Real-time interactive digital healthcare system for post-operative breast cancer patients: study protocol for a randomized controlled trial

Hae-Yeon Park, Kyung Eun Nam, Jae-Young Lim, Seung Mi Yeo, Jong In Lee, Ji Hye Hwang, Hae-Yeon Park, Kyung Eun Nam, Jae-Young Lim, Seung Mi Yeo, Jong In Lee, Ji Hye Hwang

Abstract

Background: After receiving breast cancer surgery or reconstruction, shoulder dysfunctions including weakness, post-operative pain, shoulder joint instability, and limited range of motion (ROM) often occur. Due to limited ROM, patients may suffer difficulty in activities of daily living, and quality of life may be reduced. The objective of this study is to compare the effects on shoulder ROM of a real-time interactive digital healthcare system and brochure-based home rehabilitation program in post-operative breast cancer patients.

Methods: This study is a prospective, multi-center, assessor-blinded randomized controlled trial. The study aims to recruit 100 breast cancer patients exhibiting limited shoulder ROM after undergoing axillary lymph node dissection or breast reconstruction following mastectomy. Patients will be randomly assigned to two groups for 8 weeks of rehabilitation: a digital healthcare system rehabilitation (intervention) group and a brochure-based rehabilitation (control) group. The primary outcome is the change in ROM of the affected shoulder between baseline and 12 weeks after enrollment. Secondary outcomes include pain in the affected shoulder, as measured using a numerical rating scale, functional outcomes (QuickDASH scores), and quality of life (FACT-B and EQ-5D-5L scores), all of which will be measured on enrollment and 4, 8, and 12 weeks thereafter.

Discussion: This study will compare the effectiveness of a newly developed, augmented reality-based real-time interactive digital healthcare system with that of brochure-based home rehabilitation for improving the shoulder ROM, pain, functional outcomes, and quality of life of post-operative breast cancer patients.

Trial registration: ClinicalTrials.gov NCT04316156 . Registered on 20 March 2020.

Keywords: Augmented reality; Breast cancer; Rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The schedule of enrollment, interventions, and assessments
Fig. 2
Fig. 2
Flowchart of the study

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2018;68(6):394–424. doi: 10.3322/caac.21492.
    1. Kootstra JJ, Dijkstra PU, Rietman H, de Vries J, Baas P, Geertzen JHB, Hoekstra HJ, Hoekstra-Weebers JEHM. A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Research and Treatment. 2013;139(1):125–134. doi: 10.1007/s10549-013-2509-y.
    1. Helms G, Kühn T, Moser L, Remmel E, Kreienberg R. Shoulder-arm morbidity in patients with sentinel node biopsy and complete axillary dissection – data from a prospective randomised trial. European Journal of Surgical Oncology (EJSO). 2009;35(7):696–701. doi: 10.1016/j.ejso.2008.06.013.
    1. Kuehn T, Klauss W, Darsow M, Regele S, Flock F, Maiterth C, Dahlbender R, Wendt I, Kreienberg R. Long-term morbidity following axillary dissection in breast cancer patients – clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Research and Treatment. 2000;64(3):275–286. doi: 10.1023/A:1026564723698.
    1. Nesvold I-L, Dahl AA, Løkkevik E, Marit Mengshoel A, Fosså SD. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta Oncologica. 2008;47(5):835–842. doi: 10.1080/02841860801961257.
    1. Blomqvist L, Stark B, Engler N, Malm M. Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiotherapy. Acta Oncologica. 2004;43(3):280–283. doi: 10.1080/02841860410026170.
    1. Smith SL. Functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol. 2014;5(3):181–187.
    1. Nelson JA, Lee IT, Disa JJ. The functional impact of breast reconstruction: an overview and update. Plast Reconstr Surg Glob Open. 2018;6(3):e1640. doi: 10.1097/GOX.0000000000001640.
    1. Beurskens CH, van Uden CJ, Strobbe LJ, Oostendorp RA, Wobbes T. The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study. BMC Cancer. 2007;7(1):166. doi: 10.1186/1471-2407-7-166.
    1. Recchia TL, Prim AC, Luz CM. Upper limb functionality and quality of life in women with five-year survival after breast cancer surgery. Rev Bras Ginecol Obstet. 2017;39(3):115–122. doi: 10.1055/s-0037-1598642.
    1. Lee CH, Chung SY, Kim WY, Yang SN. Effect of breast cancer surgery on chest tightness and upper limb dysfunction. Medicine. 2019;98(19):e15524. doi: 10.1097/MD.0000000000015524.
    1. Ribeiro IL, Moreira RFC, Ferrari AV, Alburquerque-Sendín F, Camargo PR, Salvini TF. Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials. Clinical Rehabilitation. 2019;33(12):1876–1886. doi: 10.1177/0269215519873026.
    1. Feyzioglu O, Dincer S, Akan A, Algun ZC. Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery? Support Care Cancer. 2020;28(9):4295–4303. doi: 10.1007/s00520-019-05287-x.
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European journal of pain. 2004;8(4):283–291. doi: 10.1016/j.ejpain.2003.09.004.
    1. Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (Quick DASH): validity and reliability based on responses within the full-length DASH. BMC musculoskeletal disorders. 2006;7(1):44. doi: 10.1186/1471-2474-7-44.
    1. Yoo HJ, Ahn SH, Eremenco S, Kim H, Kim WK, Kim SB, Han OS. Korean translation and validation of the functional assessment of cancer therapy-breast (FACT-B) scale version 4. Quality of life research. 2005;14(6):1627–1632. doi: 10.1007/s11136-004-7712-1.
    1. Nguyen J, Popovic M, Chow E, Cella D, Beaumont JL, Chu D, DiGiovanni J, Lam H, Pulenzas N, Bottomley A. EORTC QLQ-BR23 and FACT-B for the assessment of quality of life in patients with breast cancer: a literature review. J Comp Eff Res. 2015;4(2):157–166. doi: 10.2217/cer.14.76.
    1. Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974–986. doi: 10.1200/JCO.1997.15.3.974.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Quality of life research. 2011;20(10):1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Kim SH, Ahn J, Ock M, Shin S, Park J, Luo N, Jo MW. The EQ-5D-5L valuation study in Korea. Qual Life Res. 2016;25(7):1845–1852. doi: 10.1007/s11136-015-1205-2.
    1. Ng Y-L, Ma F, Ho FK, Ip P, Fu K-W. Effectiveness of virtual and augmented reality-enhanced exercise on physical activity, psychological outcomes, and physical performance: a systematic review and meta-analysis of randomized controlled trials. Computers in Human Behavior. 2019;99:278–291. doi: 10.1016/j.chb.2019.05.026.
    1. Gorman C, Gustafsson L. The use of augmented reality for rehabilitation after stroke: a narrative review. Disability and Rehabilitation: Assistive Technology. 2020:1–9. 10.1080/17483107.2020.1791264.
    1. Villiger M, Liviero J, Awai L, Stoop R, Pyk P, Clijsen R, Curt A, Eng K, Bolliger M. Home-based virtual reality-augmented training improves lower limb muscle strength, balance, and functional mobility following chronic incomplete spinal cord injury. Front Neurol. 2017;8:635. doi: 10.3389/fneur.2017.00635.

Source: PubMed

3
Abonnere