Effect of Exercise on Breast Cancer-Related Lymphedema: What the Lymphatic Surgeon Needs to Know.

BACKGROUND: Breast cancer-related lymphedema (BCRL) affects many areas of daily living. Individuals with lymphedema may experience chronic and progressive swelling, recurrent skin infections, and decreased self-image and quality of life. For many years, it was considered best practice for this population to avoid exercise; however, in recent years, research has begun to challenge this belief. This systematic review and meta-analyses examined the recent literature on the effects of exercise for patients with, or at risk for, BCRL to inform best practice. METHODS: A total of 807 articles were retrieved from CINAHL, Academic Search Complete, Medline, and PubMed. Results were systematically filtered to 26 articles through inclusion criteria, exclusion criteria, and the Effective Public Health Practice Project quality assessment tool for quantitative studies. Data were pooled from studies containing relative and absolute volume measurements of limb volume, as well as upper extremity function measured by the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire; meta-analyses were conducted using SAS software. RESULTS: The literature was reviewed and statistically analyzed. Results have indicated aerobic exercise, resistance exercise, stretching, yoga, qigong, and pilates can be safe and effective in the management of symptoms for those with, or at risk for, BCRL. CONCLUSION: Several forms of exercise appear to be safe interventions for clinicians to use when treating this population and offer benefits such as improved quality of life, strength, body mass index, and mental health and decreased pain and lymphatic swelling. Additional research should be conducted to further examine the efficacy and safety of nontraditional forms of exercise in the treatment of BCRL.

Stroke Simulation Activity: A Standardized Patient Case for Interprofessional Student Learning.

Introduction: Integration of interprofessional education (IPE) activities into health professions curricula aims to promote collaborative practice with a goal of improving patient care. Methods: Through intercollegiate collaborations involving four different educational organizations and an academic health center, an interprofessional stroke simulation involving standardized patients was developed and instituted for IPE-naive student learners from medicine, nursing, physician assistant, occupational therapy, and physical therapy programs with additional involvement from pharmacy and social work learners. Herein, we describe the design of the IPE simulation and examine its impact on students' interprofessional development as assessed by students' completion of a validated IPE competency self-assessment tool and written reflective comments after the simulation. Results: Self-assessed interprofessional interaction and values domains were evaluated before and after the activity using the shortened 16-question Interprofessional Education Collaborative Competency Self-Assessment tool; data revealed significant changes in both the values and interaction domains of the tool from pre- to postsimulation experience (p < .0001). The qualitative student reflections revealed new student realizations around the concepts of collaboration, leadership, roles of different professions, and the importance of communication after participating in the simulation. Discussion: Quantitative data coupled with qualitative reflections from learners support the effectiveness of this activity for facilitating development of interprofessional competencies among health professions students.

Development and validation of the hand assessment tool.

The objective was to develop a self-administered activity limitation measurement tool for individuals with hand and wrist injuries, and to evaluate the reliability and validity of the new instrument, the Hand Assessment Tool (HAT). The final version of the HAT instrument, the SF12, and Disabilities of Arm, Shoulder, and Hand Questionnaire (DASH) were given to 94 consecutive new hand surgery clinic patients. Statistical analyses indicated excellent internal consistency with Cronbach's alpha of 0.91. Test-retest reliability of the HAT showed a concordance correlation coefficient of 0.73, with 95% confidence interval=(0.60, 0.83). Excellent correlation between the HAT and DASH was noted. A modest agreement with the SF12 physical score was observed. The HAT correlated well with the DASH and SF12 physical score and proved to be an internally consistent and reliable instrument for evaluation of activity limitations for individuals who sustain wrist or hand injury.