Authors (including presenting author) :
Jess Li 1, O K Chun2 , Connie Lee 1, Amy Or2, Regina Leung 1, N S Wong 2, Lily Wong2, Brigitte Fung1, Irene Cheng 2, Charlie Li 1, Miranda Chan2
Affiliation :
Department of Physiotherapy (1), Breast Centre Department of Surgery (2) Kwong Wah Hospital
Introduction :
Structured multidisciplinary rehabilitation therapy (Galantino & Stout, 2013) for cancer treatment is needed to improve functioning and quality of life.Multidisciplinary breast cancer rehabilitation in KWH was established since November 2001. It was a joint collaborative service of physiotherapists and breast care nurses for the rehabilitation of the breast cancer patients. Early interventional rehabilitation for breast cancer patients after operation was established since October 2013. It could manage the early sign of complication thus improving the functioning and quality of life of patients.
Objectives :
-To provide early rehabilitation interventional program to breast cancer patient after operation -To maximize recovery in the shoulder range of movement after operation -To minimize functional complications of the operation -To educate patients on the prevention of lymphedema -To follow up the case till completion of adjuvant therapy so that prompt treatment can be offered
Methodology :
Sample: All breast cancer patients with operation done in KWH were recruited. Phase I (1) Pre-operative multidisciplinary education session Provide education on post-op physiotherapy and nursing and complications prevention as well as psychological preparation (2) Day 0 - Day 2 Inpatient care and chest physiotherapy with limbs maintenance (3) Day 3 and Day 14 Multidisciplinary Outpatient Clinic with nurse and physiotherapy exercise class: Provide early intervention to breast cancer patients to maximize rehabilitation outcomes in post-operative management, mobility, functional outcome, pain relief and psychological support Phase II (4) Physiotherapy Outpatient Clinic (Day 21 till finished chemotherapy or post radiotherapy 6 months): Monitor the rehabilitation progress with physical assessment, provide treatment for neck and shoulder pain and dysfunction, improve shoulder and chest mobility and detect early sign of lymphedema hence prompt management. Outcomes measures: Pre-operation physiotherapy satisfaction rating Nurse Clinic early rehabilitation patient satisfaction survey Range of shoulder movement Quick DASH questionnaire (Disability of Arm Shoulder and Hand) Subjective improvement (NGRCS)
Result & Outcome :
There were 284 cases included from January-December 2018. The average rating of Pre-operation physiotherapy education class satisfaction rating was 8.7/10. Nurse Clinic patient satisfaction survey average rating was 8.4/10. The improvements in range of shoulder movement (flexion and abduction) were 38.9 % (D3-D14), 54.7 % (D3-D21) and 91 % (D3-D/C). The Functional score of Quick DASH was improved from 29.3 (D14) to 9.8 (D/C). The subjective improvement NGRCS was 8.67 upon discharge.The MDT Breast Cancer patient rehabilitation program demonstrated promising outcome with more comprehensive risk management against post-operative complications and greater satisfaction. It showed benefit in restoration of patients functions and overall well-being, is worthy to endorse for future health service development in management of breast cancer.
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