results.

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