| Objective 1.To explore and understand the cognition and needs of upper limb rehabilitation in patients with breast cancer after modified radical mastectomy,and to analyze the influencing factors.2.To develop the progressive resistance rehabilitation training program for breast cancer patients after modified radical mastectomy combined with the cognition and needs of postoperative rehabilitation based on the protection motivation theory.To explore the effects of progressive resistance rehabilitation training based on protection motivation theory on shoulder motion,shoulder function,upper limb circumference,training compliance and the quality of life of patients with breast cancer after operation.Methods This study was divided into two parts.1.Qualitative research:The purpose sampling method was used to select 14 patients who was subjected to criteria of patients with breast cancer after modified radical mastectomy as the research subjects of the hospital in Guiyang City,Guizhou Province.They were interviewed semi-structured by phenomenological research method.NVIVO11 software would be used to code the interview results,and Colaizzi’s seven-step method would be used to analyze the data,refine the theme,summarized the cognition and demand.2.Quantitative study part was a randomized controlled trial.90 cases was subjected to criteria of patients with breast cancer after modified radical mastectomy were recruited to the study in the hospital of Guiyang,Guizhou Province from March-October 2019.The patients were divided into Group A(control group),Group B(progressive resistance group)and Group C(PMT group)by random number method,each group with 30 cases.All patients were given postoperative routine treatment and nursing.Group A was given routine rehabilitation guidance and training;Group B was given progressive resistance rehabilitation training by using Thera-Band elastic band on the basis of the Group A;Group C was given the PMT rehabilitation program on the basis of the Group B.Before surgery,the three groups of patients were evaluated the patient’s range of shoulder motion,shoulder adjusted Constant Murley score,upper limb circumference,and FACT-B score as baseline.At one week after operation,one month after operation,and three months after operation,rehabilitation training compliance was added on the basis of baseline.The data obtained in this study were analyzed and processed by SPSS22.0 statistical software.P<0.05 indicates statistically significant difference.Results1.In the qualitative research,the cognition and demand of upper limb rehabilitation of patients after modified radical mastectomy were extracted and refined into four primary themes:high demand for postoperative rehabilitation knowledge,different levels of physical rehabilitation willingness of different groups,lack of disease and rehabilitation knowledge,and factors affecting of upper limb rehabilitation training after operation.The results provide a basis for quantitative research to develop postoperative upper limb functional rehabilitation training programs.2.Quantitative Research:(1)There was no statistical difference in the general demographic data and disease data of the three groups before the intervention(P>0.05).(2)Comparison of range of shoulder motion(ROM):The differences in the forward flexion,extension,adduction,abduction,internal rotation and external rotation of range of shoulder motion at different time were compared by repeated measurement analysis of variance.Each direction of range of shoulder motion in three groups have interaction between the time and grouping factors(P<0.05).One week after operation,each direction of range of shoulder motion were decreased compared with before the operation in the three groups.With the passage of time,the range of shoulder motion at the three groups were showing a gradually increasing trend.On one week after the operation,there was no statistically significant difference in range of abduction and external rotation in each group(P>0.05).The improvement effect of other direction of range of shoulder motion in PMT combined group better than progressive resistance group and the control group(P<0.05).On one month and three month after the operation,the PMT combined group was better than progressive resistance group and the control groupof the range of shoulder motion in all directions(P<0.05).(3)Comparison of shoulder adjusted Constant Murley score:The improved shoulder adjusted Constant Murley score in the three groups were higher than those in the first month and the third month after operation(P<0.05).There was no significant difference in shoulder adjusted Constant Murley score between the three groups on one week after the operation(P=0.225).The shoulder adjusted Constant Murley score in the PMT group was higher than that in the progressive resistance group,and the progressive resistance group was higher than the control group(P<0.05).(4)Comparison of functional training compliance:Three groups of patients showed a downward trend at each time point in postoperative functional training compliance.At one week after the operation,there was no significant difference in functional training compliance between the three groups(P=0.939).At one month and three months after the operation,the functional training compliance of PMT group was better than that of the progressive resistance group and the control group,but there was no significant difference in the progressive resistance group and the control group(P=0.298,P=0.487).(5)Comparison of quality of life scores(FACT-B):The differences in the FACT-B score at different time were compared by repeated measurement analysis of variance,it has interaction between the time and grouping factors in the three groups(P<0.05).At one week after operation,FACT-B score were decreased compared with before the operation in the three groups.With the passage of time,the FACT-B score at all the three groups were showing a gradually increasing trend.At one week after the operation,there was no significant difference in the FACT-B total and dimensions score between the three groups(P>0.05).At one month after the operation,the FACT-B total score in the PMT group were better than the progressive resistance group,and the progressive resistance group was better than the control group(P<0.05).The gradual resistance group was better than the control group in values of PWB SWB and FWB(P<0.05),but there was no statistically significant difference in values of EWB and BCS between the control group and the progressive resistance group(P>0.05).(6)There were no nursing adverse events in the three groups during the study period.There was no interaction between the time factor and grouping factor of upper limb circumference in different parts of the three groups(P>0.05),indicating that the variation trend of upper limb circumference in different time points of the three groups was the same.At one month and three months after the operation,the difference in peripheral diameter of the upper limb at the same site in the three groups was no more than 2cm,and no upper limb lymphedema occurred in any of the three groups.Conclusion1.The progressive resistance training based on PMT can improve the range of shoulder motion,the upper limb function and quality of life of patients after modified radical mastectomy.The improvement effect is better than that conventional rehabilitation training and the only implementation of progressive resistance training.2.The progressive resistance training based on PMT can stimulate the generation of patients’ self-protection motivation,enhance patients’ self-efficacy,promote the establishment and maintenance of protective behavior,and improve patients’ compliance with postoperative rehabilitation training.3.The progressive resistance training based on PMT does not increase the occurrence of upper limb lymphedema,which is which is safe,effective and easy to be accepted by patients,and can be popularized in clinical practice. |
PDF Full Text Request