Jornal Internacional de Medicina Física e Reabilitação
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Abstrato

Multidisciplinary Rehabilitation in Women with Breast Cancer: a Systematic Review

Fary Khan and Bhasker Amatya

Background: With improved survival rates in breast cancer (BC), there are implications for longer-term impact on disability, psychological function and quality of life, which may be amenable to rehabilitation. Rehabilitation is an expensive resource and the evidence to support its justification is urgently needed. The aim of this systematic review is to present an evidence-based overview of the effectiveness of multidisciplinary (MD) rehabilitation interventions in women with BC and the outcomes that are affected. Methods: A search of the literature was conducted using medical and health science electronic databases (Medline, EMBASE, CINAHL, AMED, PEDro, LILACS and the Cochrane Library) up to May 2013 for studies reporting outcomes of BC patients following MD rehabilitation that addressed functional restoration and improved participation. Two reviewers applied the inclusion criteria to select potential studies and independently extracted data and assessed the methodological quality. Included studies were critically appraised using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodological quality approach. Results: Seven studies (two randomised controlled trials (RCTs), one controlled clinical trial (CCT) and 4 prospective observational studies) for MD rehabilitation programmes for women with BC were evaluated for the “best” evidence to date. There is ‘moderate level evidence’ (2 RCTS and 2 cohort studies) for the effectiveness of MD ambulatory rehabilitation in reducing disability, improving participation and quality of life in women with BC in the later stages, compared with lesser intensity rehabilitation intervention for up to 12 months. Further, one CCT and two observational studies demonstrated ‘low level evidence’ for inpatient MD rehabilitation for improved participation (up to 12 months); and ‘very low level evidence’ for longer term reduction in disability (6-12 months). Conclusion: This review found ‘moderate’ quality evidence for ambulatory (outpatient) and ‘low’ quality evidence for inpatient MD rehabilitation in women with BC. The gaps in existing research should not be interpreted as ineffectiveness of MD rehabilitation in this population. Further research is needed with appropriate study designs, outcome measurement, and type of modalities and cost-effectiveness of these interventions.