• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Results from PROSPER RCT: Does Post-Surgical Exercise Improve Shoulder Mobility Outcomes After Breast Cancer Surgery?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Bruce et al. (BMJ, 2021) assessed whether a structured exercise program improved functional and health related quality of life outcomes compared with usual care for women after breast cancer surgery

METHODS:

  • Multicenter, pragmatic, superiority, randomized controlled trial with economic evaluation
  • Participants
    • Women undergoing breast cancer surgery
    • High risk for postoperative upper limb morbidity
      • Planned axillary node
      • Planned radiotherapy to the axilla or supraclavicular fossa
      • BMI ≥30
      • Existing shoulder problems
      • Subsequent axillary surgery after sentinel lymph node biopsy
      • Planned axillary or supraclavicular radiotherapy within six weeks of primary surgery
  • Interventions
    • Usual care (information leaflets) only
    • Usual care plus a physiotherapy led exercise program
      • Stretching | Strengthening | Physical activity | Behavioral change techniques to support adherence to exercise
      • Introduced at 7 to 10 days postoperatively | 2 more appointments at 1 and 3 months
  • Study design
    • Randomized 1:1 to an intervention group
    • Analysis by intention to treat
  • Primary outcome
    • Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months (0 score for no disability to 100 for most severe disability)
  • Secondary outcomes
    • DASH subscales
    • Pain using Numerical rating scale (Moderate to severe pain 4 to 10)
    • Complications
    • Health related quality of life using Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4), a validated quality of life tool designed to assess the impact of arm morbidity on patients following breast cancer surgery
    • Resource use (healthcare and social services)

RESULTS:

  • 382 participants
    • Mean age: 58.1 years
    • Exercise group: 191 participants | 95% attended ≥1 appointment
  • Upper limb function mean DASH score improved after exercise compared with usual care
    • Exercise: 16.3
    • Usual care: 23.7
    • Adjusted mean difference (aMD): 7.81 (95% CI, 3.17 to 12.44); P=0.001
  • Secondary outcomes were better with exercise over usual care
    • Lower pain intensity at 12 months
      • Numerical rating scale aMD: −0.68 (95% CI,−1.23 to −0.12); P=0.02
    • Fewer arm disability symptoms at 12 months
      •  FACT-B+4 aMD: −2.02 (95% CI, −3.11 to −0.93); P=0.001
  • No differences in complications, lymphoedema, or adverse events
  • Exercise was cost effective, compared to usual care

CONCLUSION:

  • An exercise program, implemented 7 to 10 days post-breast cancer surgery, improved upper limb function and reduced pain in patients at risk of treatment related postoperative complications
  • Exercise was also cost effective
  • The authors state

Early, structured exercise was safe, and women had better arm function and health related quality of life, with less pain and limb related disability over one year compared with usual care

The PROSPER exercise programme was clinically impactful and cost effective

This trial provides the best quality evidence to date in support of early exercise for women at high risk of shoulder problems after breast cancer treatment

Learn More – Primary Sources:

Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation

Want to stay on top of key guidelines and research papers?

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Restricted vs. Liberal Activity Following Reconstructive Pelvic Surgery
Does Drinking Coffee Speed Gut Recovery Post GYN Surgery?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site