Bone Mineral Density Among Individuals With Residual Lower Limb Weakness After Polio.

BACKGROUND: Literature indicates that individuals with long-term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) related to muscle weakness. Where weakness is asymmetrical, bone densitometry measured only on the stronger LE may misclassify BMD. OBJECTIVE: To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck. DESIGN: Retrospective study. SETTING: Outpatient postpolio center. PARTICIPANTS: Patients >18 years old with complete relevant data. MAIN OUTCOME MEASURES: Bone densitometry T scores, BMD categories based on standard T-score ranges, and side of LE weakness determined by a strength score. RESULTS: Forty-three patients had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had bone densitometry only on their weaker LE and 14 (32.5%) had bone densitometry only on their stronger LE. Of the 15 patients with bone densitometry done on both femoral necks, T scores (mean [SD]) were lower in the weaker LE (-1.73 [1.09]) than the stronger LE (-0.88 [1.0]) (P = .001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively). CONCLUSIONS: In this small sample, using strong-limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak-limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high-fall-risk group. LEVEL OF EVIDENCE: III.

Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer.

Women's experience of breast cancer is complex, affecting all aspects of life during and after treatment. Patients' perspectives about common impairments and functional limitations secondary to breast cancer treatment, including upper extremity motion restriction, lymphedema, fatigue, weight gain, pain, and chemotherapy-induced peripheral neuropathy, are addressed. Women often report being uninformed regarding these side effects and surprised that they do not always disappear after treatment, but remain part of their lives. Breast cancer patients express strong, unmet needs for education, information, and intervention for these side effects. Evidence suggests that rehabilitation and exercise are effective in preventing and managing many physical side effects of breast cancer treatment. Nevertheless, few women are referred to rehabilitation during or after treatment, and fewer receive baseline assessments of impairment and function to facilitate early detection of impairment and functional limitations. The prospective surveillance model of rehabilitation will serve the needs of women with breast cancer by providing education and information about treatment side effects, reducing the incidence and burden of side effects through early identification and treatment, and enhancing access to timely rehabilitation. Integration of exercise as a component of the model benefits patients at every phase of survivorship, by addressing individual concerns about exercise during and after treatment and highlighting the important contribution of exercise to overall health and survival. The prospective surveillance model of rehabilitation can meet the evident and often expressed needs of survivors for information, guidance, and intervention--thus addressing, and potentially improving, overall quality of life for individuals diagnosed with and treated for breast cancer.

A qualitative assessment of upper quarter dysfunction reported by physical therapists treated for breast cancer or treating breast cancer sequelae.

PURPOSE: As survival rates for breast cancer improve, long-term effects of treatment are receiving increasing attention, including upper quarter impairments and functional limitations. The purpose of this study was to assess, through qualitative means, the long-term effects of breast cancer treatment on upper quarter function as reported by those with expertise in upper quarter dysfunction. Participants were physical therapists who were either breast cancer survivors ("survivors") or those who specialized in treatment of individuals post-breast cancer ("treaters"). SUBJECTS AND METHODS: Three focus groups (two groups of survivors [n=16] and one group of treaters [n=10]) were convened to discuss their experiences with upper quarter dysfunction post-breast cancer. Qualitative research methods were used to collect and analyze the data, to extract themes, and to assure reliability and validity of the original and extracted data. RESULTS: Two themes emerged from the data and are supported by participant quotes. The first theme described the presence of upper quarter dysfunction that impacted body structure and function and resulted in activity/participation limitations. The second theme described the contextual factors that impacted the reported dysfunction, including access to comprehensive care, inadequate attention by health care providers, and a resulting need for self-advocacy. CONCLUSIONS: The study supports the problem of late effects from breast cancer treatment on upper quarter function and points out the need for better education for health care providers, increased long-term surveillance of survivors, and a more proactive model of health care delivery for this population.

Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review.

Late effects of treatment for breast cancer on shoulder function have been documented by a number of investigators; however, many studies include only prevalence data. When comparisons are provided that assess differences between treatment groups, only P-values without magnitudes of effect are often reported. The purpose of this systematic review was to identify literature that could be used to examine the magnitude of late effects of breast cancer treatments on shoulder function with a particular focus on axillary lymph node dissection (ALND) and on radiotherapy. A comprehensive search of online databases was performed for research papers published between 1980 and 2008 that provided comparison data between treatment groups, between the affected and unaffected side of individuals, or between pre-operative and subsequent assessments 12 months or more after diagnosis of breast cancer. Papers that met inclusion criteria were reviewed using a methodological checklist. Standardized effect sizes were computed for continuous data; odds ratios and 95% confidence intervals were computed for dichotomous data if not already available. Twenty-two papers met the inclusion criteria. With a few exceptions, most analyses showed excess shoulder morbidity with breast cancer treatment, ALND, or radiotherapy. Although effect sizes varied, moderate to large effects predominated across the different outcomes. There is sufficient evidence of late effects of ALND or radiotherapy post-breast cancer to warrant careful attention to shoulder function across time in individuals who have had breast cancer. Implications for future shoulder dysfunction are discussed.