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Nurse-Led Exercise Intervention Sharply Reduces Shoulder Dysfunction After Mastectomy
A randomized controlled trial of 320 breast cancer patients found that those receiving a structured nurse-led rehabilitation intervention had dramatically lower disability scores at 12 months — a median DASH score of 5.17 compared to 24.14 in the control group (p < 0.001). The magnitude of this difference, sustained across a full year of follow-up, suggests nurse-delivered early shoulder rehabilitation may substantially prevent the functional losses commonly seen after modified radical mastectomy.
What Was Studied
The study investigated whether a structured nurse-led intervention could reduce shoulder dysfunction — including restricted range of motion and upper limb disability — in women undergoing modified radical mastectomy (MRM) for breast cancer. Post-mastectomy shoulder morbidity is a well-recognized but often undertreated complication, and understanding how early nurse-directed rehabilitation compares to standard postoperative care has direct implications for survivorship outcomes.
How It Was Studied
This randomized controlled trial was conducted at a center in South India and enrolled 320 women who were scheduled for MRM and met predefined inclusion criteria. Participants were allocated equally — 160 to the experimental group and 160 to the control group — using block randomization via a computer-generated sequence. The experimental group received a nurse-led structured intervention layered on top of routine postoperative care, while the control group received routine care alone. Shoulder range of motion (ROM) was measured with a goniometer at baseline and at 3-month intervals over one year, and upper limb disability was assessed using the validated Disability of the Arm, Shoulder, and Hand (DASH) questionnaire at the 6-month and 12-month time points.
What Was Observed
- Shoulder ROM improved significantly more in the intervention group than in controls across all five movement planes — flexion, extension, abduction, internal rotation, and external rotation — with a statistically meaningful time-by-group interaction (p < 0.001), meaning the two groups diverged in their trajectories of recovery, not merely in their absolute values at one point in time.
- Clinically significant ROM loss (Grade II) at the 3rd and 6th month follow-ups was present in only 1 patient (0.68%) in the experimental group, compared to 25 patients (16.89%) and 18 patients (12.41%) in the control group during the same periods, representing a more than 20-fold difference in the rate of moderate shoulder restriction.
- Upper limb disability scores at 12 months were markedly lower in the intervention group, with a median DASH score of 5.17 (IQR 1.72–8.62) versus 24.14 (IQR 15.52–35.34) in the control group (p < 0.001), indicating the intervention group retained near-normal functional capacity while controls experienced meaningful disability on average.
- At the earlier 6-month follow-up, the same directional pattern was evident — DASH scores of 6.00 (IQR 3.06–10.25) in the intervention group versus 21.5 (IQR 14.25–34.25) in controls (p < 0.001) — confirming that the functional benefit emerged early and was sustained rather than narrowing over time.
Why This Matters
Post-mastectomy shoulder dysfunction affects a substantial proportion of breast cancer survivors and can persist for years, impairing daily activities and reducing quality of life. This trial adds to a growing body of evidence supporting early structured rehabilitation, but its specific contribution is demonstrating that nurse-led delivery — without requiring specialized physiotherapy — can achieve clinically substantial and durable gains. The findings are particularly relevant to health systems in low- and middle-income settings where physiotherapy resources may be limited.
How to Read This Result
While the findings are internally robust, the trial was conducted at a single center in South India, which limits how broadly the results can be applied to different healthcare environments, patient populations, or mastectomy practices.
Limitations
The abstract does not explicitly report study limitations.