英国华威大学Julie Bruce团队比较了非重建性乳腺癌手术后的锻炼与常规护理对患者健康和生活质量的影响。2021年11月11日出版的《英国医学杂志》发表了这项成果。
为了评估与常规护理相比，结构化锻炼计划是否能改善乳腺癌术后上肢残疾高风险女性的功能和健康相关生活质量，研究组在英国17个国家卫生服务癌症中心进行了一项多中心、实用、优越性、随机对照试验，并进行经济性评价。
研究组共招募了392名接受乳腺癌手术的女性，有术后上肢发病的风险，将其按1：1随机分组，其中196例接受常规护理和锻炼计划，196例接受单纯常规护理。单纯常规护理组接受信息传单；锻炼组在常规护理的基础上联合物理疗法主导的锻炼计划，包括伸展、强化、体力活动和行为改变技术，以支持坚持锻炼，在术后7-10天开始实施，并在术后1个月和3个月时再进行两次预约。
主要结局为12个月时手臂、手和肩膀残疾（DASH）问卷，按治疗意向分析。次要结局包括DASH分量表、疼痛、并发症，以及从健康和个人社会服务角度来观察的与健康相关的生活质量和资源使用情况。
2016年1月26日至2017年7月31日，研究组对951名患者进行了筛查，并随机分配了392名患者（平均年龄58.1岁），其中382名（97%）符合意向治疗分析。锻炼组的191名参与者中有181名（95%）至少参加了一次预约。
与常规护理相比，运动锻炼后上肢功能有所改善，锻炼组平均DASH得分为16.3分，显著低于常规护理组的23.7分。锻炼组的次要结局亦均优于常规护理组，12个月时疼痛强度显著较低，手臂残疾症状更少。锻炼组参与者中未发现并发症、淋巴水肿或不良事件的增加。每名患者的运动累积成本较低，平均花费387英镑，与常规护理相比具有成本效益。
研究结果表明，运动锻炼计划具有临床疗效和成本效益，并可降低乳腺癌患者术后一年的上肢残疾发病率，降低患者的治疗相关并发症风险。
附：英文原文
Title: Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation
Author: Julie Bruce, Bruno Mazuquin, Alastair Canaway, Anower Hossain, Esther Williamson, Pankaj Mistry, Ranjit Lall, Stavros Petrou, Sarah E Lamb, Sophie Rees, Emma Padfield, Raghavan Vidya, Alastair M Thompson
Issue&Volume: 2021/11/11
Abstract:
Objective To evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery.
Design Multicentre, pragmatic, superiority, randomised controlled trial with economic evaluation.
Setting 17 UK National Health Service cancer centres.
Participants 392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196).
Interventions Usual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months.
Main outcome measures Disability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective.
Results Between 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale 0.68, 1.23 to 0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) 2.02, 3.11 to 0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average ￡387 (€457; $533) (95% confidence interval ￡2491 to ￡1718; 2015 pricing) and was cost effective compared with usual care.
Conclusions The PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications.
DOI: 10.1136/bmj-2021-066542
Source: https://www.bmj.com/content/375/bmj-2021-066542
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
