اله السماء يعطينا النجاح

Transcription

1 اله السماء يعطينا النجاح Q.E.D. Systems 2003 و نحن عبيده نقوم و نبنى

2 EFFECT OF REFLEXOLOGY ON STIFF SHOULDER IN PATIENTS WITH LYMPHEDEMA Q.E.D. Systems 2003 By MARIAN SHAWKY HABIB FAM B.Sc.PT.Cairo University, 2000 Physical Therapist at Nasr City police hospital

3 تأثير الريفلكسولوجى على تيبس الكتف فى مرضى التورم الليمفاوى

4 Acknowledgement First of all I would like to kneel thanking to ALLAH that enable me to conduct this work. I would like to thank PROF. DR. ZAHRA MOHAMED HASSAN SERRY Professor of Physical therapy for Cardiovascular / Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, For her great support and advice to start and complete this study as the best as I could do.

5 I am extremely thankful to Prof.Dr. Nesreen Ghareb Mohammed El-Nahas, Assistant Professor of Physical Therapy, for Cardiovascular / Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, For her great support and her valuable advices, constructive criticism and continuous support. My gratitude appreciation wishes Prof. Dr. Tamer Mohammed Fared, Assistant professor of Geriatric Medicine, Faculty of medicine, Ain Shams University, for his coordination and cooperation and for his kind guidance and encouragement.

6 I cannot forget to thank, Physical Therapists and patients in Nasr City police hospital, who gave me their time and effort voluntarily. Finally special gratitude to my family, for their unconditional love, care and support during this work completion and throughout my life.

7 INTRODUCTION Breast cancer refers to a malignant tumor that has developed from cells in the breast. Breast cancer is second only to skin cancer as the most common cancer in women. The World Health Organization classification of breast tumors organizes both benign and malignant lesions by histological pattern. Mastectomy is a medical removal of one or both breasts partially or completely. Mastectomy is usually done to treat breast cancer and is the main treatment of breast cancer(american Joint Committee on Cancer Breast, 2010).

8 Following mastectomy for breast cancer, many women experience impairment in shoulder movements that can substantially affect their everyday function and quality of life. Although some symptoms, such as arm swelling due to lymphedema are easily accounted for, other symptoms, such as chronic ache and pain which women report in the shoulder and upper trunk months to years after surgery, are not always associated with their physical strength (force-generating capacity) or range of motion at the shoulder. The lack of a relationship between impairments and self-reported function suggests that other factors are likely to contribute to these persisting problems (Merchant et al., 2008).

9 Statement of Problem: Did reflexology have an effect on stiff shoulder in patients with lymphedema? Purpose of Study: To find out the effect of reflexology on stiff shoulder in patients with lymphedema.

10 Significance of Study: Breast cancer is the most common noncutaneous malignancy, accounting for nearly one in three cancers diagnosed among women. Lymphedema is a side effect that can begin during or after breast cancer treatment. It isn't life threatening, but can last over a long period of time(desantis et al., 2011).

11 Women who undergo mastectomy are almost 6 times more likely to experience shoulder restriction and impairment than patients who undergo breast-conserving surgery, and, despite improved surgical techniques and postoperative care, pain and functional limitation continue to pose problems (Cheville and Tchou, 2007).

12 There are a lot of women suffering from lymphedema and shoulder restriction and impairment following mastectomy so this study was needed to provide a guideline about the role of reflexology in the management of post mastectomy lymphedema and stiff shoulder.

13 Current therapies available for weight management that cause weight loss by inducing a negative energy balance include: dietary intervention, physical activity, pharmacotherapy, and surgery. Behavior modification to enhance dietary and activity compliance is an important component of all of these treatments. (Sjostrom et al., 2004)

14 Null Hypothesis: There would be an effect of reflexology on stiff shoulder in patients with lymphedema.

15 PATIENTS AND METHODS 1-Patients: 40 women (ages from 40to 60 years)had radical or modified radical mastectomy with axillary lymph nodes dissection and lymphedema of the upper limb secondary to surgical and for radiotherapy intervention for breast cancer was participated in the study for three months. The study was done in Nasr City police hospital. The training program was carried in the duration from December 2013 to January 2015.

16 Inclusion criteria: Criteria of selecting the patients from hospital included the following: 1-Women (unilateral) patients with ages ranged from years. 2-All patients were free from any other pathological conditions or histories of other health abnormalities except arm lymphedema and stiff shoulder. 3-They had under gone modified radical mastectomy with axillary lymph node dissection with or without radiotherapy intervention. 4-Body mass Index were 29.7 ± 2.27 kg/m2

17 Exclusion criteria: Patients excluded from the study if they had met one of the following criteria: 1- Recurrent malignancy. Active infection and clinical evidence of obstructive venous disease. 2-Bilateral upper limb lymphedema disease. 3- Neurological or orthopedic problems and diabetes. Patients were assigned randomly into two groups equal in number:

18 -Group A (study group): Twenty women had radical or modified radical mastectomy with axillary lymph nodes dissection and lymphedema of the upper limb received foot and hand reflexology on shoulder area and upper lymphatic area in addition to traditional physical therapy treatment that include active shoulder ROM exercise and short-stretch compression bandagingfor3 times per week for 12 weeks.

19 -Group B (control group): Twenty women had radical or modified radical mastectomy with axillary lymph nodes dissection and lymphedema of the upper limb received the traditional physical therapy treatment that include active shoulder ROM exercise and short-stretch compression bandaging for 3 times per week for 12 weeks.

20 2-Instrumentation: A) Evaluation instruments: 1) Tape measurement: A simple retracting unstretchable plastic tape of 50 cm. It was used to measure amount of edema :

21 2) Goniometer: It was fabricated in plastic material. It is consisted of two plastic arms (stationary arm and movable or free arm) and falcurum. It was used to measure range of motion of shoulder joint (flexion abduction- external rotation).

22 B) Training instruments: 1-Reflexology on shoulder area and upper lymphatic area. 2-Active shoulder ROM exercise. 3-Short-stretch compression bandaging.

23 3-Procedures: A) Evaluation procedures: Before starting procedure: 1-Measurements of circumferential lymphedema formation

24 2-Measurement of shoulder ROM: a-shoulder b-shoulder C-Shoulder flexion abduction external measurements rotation measurement procedures procedures

25 B) Treatment procedures: Reflexology on upper lymphatic area Reflexology on shoulder point

26 B-Hand reflexology Reflexology on edge of the base of the little finger Reflexology on entire of the thumb

27 Reflexology on the channel between the bones on the back of the palm

28 2-Active shoulder ROM exercise: Active shoulder abduction range of motion exercise Active shoulder flexion range of motion

29 Active shoulder external rotation range of motion exercise

30 3-Short-stretch compression bandaging. Application of Short-stretch compression bandaging

31 RESULTS Shows mean age (years) of study and control groups

32 Shows mean weight (kg) of study and control groups.

33 Shows mean height (cm) of study and control groups

34 Shows mean BMI (kg/m²) of study and control groups.

35 Shows pre treatment mean values of lymphedema measurement of study and control groups

36 Shows pre treatment mean values of shoulder ROM of study and control groups.

37 Shows pre and post treatment mean values of lymphedema measurement of study group.

38 Shows pre and post treatment mean values of shoulder ROM of study groups

39 Shows pre and post treatment mean values of lymphedema measurement of control group

40 Shows pre and post treatment mean values of shoulder ROM of control groups.

41 Shows post treatment mean values of lymphedema measurement of study and control groups.

42 Shows post treatment mean values of shoulder ROM of study and control groups.

43 CONCLUSION It was concluded that: Hand and foot reflexology plus traditional physical therapy have a significant effect on breast cancer patients with lymphedema which in turn help to improve shoulder ROM and functional capacity of upper limb.

44 RECOMMENDATIONS Posters in lymphedema outpatient clinics to show the benefits of reflexology in dealing with stiff shoulder in patients with lymphedema. More researches are recommended to study the effect of reflexology on quality of life and finger mobility in patients with lymphedema especially in self-care activities. Future researches to find out the effect of reflex and exercises on all shoulder movements directions.

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