Introduction
Methods
Participants
Procedures
Data analysis
Results
Participant characteristics
Characteristics | All participants n = 144 | Non-Lymphedema n = 71 | Lymphedema n = 73 | Difference in means (sd) | 95% confidence interval | Sig. (p)
|
---|---|---|---|---|---|---|
Age (years) | 56.33 (9.44) | 55.17 (8.76) | 57.47 (9.98) | 2.30 (1.57) | (−5.39, 0.80) | 0.15a
|
Body mass index | 26.4 (5.54) | 25.45 (4.63) | 27.33 (6.22) | 1.88 (0.91) | (−3.68, −0.08) |
0.04
a
|
Arm volume difference (ml) | 109.9 (243.21) | −7.9 (72.61) | 224.5 (292.16) | −232.34 (35.26) | (−302.5, −162.2) |
<0.001
a
|
Affected side Right/Left | 67/77 | 29/42 | 38/35 | 0.18b
| ||
Dominant UE R/L/ambidext. | 130/11/3 | 64/5/2 | 66/6/1 | 0.81b
| ||
Affected side = Dominant side | 71 | 33 | 38 | 0.50b
| ||
Years of education | 16.69 (2.71) | 17.04 (2.48) | 16.33 (2.98) | 0.71 (0.45) | (−0.18, 1.60) | 0.12a
|
Days/week of exercise | 3.41 (1.72) | 3.51 (1.64) | 3.31 (1.80) | 0.21 (0.29) | (−0.37, 0.77) | 0.48a
|
No. of women working for pay | 85 | 41 | 44 | 0.76b
| ||
Years since breast cancer diagnosis | 6.17 (5.35) | 4.94 (4.06) | 7.37 (6.15) | 2.43 (0.87) | (−4.15, −0.72) |
0.01
a
|
No. of women who had: | ||||||
BCSc
| 82 | 39 | 43 | 0.63b
| ||
Mastectomy | 62 | 32 | 30 | |||
Sentinel lymph node biopsy | 93 | 54 | 39 |
0.01
b
| ||
Axillary lymph node dissection | 108 | 46 | 62 |
<0.005
b
| ||
No. of nodes removed | 10.99 (7.48) | 8.59 (6.43) | 13.39 (7.73) | 4.80 (1.20) | (−7.18, −2.43) |
<0.001
a
|
No. who received radiation therapy | 107 | 49 | 58 | 0.15b
| ||
No. who received chemotherapy | 101 | 48 | 53 | 0.51b
| ||
No. who received prior treatment for lymphedema | 81 | 15 | 66 |
<0.001
b
|
Non-lymphedema group | Lymphedema group | Difference in means (Mann Whitney U) | |||
---|---|---|---|---|---|
Mean (SD) | Median (range) | Mean (SD) | Median (range) | ||
DASH | |||||
(0–100 scale) | 8.67 | 3.67 | 18.48 | 14.17 |
p
< .001
|
(12.63) | (0–7.8) | (17.30) | (1–76.7) |
Differences between sides
Non lymphedema group n = 71 | Lymphedema group n = 73 | |||||
---|---|---|---|---|---|---|
Unaffected arm versus affected arm | Unaffected arm versus affected arm | |||||
UE measures | Unaffected Mean (SD) | Affected Mean (SD) | Mean diff (95% CI) | Unaffected Mean (SD) | Affected Mean (SD) | Mean diff (95% CI) |
Purdue Pegboard time(sec) | 80.2 (8.1) | 80.6 (12.3) | −0.4 (−3.0, 2.2) | 82.4 (10.4) | 82.8 (12.1) | −0.3 (−3.1, 2.4) |
Finger Tapper (no. of taps) | 44.5 (7.6) | 45.4 (7.0) | −0.9 (−2.3, 0.6) | 43.0 (7.5) | 43.5 (6.9) | −0.5 (−2.1, 1.1) |
Shoulder ABDb strength kg | 12.5 (2.4) | 12.1 (2.6) |
0.4 (0.03, 0.8)
a
| 11.8 (2.5) | 11.5 (4.6) | 0.3 (−0.6, 1.2) |
Elbow flexion strength | 20.9 (4.0) | 20.9 (4.2) | −0.01 (−0.4, 0.4) | 19.6 (3.7) | 18.5 (3.8) |
1.1 (0.6, 1.5)
a
|
Wrist flexion strength | 9.4 (2.2) | 9.6 (2.2) | −0.2 (−0.5, 0.1) | 8.9 (2.2) | 9.4 (2.2) |
−0.4 (−0.8, −0.1)
a
|
Grip strength | 27.5 (7.0) | 26.6 (7.1) | 0.9 (−0.02, 1.8) | 26.6 (6.4) | 25.2 (6.2) |
1.4 (0.3, 2.5)
a
|
Key grip strength | 5.6 (1.5) | 5.6 (1.6) | 0.1 (−0.2, 0.4) | 5.5 (1.6) | 5.3 (1.4) | 0.2 (−0.9, 0.5) |
3 point chuck grip | 6.5 (1.7) | 6.7 (1.8) | −0.2 (−0.5, 0.1) | 6.7 (1.8) | 6.3 (1.7) |
0.4 (0.1, 0.7)
a
|
All strength | 82.8 (15.4) | 81.6 (15.9) | 1.3 (−0.3, 2.9) | 79.5 (13.8) | 75.8 (14.9) |
3.8 (1.6, 5.9)
a
|
VPTc digits (microns) | 0.1 (0.10) | 0.13 (0.15) | −0.01 (−0.03, 0.003) | 0.12 (0.08) | 0.13 (0.10) | −0.01 (−0.03, 0.002) |
VPT radial styloid | 0.5 (0.4) | 0.5 (0.5) | −0.03 (−0.1, 0.04) | 0.5 (0.4) | 0.5 (0.3) | −0.1 (−0.1, 0.01) |
VPT medial epic. | 0.9 (0.9) | 0.8 (0.9) | 0.1 (−0.1, 0.2) | 0.9 (0.86) | 1.1 (1.08) | −0.2 (−0.5, 0.1) |
SWMd web | 20.5 (2.7) | 20.9 (2.6) | −0.4 (−1.1, 0.3) | 20.04 (2.42) | 20.18 (2.30) | −0.2 (−0.7, 0.4) |
SWM index finger | 20.5 (2.4) | 21.0 (2.28) | −0.5 (−1.0, 0.03) | 20.6 (2.67) | 20.1 (2.9) |
0.5 (0.04, 1.03)
a
|
SWM little finger | 21.5 (2.5) | 22.1 (2.2) | −0.6 (−1.1, −0.03)
a
| 21.6 (2.6) | 21.7 (2.7) | −0.1 (−0.6, 0.5) |
SWM lateral forearm | 20.8 (2.5) | 21.3 (2.1) | −0.5 (−1.0, 0.1) | 20.3 (2.2) | 19.9 (2.9) | 0.5 (−0.2, 1.2) |
SWM medial forearm | 19.8 (2.0) | 19.8 (1.9) | −0.04 (−0.5, 0.4) | 19.3 (2.2) | 18.6 (2.2) |
0.7 (0.2, 1.2)
a
|
SWM lateral arm | 20.1 (2.3) | 20.1 (2.5) | −0.04 (−0.6, 0.5) | 19.7 (2.2) | 19.4 (2.2) | 0.3 (−0.1, 0.8) |
SWM medial arm | 19.1 (2.5) | 18.9 (2.6) | 0.3 (−0.3, 0.8) | 19.1 (2.6) | 17.4 (3.2) |
1.7 (0.9, 2.5)
a
|
Shoulder flexion ROMe
| 169 (8) | 166 (9) |
3.0 (1.7, 4.5)
a
| 167 (9) | 161 (12) |
6.0 (3.9, 8.2)
a
|
Shoulder ABD ROM | 162 (19) | 153 (25) |
9.3 (4.8, 13.7)
a
| 158 (20) | 140 (29) |
17.5 (11.7, 23.4)
a
|
Shoulder ERb ROM | 93 (9) | 89 (11) |
3.7 (1.4, 6.0)
a
| 89 (10) | 86 (13) |
2.8 (0.3, 5.3)
a
|
Shoulder IRb ROM | 43 (9) | 42 (10) | 0.9 (−1.1, 2.9) | 45 (9) | 44 (10) | 1.1 (−0.9, 3.2) |
Elbow flexion ROM | 149 (4) | 150 (4) | −0.5 (−1.2, −0.2) | 150 (4) | 149 (4) | 0.8 (−0.1, 1.6) |
Elbow extension ROM | 2 (4) | 2 (4) | 0.2 (−0.4, 0.7) | 0.3 (5) | 0.9 (4) | −0.7 (−1.4, 0.1) |
Wrist flexion ROM | 77 (8) | 78 (7) | −0.6 (−2.0, 0.8) | 77 (7) | 75 (7) |
2.0 (0.8, 3.1)
a
|
Wrist extension ROM | 74 (7) | 73 (8) | 0.3 (−0.8, 1.3) | 72 (7) | 71 (8) | 1.5 (−0.1, 3.2) |
Index PIPb ROM | 114 (6) | 114 (4) | −0.3 (−1.3, 0.7) | 112 (9) | 110 (7) |
1.6 (0.01, 3.2)
a
|
Overall ROM score | 882 (40) | 866 (54) |
15.9 (8.3, 23.4)
a
| 870 (47) | 836 (62) |
32.7 (22.2, 43.2)
a
|
Within subjects contrasts: main effect of side | Between subjects effects: main effect of lymphedema | Interaction effect: side and lymphedema | |
---|---|---|---|
Was the difference between sides significant, regardless of group? | Was the difference between groups significant, averaged across both arms? | Were the differences greater in the lymphedema group? | |
p
|
p
|
p
| |
Purdue Pegboard time(sec) | 0.68 | 0.16 | 0.95 |
Finger Tapper (no. of taps) | 0.23 | 0.13 | 0.73 |
Shoulder ABDb strength kg | 0.16 | 0.16 | 0.82 |
Elbow flexion strength |
0.001
a
|
0.004
|
0.001
|
Wrist flexion strength |
0.01
| 0.25 | 0.32 |
Grip strength |
0.02
| 0.27 | 0.51 |
Key grip strength | 0.16 | 0.53 | 0.51 |
3 point chuck grip | 0.34 | 0.65 |
0.002
|
All strength |
<0.001
|
0.06
|
0.07
|
VPTc digits (microns) |
0.03
| 0.69 | 0.98 |
VPT radial styloid | 0.07 | 0.69 | 0.66 |
VPT medial epic. | 0.32 | 0.22 | 0.06 |
SWMd web | 0.20 | 0.10 | 0.60 |
SWM index finger | 0.94 | 0.40 |
0.01
|
SWM little finger | 0.09 | 0.57 | 0.20 |
SWM lateral forearm | 1.0 |
0.01
|
0.03
|
SWM medial forearm | 0.07 |
0.01
|
0.04
|
SWM lateral arm | 0.42 | 0.09 | 0.30 |
SWM medial arm |
0.004
|
0.04
|
0.00
|
Shoulder flexion ROMe
|
<0.001
|
0.02
|
0.02
|
Shoulder abduction ROM |
<0.001
|
0.01
|
0.03
|
Shoulder ERb ROM |
<0.001
|
0.03
| 0.59 |
Shoulder IRb ROM | 0.15 | 0.15 | 0.86 |
Elbow flexion ROM | 0.63 | 0.91 |
0.02
|
Elbow extension ROM | 0.29 |
0.03
| 0.07 |
Wrist flexion ROM | 0.14 | 0.13 |
0.01
|
Wrist extension ROM |
0.07
| 0.12 | 0.20 |
Index PIPb ROM | 0.16 |
0.01
|
0.05
|
Overall ROM score |
<0.001
|
0.01
|
0.01
|
Regression analysis
Change Statistics | |||||||
---|---|---|---|---|---|---|---|
Model | R | R Square | R Square Change | F Change | Sig. F Change p
| ||
1. Subject diagnosed with lymphedema | .378 | .143 | .143 | 23.269 | .000 | ||
2. Subject diagnosed with lymphedema, grip strength affected side | .592 | .351 | .208 | 44.646 | .000 | ||
3. Subject diagnosed with lymphedema, grip strength affected side, shoulder abduction ROM affected side | .620 | .385 | .034 | 7.618 | .007 | ||
4. Subject diagnosed with lymphedema, grip strength affected side, shoulder abduction ROM affected side, Number of comorbidities | .681 | .463 | .078 | 19.977 | .000 |
B | Std. error | Beta | t | Sig | 95% CI for B | |
---|---|---|---|---|---|---|
(Constant) | .466 | .699 | 0.668 | 0.51 | −.915, 1.848 | |
subject diagnosed with lymphedema | .911 | .212 | .277 | 4.302 | <.001 | .492, 1.330 |
shoulder abduction ROM affected side | −.012 | .004 | −.202 | −3.072 | 0.003 | −.020, −.004 |
grip strength affected side | −.038 | .007 | −.341 | −5.099 | <.001 | −.052, −.023 |
Number of comorbidities | .320 | .072 | .291 | 4.470 | <.001 | .178, .461 |