Effect of Preoperative Rehabilitation Exercise on Improving Postoperative Lymphedema, Quality of Life and Care Needs in Patients With Breast Cancer Surgery

Background:

Surgical resection combined with axillary lymph node dissection in breast cancer patients frequently causes upper extremity lymphedema, negatively impacting physical function and quality of life. Implementing upper limb rehabilitation exercises prior to surgery may facilitate functional recovery and reduce postoperative complications.

Objectives:

• To evaluate the effect of preoperative upper limb rehabilitation exercise on reducing postoperative lymphedema in patients with breast cancer.
• To examine changes in quality of life and home care needs following preoperative rehabilitation intervention.
• To analyze factors influencing upper extremity function, lymphedema severity, quality of life, and care needs among breast cancer surgical patients.

Methods & Procedures:

This longitudinal quasi-experimental study will recruit 105 patients scheduled for tumor resection with axillary lymph node dissection at National Taiwan University Hospital and National Taiwan University Hospital Cancer Center.

• Experimental Group: Receives individualized preoperative instruction and guidance on upper limb rehabilitation exercises starting preoperatively.
• Control Group: Receives routine clinical nursing education preoperatively or on postoperative Day 1 according to standard ward procedures.

Data Collection Timeline:

Data will be collected at seven time points:

• Pre-operation (1 week / 1 day prior to surgery)
• Postoperative Day 1
• Postoperative Week 2 (first clinic visit)
• Postoperative Week 4
• Postoperative Month 3
• Postoperative Month 6
• Postoperative Year 1

Assessment Parameters:

Measurements include arm circumference, handgrip strength, shoulder range of motion, functional activities of daily living (ADL), lymphedema-related symptoms, quality of life, and care needs. Descriptive statistics and Generalized Estimating Equations (GEE) will be used to analyze treatment outcomes over time.

Inclusion criteria

• Diagnosed with malignant breast cancer confirmed by post-surgical tissue examination.
• Receiving primary surgery, including tumor resection combined with axillary lymph node dissection.
• Age 20 years or older.
• Conscious, able to communicate in Mandarin or Taiwanese, aware of diagnosis, capable of completing questionnaires and participating in interventions, and signed informed consent.

Exclusion criteria

• Severe cognitive impairment or unaware of diagnosis, unable to complete questionnaires or correctly execute intervention measures.
• Patients in the control group who independently schedule outpatient rehabilitation after returning home.
• Unable to communicate in Mandarin or Taiwanese.
• Undergoing breast reconstruction surgery.