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Background: Lymphedema is associated with significant physical and psychosocial problems. The Lymphedema Functioning, Disability and Health questionnaire for upper limb lymphedema is a valid and reliable tool quantifying the amount of problems in functioning in patients with breast cancer-related lymphedema. Patients suggested a revision of the scoring system to facilitate completion of the questionnaire. Therefore, adjustment of the questionnaire was carried out by implementing a numeric rating scale instead of the existing visual analog scale. Purpose of this study was to investigate reliability and validity of the revised Lymph-ICF, called the Lymph-ICF-UL. Methods and Results: Reliability and validity of the Lymph-ICF-UL were examined in 56 participants with upper limb lymphedema. Intraclass correlation coefficients for test-retest reliability ranged from 0.79 to 0.95. Cronbach's alpha coefficients for internal consistency were higher than 0.80. Face and content validity were very good because the scoring system was clear for all participants (100%), questions were understandable for all participants (100%), and all complaints due to arm lymphedema were mentioned by 98% of the participants. Construct validity was good. Convergent validity was established since four out of five expected domains of the Lymph-ICF-UL showed a moderate correlation with expected domains of the 36-Item Short-Form Health Survey questionnaire. There was good divergent validity because seven out of nine hypotheses assessing divergent validity were accepted. Conclusion: The Lymph-ICF-UL is a reliable and valid questionnaire using a simplified and clearer scoring procedure to assess impairments in function, activity limitations, and participation restrictions of patients with breast cancer-related arm lymphedema.

Purpose: Besides pain, myofascial dysfunctions may contribute to the presence of upper limb impairments such as impaired range of motion, decreased strength, lymphedema, and altered postures and kinematics. Therefore, the aim of this study was to investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of upper limb dysfunctions in breast cancer survivors., Methods: Fifty women treated for a unilateral breast cancer with pain and myofascial dysfunctions at the upper limb region. The intervention group received 12 sessions of myofascial therapy consisting of release techniques on myofascial trigger points and adhesions in addition to a standard physical therapy program for 3 months. The control group received 12 sessions of a placebo intervention in addition to the same standard physical therapy program during the 3 months. Outcome parameters are active shoulder range of motion (inclinometer); arm lymphedema (perimeter); upper limb strength (handheld dynamometer); scapular statics and dynamics (acromion-table and pectoralis minor index, inclinometer); shoulder function (Disability of Shoulder, Arm and Hand questionnaire); and quality of life (Short Form 36). Measures were taken before and after the intervention at 6 and 12 months follow-up., Results: No differences between groups were found for all outcome parameters over the course of 1 year. However, overall beneficial effects of the standard physical therapy program for active shoulder range of motion and shoulder function were found in both groups up to 1 year follow-up., Conclusion: Myofascial therapy has no additional beneficial effect for improvement of upper limb function in breast cancer survivors.

Purpose: The aim of this study was to explore the treatment, patient, and impairment-related risk factors associated with upper limb dysfunctions in breast cancer survivors., Methods: A cross-sectional study was performed in 274 women treated for breast cancer. The following risk factors were analysed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy and trastuzumab); 2) patient's related variables (age and Body Mass Index); 3) and finally impairment-related variables such as pain (intensity, quality and pressure hypersensitivity, signs of central sensitisation, the degree of pain catastrophizing and vigilance and awareness to pain), active ROM and upper limb strength were investigated. The dependent variable was upper limb function measured with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Additionally, a stepwise regression was performed., Results: An impaired upper limb function was noted in 170 (62%) of patients. Mean time after surgery was 1.5 (1.6) years. From multivariable analysis, it appears that in particular certain pain characteristics such as pain intensity, pain quality, signs of central sensitisation and pain catastrophizing are contributing to upper limb dysfunctions after breast cancer treatment at long term. Additionally, higher age, shoulder ROM and handgrip strength are possible contributing factors. The stepwise regression analysis revealed that central sensitisation mechanisms alone can explain about 40% of the variance in upper limb function., Conclusions: At long term, especially pain and central sensitisation mechanisms contribute to upper limb function in breast cancer survivors., (Copyright © 2017 Elsevier Ltd. All rights reserved.)