ABSTRACT
PURPOSE: To evaluate the incidence of arm morbidity following breast cancer surgery including axillary dissection and to identify related factors. MATERIASL AND METHODS: One hundred and fifty nine patients were studied using a self-report questionnaire and a clinical examination. Lymphedema, reduction of range of motion in shoulder joint and subjective symptoms (pain, impaired arm movement, numbness, stiffness) were evaluated. As related factors, demographic, oncologic characteristics and types of treatment were analysed. RESULTS: The incidence of lymphedema (> or =2 cm difference comparing to unaffected arm) was 6.3%, 10.7%, 22.6% and 23.3% at each 10 cm, 20 cm, 30 cm, and 40 cm from wrist. Reduction of range of motion in shoulder joint (> or =20 degree difference comparing to unaffected arm) was noted in more than 1/3 patients for flexion, abduction and internal rotation. Especially the reduction of range of motion in internal rotation was severe (> 50% reduction) in 1/3 patients. Approximately 50 to 60% of patients complained impaired arm movement, numbness, stiffness and pain. Body mass index (BMI) was the significant risk factor for lymphedema. CONCLUSION: Lymphedema was present in 1/3 of patients and the common sites of edema were 30 cm 40 cm proximal from the wrist. Also most severe reduction of range of motion in shoulder joint was with internal rotation. There needs weight control for lymphedema because BMI was the significant risk factor for lymphedema. Also rehabilitation program for range of motion especially internal rotation in shoulder joint should be developed.
Subject(s)
Humans , Arm , Body Mass Index , Breast Neoplasms , Breast , Demography , Edema , Hypesthesia , Incidence , Lymphedema , Surveys and Questionnaires , Range of Motion, Articular , Rehabilitation , Risk Factors , Shoulder Joint , WristABSTRACT
The main purpose of this study was to identify the effect of hand massage on pain and anxiety related to chest tube removal in patients with a lobectomy. The research design of this study was a nonequivalent control group non-synchronized design. Of the twenty nine adult subjects, fourteen were assigned to the experimental group and fifteen to the control group. The data were obtained over 3 months from a medical center in Seoul. The instruments used to assess trait state anxiety was the Spielberger Trait-State anxiety Inventory. For Pain and psychological anxiety, The Visual Analogue Scale was used. Hiko analogue sphygmo- manometer(2001) was used to check blood pressure and pulse rate as indicators of physiological anxiety. Subjects in the experimental group received hand massage for 5 minutes just before chest tube was removed, and subjects assigned to the control group did not receive hand massage. Data were analysed with x2-test and Mann-Whitney U test using the SPSSWIN 10.0 program. The results of the study are as follows; 1. Hypothesis 1: "there will be a significant difference between two groups in the level of pain after chest tube removal" was supported (u = 23.00, p<0.001). 2. Hypothesis 2: "there will be a significant difference between the two groups in the level of psychological anxiety after chest tube removal" was supported (u = 3.00, p<0.001). 3. Hypothesis 3: "there will be a significant difference between the two groups in physiological anxiety(systolic, diastolic blood pressure and pulse rate) after chest tube removal" was supported(u = 55.50, p = 0.01 ; u = 41.50, p = 0.01 ; u = 20.50, p<0.001, relatively). The findings of this study indicate that hand massage is effective for pain and anxiety related to chest tube removal in patients with lobectomy. Therefore, hand massage is recommended as an effective nursing intervention for relieving pain and anxiety in patients undergoing chest tube removal. Further research is needed to identify the proper duration and timing to achieve the optimal effect of hand massage. A larger subject population is required to apply the current findings to the general population. Further research is also needed to assess the effects of hand massage in other patient subsets. Finally, it would be interesting to see if the effects of hand massaging would be attenuated when performed by a non-medical specialist.