A survey of written information on the use of post-operative exercises after breast cancer surgery

Objective
Shoulder and arm exercises are a routine part of post-operative care after axillary dissection for breast cancer. There appears to be a wide variation in recommendations in relation to the commencement of shoulder mobilisation in the post-operative period. The objective of this national survey was to collect printed information to identify common approaches and trends in the guidance supplied to patients through written material.

Design
Postal survey to collect patient information on shoulder and arm exercises for breast cancer patients.

Participants
One hundred and fourteen cancer units in England, Scotland, Wales and Northern Ireland.

Main outcome measures
A content analysis of written material provided to patients was undertaken to evaluate information relating to shoulder mobilisation in terms of commencement, frequency and intensity of exercise.

Results
In total, 105 of 114 units responded (response rate 92%). Over half (59%) recommended a delayed initiation of movement and exercise until the seventh post-operative day. Common features of exercise programmes included initial shoulder girdle exercises (65, 62%), arm movements with the elbow flexed or short lever exercise (72, 69%) and active assisted movement (88, 71%). Some problems were identified with the generic nature of the information which failed to provide specific regimens for individual patient groups.

Conclusions
There is little consensus in the written instructions for shoulder mobilisation provided for breast cancer patients in the post-operative period. Although there is a tendency to delay full shoulder mobilisation until the seventh post-operative day, just under half of the units studied recommend early mobilisation. Standardisation of guidelines is recommended.