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Effect of Nurse-led Intervention on Shoulder Dysfunction among Breast Cancer Patients Undergoing Modified Radical
Arul Nisha S1, Kumari Mj1, Biswajit Dubashi2
1College of Nursing, JIPMER, Puducherry, India.
Background:
Breast cancer can strike women at any age after puberty, though its incidence increases with age. The WHO's Global Breast Cancer Initiative (GBCI), between 2020 and 2040, aims to prevent 2.5 million breast cancer deaths globally. This study aimed to assess the effect of a nurse-led intervention on shoulder dysfunction among breast cancer patients undergoing modified radical mastectomy (MRM) - a randomized controlled trial.
Methods:
A total of 320 breast cancer patients undergoing MRM (Study group-160, Control group-160) who met the inclusion criteria were included in the study. Block randomization was used to allot participants to both groups through a computer-generated random sequence. The experimental group received a nurse-led intervention in addition to routine care, while the control group received routine care only. Shoulder range of motion (ROM) was measured using a goniometer at baseline and at every 3-month interval up to 1 year. Disability of the Arm, Shoulder, and Hand (DASH) was assessed at 6th and 12th month follow-ups using the DASH questionnaire.
Results:
Overtime comparison of shoulder ROM shows the significant effect of time, group, and a significant time × group interaction (p < 0.001), indicating that the flexion, extension, abduction, internal rotation, and external rotation angles improved significantly over time, and that the pattern of improvement differed between the intervention and control groups. During the 3rd and 6th month follow-up, Grade II loss of shoulder ROM was observed in one patient (0.68%) in the experimental group, whereas in the control group, it was observed in 25 patients (16.89%) and 18 patients (12.41%), respectively. DASH scores during the 6th and 12th month follow-up were 6 (3.06-10.25) and 5.17 (1.72-8.62) in the experimental group, whereas in the control group, they were 21.5 (14.25-34.25) and 24.14 (15.52-35.34) (p <0.001).
Conclusion:
In this study, early intervention and consistent motivation and reinforcement helped in preventing or reducing shoulder dysfunction, thereby reducing disability and enhancing quality of life (QOL).
