Efetividade da fisioterapia na síndrome da rede axilar após cirurgia de câncer de mama – ensaio clínico e seguimento tardio.
Data
2022-10-11
Autores
Figueira, Patricia Vieira Guedes 
Orientadores
Nazário, Afonso Celso Pinto
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A síndrome da rede axilar (SRA) é uma complicação comum em mulheres com câncer de mama que ocorre no pós-operatório (PO) imediato caracterizada por dor axilar, limitação de amplitude de movimentos (ADM) do ombro e presença de cordões que afetam significativamente o retorno às atividades de vida diária (AVD). Objetivos: Avaliar o impacto do exercício físico com ou sem mobilização tecidual, sobre os parâmetros de dor, presença de cordões e ADM de flexão e abdução de ombro. Métodos: Ensaio clínico randomizado realizado no ambulatório de fisioterapia da Disciplina de Mastologia do Departamento de Ginecologia da Escola Paulista De Medicina/Universidade Federal de São Paulo (EPM/UNIFESP). Setenta e três mulheres com SRA foram randomizadas no grupo mobilização (ME) (N=37) e grupo exercício (E) (N=36), e acompanhadas durante três meses após a cirurgia de câncer de mama. Ambos os grupos receberam orientações para exercícios físicos para ADM de ombro a serem realizados em domicílio diariamente, e a mobilização tecidual no grupo específico foi realizada no ambulatório com máximo de seis sessões, conforme a necessidade da paciente. ADM, dor, presença de cordões foram avaliados em cada período de pós-operatório. Resultados: Em ambos os grupos, ao final de 90 dias, observaram-se melhora na flexão em relação aos 7 dias e 15 dias de PO, porém ainda inferior à média do pré-operatório (Pré). Quanto ao número de cordões, também para ambos os tratamentos, observou-se melhora já aos 60 dias de PO. Na abdução, o grupo E mostrou-se melhor que o ME, uma vez que, em média, o nível da abdução aos 60 e 90 dias de PO não foi diferente do Pré, ao passo que no ME, a média nas duas últimas avaliações foram inferiores às do Pré. Conclusões: O exercício físico orientado a ser realizado após a cirurgia de câncer de mama em pacientes com SRA é de extrema importância e padrão ouro na recuperação funcional e se mostrou superior em relação a mobilização tecidual para o movimento de abdução. Entretanto, a mobilização tecidual aparece como coadjuvante ao tratamento por causar melhora imediata na ADM, na dor e na presença de cordões.
Introduction: Axillary web syndrome (AWS) is a common complication in women after breast cancer that occurs in the immediate postoperative (PO) period characterized by pain, limited shoulder range of motion (ROM) and presence of cords that significantly affect the return to activities of daily living. Objectives: To evaluate the impact of physical exercise with or without tissue mobilization, on pain, presence of cords and shoulder flexion and abduction ROM. Methods: Randomized clinical trial was performed at Breast Diseases Division of the Universidade Federal de São Paulo. Seventy-three women with AWS were randomized into mobilization group (ME) (N=37) and exercise group (E) (N=36) and followed for three months after breast cancer surgery. Both groups received guidelines for shoulder exercise to be performed at home daily and tissue mobilization in the specific group was performed with a maximum of six sessions, according to the patient's need. ROM, pain and presence of cords was evaluated in each postoperative period. Results: In both groups, at the end of 90 days, improvement in flexion was observed in relation to 7 days and 15 days PO, but still lower than the pre mean. As for the number of cords, also for both treatments, improvement was observed at 60 days PO. In abduction, the group E was better than the ME, since, on average, the level of abduction in the control group at 60- and 90-days PO was not different from pre, whereas in the ME, the average in the last two evaluations were lower than the pre. Conclusions: The physical exercise oriented to be performed after breast cancer surgery in patients with AWS is extremely important and the gold standard in functional recovery and proved to be superior in relation to tissue mobilization for abduction movement. However, tissue mobilization appears as an adjunct to treatment for causing a more immediate improvement in ROM, pain, and presence of cords.
Introduction: Axillary web syndrome (AWS) is a common complication in women after breast cancer that occurs in the immediate postoperative (PO) period characterized by pain, limited shoulder range of motion (ROM) and presence of cords that significantly affect the return to activities of daily living. Objectives: To evaluate the impact of physical exercise with or without tissue mobilization, on pain, presence of cords and shoulder flexion and abduction ROM. Methods: Randomized clinical trial was performed at Breast Diseases Division of the Universidade Federal de São Paulo. Seventy-three women with AWS were randomized into mobilization group (ME) (N=37) and exercise group (E) (N=36) and followed for three months after breast cancer surgery. Both groups received guidelines for shoulder exercise to be performed at home daily and tissue mobilization in the specific group was performed with a maximum of six sessions, according to the patient's need. ROM, pain and presence of cords was evaluated in each postoperative period. Results: In both groups, at the end of 90 days, improvement in flexion was observed in relation to 7 days and 15 days PO, but still lower than the pre mean. As for the number of cords, also for both treatments, improvement was observed at 60 days PO. In abduction, the group E was better than the ME, since, on average, the level of abduction in the control group at 60- and 90-days PO was not different from pre, whereas in the ME, the average in the last two evaluations were lower than the pre. Conclusions: The physical exercise oriented to be performed after breast cancer surgery in patients with AWS is extremely important and the gold standard in functional recovery and proved to be superior in relation to tissue mobilization for abduction movement. However, tissue mobilization appears as an adjunct to treatment for causing a more immediate improvement in ROM, pain, and presence of cords.
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Citação
FIGUEIRA, Patricia Vieira Guedes. Efetividade da fisioterapia na síndrome da rede axilar após cirurgia de câncer de mama – ensaio clínico e seguimento tardio. 2022. 105 f. Tese (Doutorado em Ginecologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, 2022.