Research On The Construction And Application Of Rehabilitation Exercise Program For Breast Cancer Patients After Surgery

Breast cancer is the most common malignant tumor in women.By 2020,breast cancer will have surpassed lung cancer and become the first cancer incidence rate.With the progress of diagnosis and treatment technology and multidisciplinary integration,the survival rate of breast cancer has significantly improved,which means that the number of breast cancer patients will continue to increase.At present,surgery is still the main treatment method for breast cancer.While striving for survival opportunities for patients,it also brings a series of complications such as pain,upper limb dysfunction,lymphedema,which seriously affects the quality of life of patients and hinders them from returning to normal life.Postoperative rehabilitation exercise has a certain effect on the prevention and treatment of complications,but the existing research related to breast cancer postoperative rehabilitation exercise mostly focuses on the impact of a single rehabilitation exercise program on the outcome indicators,and there are few reports that multiple rehabilitation exercise programs are studied at the same time.Different rehabilitation exercise programs may have similar and different effects on outcome indicators.There will be many possible outcomes,and more choices for patients.Therefore,this study first integrates the existing research results related to rehabilitation exercise after breast cancer surgery,and refers to the guidelines and norms for breast cancer diagnosis and treatment of the Chinese Anti Cancer Association and the guidelines of the American College of Sports Medicine,to develop a rehabilitation exercise program for breast cancer surgery patients in China.On this basis,it explores the intervention effects of different exercise programs on outcome indicators,At the same time,the effects of different rehabilitation training programs on the same outcome index were compared horizontally to provide ideas for alleviating postoperative complications and improving the quality of life of patients,and also provide practical basis for further development of postoperative rehabilitation nursing.Aims1.To construct a rehabilitation exercise program for patients undergoing breast cancer surgery.2.Intervention will be carried out on the patients after breast cancer surgery with the constructed program to explore the effect of different exercise programs on the outcome indicators and the effect differences between programs.Methods1.Sstematic review and Meta-analysis.To evaluate the impact of different rehabilitation exercise methods on the rehabilitation effect of patients undergoing breast cancer surgery,we searched CNKI,Pub Med,VIP,CBM,Embase and Wanfang databases for a randomized controlled study on the promotion of rehabilitation exercise for patients undergoing breast cancer surgery.Two researchers screened according to the inclusion and exclusion criteria,used the modified Jadad scale to evaluate the quality of the included literature,and excluded low-quality literature.Use CMA2.0 software for meta-analysis.2.Theoretical research.Construct a rehabilitation exercise program for patients undergoing breast cancer surgery.According to the Meta-analysis results,and referring to the Guidelines and Specifications for Diagnosis and Treatment of breast cancer of the Chinese Anti Cancer Association（2021）and the Physical Activity Guidelines for Cancer Patients issued by the American College of Sports Medicine in 2019,construct the first draft of the rehabilitation exercise program,and then determine the final exercise program through discussion by the research group.Plan 1:rehabilitation exercise+intensive follow-up;Plan 2:rehabilitation exercise+fast walking exercise+intensive follow-up;Plan 3:rehabilitation exercise+progressive resistance exercise+intensive follow-up.3.Single center randomized controlled single blind trial.Through the rehabilitation exercise program formulated in the second part,we carried out exploratory intervention of rehabilitation exercise program for patients undergoing breast cancer surgery,and discussed the intervention effects of different exercise programs on patients’upper limb dysfunction,pain,shoulder joint mobility,lymphedema and quality of life,as well as the effect differences between programs.（1）Grouping and intervention methods.According to the sample size of repeated measurement analysis of variance,and referring to the preliminary experimental results,the final result is that the sample size of each group is n=50,and the total sample size is N=200.In strict accordance with the inclusion and exclusion criteria,the patients who underwent breast cancer surgery in Xijing Hospital from March to July 2021 were selected as the research objects,and the patients were randomly divided into 4 groups（1control group,3 intervention groups）.The control group（G₀）carried out routine nursing and rehabilitation exercise.The intervention group carried out rehabilitation exercise program intervention on the basis of routine nursing.The intervention group Ⅰ（G₁）was"rehabilitation exercise+intensive follow-up",the intervention group Ⅱ（G₂）was"rehabilitation exercise+fast walking+intensive follow-up",and the intervention group Ⅲ（G₃）was"rehabilitation exercise+progressive resistance exercise+intensive follow-up".（2）Outcome indicators and measurement.The quality of life,pain,upper limb dysfunction,shoulder joint range of motion and lymphedema were evaluated before intervention（T₁）,3 months after intervention（T₂）and 6 months after intervention（T₃）.（3）Statistical methods.Chi-square test,analysis of variance,Fisher’s exact probability method,repeated measurement analysis of variance and H test statistics were used to evaluate the intervention effect of rehabilitation exercise program.ResultsA total of 200 subjects were included in the study,of which 192 completed the whole intervention study process,2 dropped out of the study,3 lost their visit,and 3 were not suitable to continue to participate in the study due to the change of their condition.There were 48 cases in the final control group,48 cases in the intervention group Ⅰ,49cases in the intervention group Ⅱ,and 47 cases in the intervention group Ⅲ.1.Intervention effect of rehabilitation exercise program on quality of lifeThere was no significant difference in quality of life scores among the four groups before intervention（all P>0.05）.The difference in time effect was statistically significant（F=104.472,P<0.001）.With the passage of time,the quality of life of all patients improved;The effect difference between the groups was statistically significant（F=5.690,P=0.001）,and the impact of different intervention methods on their quality of life varied;There was statistically significant difference in the interaction effect between time and group（F=4.892,P=0.003）.The range of changes in the quality of life of the subjects with different intervention methods was significantly different over time.Among the four groups,the best effect on improving quality of life was rehabilitation exercise+progressive resistance exercise+intensive follow-up group(T₂:Δ_G3-G0=13.032,P=0.008.T₃:Δ_G3-G1=13.066,P<0.001;Δ_G3-G0=17.379,P<0.001).2.Intervention effect of rehabilitation exercise program on upper limb dysfunctionThere was no statistically significant difference in the DASH scores of the four groups before intervention（all P>0.05）.The difference in time effect was statistically significant（F=223.507,P<0.001）.With the passage of time,the DASH scores of all patients decreased;The effect difference between the groups was statistically significant（F=8.275,P<0.001）,and the effect of different intervention methods on their upper limb function was significantly different;There was no statistically significant difference in the interaction effect between time and group（F=2.411,P=0.068）.There was no significant difference in the change range of upper limb dysfunction among subjects with different intervention methods over time.With the DASH brief table score of intervention groupⅢas a reference,the DASH scores of four groups of patients were compared.The results showed that the rehabilitation exercise+progressive resistance exercise+intensive follow-up group had the best effect on improving upper limb dysfunction(T₂:Δ_G0-G3=13.364,P<0.001;Δ_G1-G3=10.760,P<0.001;Δ_G2-G3=7.909,P=0.002。T₃:Δ_G0-G3=11.991,P<0.001;Δ_G1-G3=7.919,P<0.001;Δ_G2-G3=4.523,P=0.015).3.Intervention effect of rehabilitation exercise program on painThere was no statistically significant difference in the DASH scores of the four groups before intervention（all P>0.05）.The difference in time effect was statistically significant（F=45.811,P<0.001）.With the passage of time,the NRS score of all patients decreased;The effect difference between the groups was statistically significant（F=5.729,P=0.001）,and the influence of different intervention methods on NRS score changed;There was a statistically significant difference in the interaction effect between time and group（F=6.193,P<0.001）.The NRS score of the subjects with different intervention methods varied significantly over time.Among the four groups,the best effect on pain improvement was rehabilitation exercise+fast walking+intensive follow-up group(T₃:Δ_G2-G1=-0.931,P=0.010;Δ_G2-G0=-1.577,P<0.001)。4.Intervention effect of rehabilitation exercise program on shoulder joint range of motionThere was no significant difference in the angle of flexion,extension and abduction of the shoulder joint of the affected limb in the first four groups（all P>0.05）.The difference of time effect,inter-group effect and interaction effect between time and group were statistically significant（all P<0.05）.Further analysis showed that the rehabilitation exercise+progressive resistance exercise+intensive follow-up group had the best effect on improving the range of motion of the shoulder joint.5.Intervention effect of rehabilitation exercise program on lymphedemaAt T₂ and T₃,there are trends to support that lymphedema prevalence was lower for rehabilitation exercise+fast walking+intensive follow-up（4.1%;8.2%）and the rehabilitation exercise+progressive resistance exercise+intensive follow-up（4.2%;4.2%）group versus JME（10.4%;25.0%）and rehabilitation exercise+intensive follow-up（10.5%;12.5%）group.At T₂,no significant differences were observed in the incidence of lymphedema between any two of the four groups（H=1.043,P=0.791）.At T₃,the incidence of lymphedema in each group was not the same（H=13.466,P=0.004）.After the Bonferroni method was used to correct the significance level,significant differences were found in the occurrence of lymphedema between rehabilitation exercise+progressive resistance exercise+intensive follow-up group and control group（Z=3.277,adjusted P=0.006）and between rehabilitation exercise+fast walking+intensive follow-up group and control group（Z=2.651,adjusted P=0.048）.ConclusionThe results of this study show that rehabilitation exercise+fast walking+intensive follow-up and rehabilitation exercise+progressive resistance exercise+intensive follow-up have good effects on improving the quality of life and preventing lymphedema after surgery,but the effect of rehabilitation exercise+progressive resistance exercise+intensive follow-up is more prominent.Rehabilitation exercise+progressive anti-resistance exercise+intensive follow-up have better effects on improving upper limb dysfunction and pre-shoulder joint range of motion after surgery.Both rehabilitation exercise+fast walking+intensive follow-up and rehabilitation exercise+progressive resistance exercise+intensive follow-up have good analgesic effects.The effect of rehabilitation exercise+fast walking+intensive follow-up appears earlier,while the overall effect of rehabilitation exercise+progressive resistance exercise+intensive follow-up is better.In addition,long-term and planned monitoring and follow-up are also important for postoperative rehabilitation of breast cancer.