Assessment of Postural Balance in Women Treated for Breast Cancer
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design
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- signing consent to participate in the study;
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- age over 35 years at the time of surgery;
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- patients declaring regular use of an external breast prosthesis after surgery;
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- patients declaring participation in physiotherapy;
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- patients who have undergone surgery for breast cancer 5–6 years before.
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- cognitive dysfunction;
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- patients diagnosed with diseases of the nervous system (Parkinson’s disease, peripheral nerve palsy) or skeletal system (inflammatory diseases, scoliosis >10 Cobb angle), or rheumatic diseases;
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- patients with disseminated cancer;
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- patients with lymphoedema of the limb on the operated side;
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- patients taking medication that affect body balance.
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- consent to participate in the study.
- Medical interview (BG patients: type of surgery, type of adjuvant treatment);
- Measurement of body weight—without footwear, on the scale of 1 kg accuracy;
- Height measurement.
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- maximum deviation of the center of foot pressure (mm)—this parameter was calculated for left-sided, right-sided, back and forward deviation;
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- average deviation of the center of foot pressure in the lateral (X) and anteroposterior (Y) directions;
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- average velocity (mm/s)—mean velocity at which the foot pressure center moves during the test, average velocities in the lateral (X) and antero-posterior (Y) direction were calculated;
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- path length (mm)—the length of the path traveled by the center of pressure;
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- surface area (mm2)—this parameter is calculated by connecting the points of the statokinesigram with lines.
2.2. Statistical Analysis
3. Results
3.1. Group Characteristics
3.2. Comparison of Open-Eye and Closed-Eye Romberg’s Test Results in Patients from BG
3.3. Comparison of Open-Eye vs. Closed-Eye Romberg’s Test Results among Patients from CG
3.4. Comparison of Romberg Test Results in BG and CG Groups
3.5. Comparison of Romberg’s Test Results in the MAS Group in Terms of the Operated Breast
3.6. Comparison of Romberg’s Test Results in the MAS Group in Terms of BMI of Examined Women
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Bardy, B.G.; Oullier, O.; Bootsma, R.J.; Stoffregen, T.A. The dynamics of human postural transitions. J. Exp. Psychol. Hum. 2002, 2, 499–514. [Google Scholar] [CrossRef]
- Corna, S.; Tarantola, J.; Nardone, A.; Giordano, A.; Schieppati, M. Standing on a continuously moving platform: Is body intertia counteracted or exploited? Exp. Brain Res. 1999, 124, 331–341. [Google Scholar] [CrossRef] [PubMed]
- Dimitrov, G.; Baytchev, G.; Inkov, I.; Dimitrov, D. The advancement and history of breast cancer surgical therapy at a glance. Int. J. Surg. Med. 2017, 3, 119–127. [Google Scholar] [CrossRef]
- Barbosa, J.A.; Amorim, M.H.; Zandonade, E.; Delaprane, M.L. Evaluation of body posture in women with breast cancer. Rev. Bras. Ginecol. Obs. 2013, 35, 215–220. [Google Scholar] [CrossRef] [PubMed]
- Głowacka, I.; Nowikiewicz, T.; Siedlecki, Z.; Hagner, W.; Nowacka, K.; Zegarski, W. The Assessment of the Magnitudeof Frontal Plane Postural Changes in Breast Cancer PatientsAfter Breast-Conserving Therapy or Mastectomy—Follow-upResults 1 Year after the Surgical Procedure. Pathol. Oncol. Res. 2016, 22, 203–208. [Google Scholar] [CrossRef] [PubMed]
- Głowacka-Mrotek, I.; Sowa, M.; Siedlecki, Z.; Nowikiewicz, T.; Hagner, W.; Zegarski, W. Evaluation of changes to foot shape in females 5 years after mastectomy: A case-control study. Breast Cancer Res. Treat. 2017, 163, 287–294. [Google Scholar] [CrossRef] [Green Version]
- Serel, S.; Tuzlalı, Z.Y.; Akkaya, Z.; Uzun, Ç.; Kaya, B.; Bayar, S. Physical effects of unilateral mastec-tomy on spine deformity. Clin. Breast Cancer 2017, 17, 29–33. [Google Scholar] [CrossRef]
- Riegger-Krugh, C.; Keysor, J.J. Skeletal malalignments of the lower quarter: Correlated and compensatory motions and postures. J. Orthop. Sports Phys. 1996, 23, 164–170. [Google Scholar] [CrossRef]
- Juhl, A.A.; Christiansen, P.; Damsgaard, T.E. Persistent Pain after Breast Cancer Treatment: A Questionnaire-Based Study on the Prevalence, Associated Treatment Variables, and Pain Type. J. Breast Cancer 2016, 19, 447–454. [Google Scholar] [CrossRef] [Green Version]
- Hojan, K.; Manikowska, F.; Chen, P.J.; Lin, C.C. The influence of an external breast prosthesis on the posture ofwomen after mastectomy. J. Back Musculoskelet. Rehabil. 2016, 29, 337–342. [Google Scholar] [CrossRef]
- Glausand, S.W.; Carlson, G.W. Long-term role of external breast prostheses after total mastectomy. Breast J. 2009, 15, 385–393. [Google Scholar]
- Mangone, M.; Bernetti, A.; Agostini, F.; Paoloni, M.; De Cicco, F.A.; Capobianco, S.V.; Bai, A.V.; Bonifacino, A.; Santilli, V.; Paolucci, T. Changes in Spine Alignment and Postural Balance After Breast Cancer Surgery: A Rehabilitative Point of View. BioResearch Open Access 2019, 8, 121–128. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Metcalfe, K.; Gershman, S.; Ghadirian, P. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 muta-tions: Retrospective analysis. BMJ 2014, 348, 226. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Almstedt, H.C.; Grote, S.; Perez, S.E.; Shoepe, T.C.; Strand, S.L.; Tarleton, H.P. Training-related improvements in musculoskeletal health and balance: A 13-week pilot study of female cancer survivors. Eur. J. Cancer Care 2017, 26, e12442. [Google Scholar] [CrossRef]
- Meric, F.; Buchholz, T.A.; Mirza, N.Q.; Vlastos, G.; Ames, F.C.; Ross, M.I.; Pollock, R.E.; Singletary, S.E.; Feig, B.W.; Kuerer, H.M.; et al. Long term complications associated with breast-conservation surgery and radiotherapy. Ann. Surg. Oncol. 2002, 9, 543–549. [Google Scholar] [CrossRef]
- Gonzalez-Fernandez, S.; Fernandez-Rodrıguez, C.; Mota-Alonso, M.J.; García-Teijido, P.; Pedrosa, I.; Pérez-Álvarez, M. Emotional state and psychological flexibility in breast cancer survivors. Eur. J. Oncol. Nurs. 2017, 30, 75–83. [Google Scholar] [CrossRef]
- Głowacka-Mrotek, I.; Sowa, M.; Nowikiewicz, T.; Siedlecki, Z.; Hagner, W.; Zegarski, W. Foot posture in femalepatients 5 years after breast-conserving surgery: A case—Control study. Breast Cancer 2018, 25, 325–333. [Google Scholar] [CrossRef] [Green Version]
- Jeong, J.H.; Choi, B.; Chang, S.Y.; Kim, E.-K.; Kang, E.-Y.; Heo, C.Y.; Myung, Y.; Chang, S. The Effect of Immediate Breast Reconstruction on Thoracic Spine Alignment after Unilateral Mastectomy. Clin. Breast Cancer 2018, 18, 214–219. [Google Scholar] [CrossRef]
- Atanes Mendes Peres, A.C.; Dias de Oliveira Latorre, M.D.; Yugo Maesaka, J.; Filassi, J.R.; Chada Baracat, E.; Alves Gonçalves Ferreira, E. Body posture after mastectomy: Comparison between immediate brest reconstruction versus mastectomy alone. Physiother. Res. Int. 2017, 22, e1642. [Google Scholar] [CrossRef]
- Habermann, E.B.; Abbott, A.; Parsons, H.M.; Virnig, B.A.; Al-Refaie, W.B.; Tuttle, T.M. Are mastectomy rates really increasing in the United States? J. Clin. Oncol. 2010, 28, 3437–3441. [Google Scholar] [CrossRef]
- Hojan, K.; Manikowska, F. Can the Weight of an External Breast Prosthesis Influence Trunk Biomechanics during Functional Movement in Postmastectomy Women? BioMed Res. Int. 2017, 2017, 9867694. [Google Scholar] [CrossRef] [PubMed]
- Korvenoja, M.L.; Smitten, K.; Asko-Seljavaara, S. Problems in wearing external prosthesis after mastectomy and patient’s desire for breast reconstruction. Ann. Chir. Gynaecol. 1998, 87, 30–34. [Google Scholar]
- Hojan, K.; Manikowska, F.; Milinska-Glura, M.; Chen, B.P.-J.; Jozwiak, M. The impact of external breast prothesis on the gait parameters of women after mastectomy. Cancer Nurs. 2013, 37, E30–E36. [Google Scholar] [CrossRef] [PubMed]
- Angin, S.; Karadibak, D.; Yavuzşen, T.; Demirbüken, I. Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors. Contemp.Oncol. 2014, 18, 279–284. [Google Scholar] [CrossRef] [PubMed]
- Genthon, N.; Rougier, P. Influence of an asymmetrical body weight distribution on the control of undisturbed upright stance. J. Biomech. 2005, 38, 2037–2049. [Google Scholar] [CrossRef]
- Haddad, J.M.; Rietdyk, S.; Ryu, J.H.; Seaman, J.M.; Silver, T.A.; Kalish, J.A.; Hughes, C.M. Postural asymmetries in response to holding evenly and unevenly distributed loads during self-selected stance. J. Mot. Behav. 2011, 43, 345–355. [Google Scholar] [CrossRef]
- Fong, S.S.; Choi, A.W.; Luk, W.S.; Yam, T.T.; Leung, J.C.; Chung, J.W. Bone mineral density, balanceperformance, balance self-efficacy, and falls in breast cancer survivorswith and without qigong training: An observational study. Integr. Cancer Ther. 2018, 17, 124–130. [Google Scholar] [CrossRef] [Green Version]
Variable | CG (n = 74) | BG (n = 90) | t-test | P * |
---|---|---|---|---|
Age–median (SD) | 66.78 (4.78) | 65.63 (7.86) | 1.10 | 0.272 |
Weight–median (SD) | 73.96 (19.07) | 72.22 (10.15) | −0.47 | 0.641 |
Height–median (SD) | 161.91 (6.93) | 162.37 (6.57) | −0.42 | 0.669 |
BMI–median (SD) | 27.18 (4.41) | 27.44 (3.95) | −0.40 | 0.686 |
Type of procedure involving lymph nodes n (%) | ALND | 75 (83.3) | ||
SLNB | 15 (16.7) | |||
Operated side n (%) | R | 51 (50.0) | ||
L | 39 (50.0) | |||
Adjuvant treatment | CHTH, | 26 | ||
HTH | 9 | |||
RTH | 25 | |||
CHTH, RTH | 30 |
Romberg’s Test | Eyes Open | Eyes Closed | Z | p | r | ||||
---|---|---|---|---|---|---|---|---|---|
x | s | V | x | s | V | ||||
Maximal deviation to the left | −0.93 | 0.95 | −0.84 | −1.32 | 1.16 | −1.24 | −3.91 | <0.001 | 0.41 |
Maximal deviation to the right | 0.92 | 1.08 | 0.87 | 1.26 | 1.41 | 1.27 | −4.57 | <0.001 | 0.48 |
Maximal posterior deviation | 1.13 | 3.50 | 1.33 | 1.51 | 3.42 | 1.67 | −3.46 | 0.001 | 0.36 |
Maximal forward deviation | 3.89 | 3.46 | 4.41 | 4.47 | 3.60 | 4.85 | −3.96 | <0.001 | 0.42 |
Mean deviation X | 0.01 | 0.83 | 0.02 | 0.02 | 0.87 | 0.07 | −0.26 | 0.792 | 0.03 |
Mean deviation Y | 2.67 | 3.38 | 2.91 | 2.76 | 3.35 | 3.09 | −1.45 | 0.148 | 0.15 |
Mean velocity X | 0.85 | 0.59 | 0.76 | 1.45 | 1.64 | 1.11 | −7.20 | <0.001 | 0.76 |
Mean velocity Y | 1.03 | 0.71 | 0.87 | 1.62 | 2.38 | 1.12 | −6.56 | <0.001 | 0.69 |
Path length | 32.38 | 12.84 | 30.53 | 56.57 | 31.78 | 49.43 | −7.41 | <0.001 | 0.78 |
Surface area | 8.12 | 5.61 | 7.12 | 11.86 | 25.91 | 6.02 | −0.57 | 0.569 | 0.06 |
Romberg’s Test | Eyes Open | Eyes Closed | Z | p | r | ||||
---|---|---|---|---|---|---|---|---|---|
x | s | V | x | s | V | ||||
Maximal deviation to the left | −1.56 | 2.05 | −1.10 | −1.75 | 2.33 | −1.34 | −1.87 | 0.062 | 0.22 |
Maximal deviation to the right | 1.00 | 1.20 | 0.78 | 1.39 | 1.75 | 1.14 | −3.21 | 0.001 | 0.37 |
Maximal posterior deviation | −0.45 | 4.48 | −0.08 | −0.60 | 4.41 | −0.22 | −1.04 | 0.300 | 0.12 |
Maximal forward deviation | 2.66 | 4.86 | 2.71 | 2.96 | 4.88 | 3.36 | −1.64 | 0.101 | 0.19 |
Mean deviation X | −0.14 | 0.65 | −0.11 | −0.10 | 0.77 | −0.15 | −0.68 | 0.496 | 0.08 |
Mean deviation Y | 1.01 | 4.28 | 1.27 | 1.22 | 4.40 | 1.25 | −0.45 | 0.653 | 0.05 |
Mean velocity X | 0.71 | 0.27 | 0.67 | 1.13 | 0.68 | 0.96 | −6.33 | <0.001 | 0.74 |
Mean velocity Y | 0.76 | 0.32 | 0.71 | 1.31 | 0.76 | 1.13 | −6.48 | <0.001 | 0.75 |
Path length | 29.10 | 13.13 | 25.42 | 48.66 | 28.23 | 41.69 | −6.10 | <0.001 | 0.71 |
Surface area | 7.48 | 10.40 | 4.08 | 6.14 | 4.58 | 4.91 | −0.33 | 0.744 | 0.04 |
Romberg’s Test-Eyes Open | MAS Group | CG Group | Z | p | r | ||||
---|---|---|---|---|---|---|---|---|---|
x | s | V | x | s | V | ||||
Maximal deviation to the left | −0.93 | 0.95 | −0.84 | −1.56 | 2.05 | −1.10 | −2.25 | 0.025 | 0.18 |
Maximal deviation to the right | 0.92 | 1.08 | 0.87 | 1.00 | 1.20 | 0.78 | −0.12 | 0.908 | 0.01 |
Maximal posterior deviation | 1.13 | 3.50 | 1.33 | −0.45 | 4.48 | −0.08 | −3.00 | 0.003 | 0.23 |
Maximal forward deviation | 3.89 | 3.46 | 4.41 | 2.66 | 4.86 | 2.71 | −2.18 | 0.029 | 0.17 |
Mean deviation X | 0.01 | 0.83 | 0.02 | −0.14 | 0.65 | −0.11 | −1.14 | 0.256 | 0.09 |
Mean deviation Y | 2.67 | 3.38 | 2.91 | 1.01 | 4.28 | 1.27 | −2.71 | 0.007 | 0.21 |
Mean velocity X | 0.85 | 0.59 | 0.76 | 0.71 | 0.27 | 0.67 | −1.37 | 0.170 | 0.11 |
Mean velocity Y | 1.03 | 0.71 | 0.87 | 0.76 | 0.32 | 0.71 | −2.78 | 0.005 | 0.22 |
Path length | 32.38 | 12.84 | 30.53 | 29,10 | 13.13 | 25,42 | −2.11 | 0.035 | 0.16 |
Surface area | 8.12 | 5.61 | 7.12 | 7.48 | 10.40 | 4.08 | −2.60 | 0.009 | 0.20 |
Romberg’s Test-Eyes Closed | MAS Group | CG Group | Z | p | r | ||||
---|---|---|---|---|---|---|---|---|---|
x | s | V | x | s | V | ||||
Maximal deviation to the left | −1.32 | 1.16 | −1.24 | −1.75 | 2.33 | −1.34 | −0.64 | 0.521 | 0.05 |
Maximal deviation to the right | 1.26 | 1.41 | 1.27 | 1.39 | 1.75 | 1.14 | −0.25 | 0.804 | 0.02 |
Maximal posterior deviation | 1.57 | 3.42 | 1.51 | −0.60 | 4.41 | −0.22 | −2.72 | 0.007 | 0.21 |
Maximal forward deviation | 4.47 | 3.60 | 4.85 | 2.96 | 4.88 | 3.36 | −2.42 | 0.015 | 0.19 |
Mean deviation X | 0.02 | 0.87 | 0.07 | −0.10 | 0.77 | −0.15 | −1.01 | 0.310 | 0.08 |
Mean deviation Y | 2.76 | 3.35 | 3.09 | 1.22 | 4.40 | 1.25 | −2.61 | 0.009 | 0.20 |
Mean velocity X | 1.45 | 1.64 | 1.11 | 1.13 | 0.68 | 0.96 | −1.25 | 0.213 | 0.10 |
Mean velocity Y | 1.62 | 2.38 | 1.12 | 1.31 | 0.76 | 1.13 | −0.34 | 0.736 | 0.03 |
Path length | 56.57 | 31.78 | 49.43 | 48.66 | 28.23 | 41.69 | −2.00 | 0.046 | 0.16 |
Surface area | 11.86 | 25.91 | 6.02 | 6.14 | 4.58 | 4.91 | −1.69 | 0.091 | 0.13 |
Romberg’s Test | Operated Breast Right (n = 45) | Operated Breast Left (n = 45) | Z | p | r | ||||
---|---|---|---|---|---|---|---|---|---|
x | s | V | x | s | V | ||||
Maximal deviation to the left (open eyes) | −0.97 | 1.00 | −1.03 | −0.89 | 0.91 | −1.02 | −0.52 | 0.603 | 0.05 |
Maximal deviation to the right (open eyes) | 0.92 | 1.33 | 1.44 | 0.91 | 0.78 | 0.85 | −0.40 | 0.609 | 0.04 |
Maximal deviation to the left (closed eyes) | −1.29 | 1.32 | −1.02 | −1.35 | 1.00 | −0.74 | −0.45 | 0.654 | 0.05 |
Maximal deviation to the right (closed eyes) | 1.34 | 1.75 | 1.31 | 1.19 | 0.97 | 0.82 | −0.13 | 0.900 | 0.01 |
Romberg’s Test | BMI < 25 (n = 20) | BMI > 25 (n = 70) | Z | p | r | ||||
---|---|---|---|---|---|---|---|---|---|
x | s | V | x | s | V | ||||
Maximal deviation to the left (open eyes) | −0.98 | 1.09 | −1.11 | −0.91 | 0.92 | −1.00 | −0.40 | 0.691 | 0.04 |
Maximal deviation to the right (open eyes) | 0.98 | 0.98 | 1.00 | 0.90 | 1.11 | 1.24 | −0.82 | 0.415 | 0.09 |
Maximal deviation to the left (closed eyes) | −1.57 | 1.31 | −0.84 | −1.24 | 1.12 | −0.90 | −1.00 | 0.317 | 0.11 |
Maximal deviation to the right (closed eyes) | 1.24 | 1.37 | 1.11 | 1.27 | 1.43 | 1.13 | −0.58 | 0.560 | 0.06 |
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Głowacka-Mrotek, I.; Tarkowska, M.; Nowikiewicz, T.; Hagner-Derengowska, M.; Goch, A. Assessment of Postural Balance in Women Treated for Breast Cancer. Medicina 2020, 56, 505. https://doi.org/10.3390/medicina56100505
Głowacka-Mrotek I, Tarkowska M, Nowikiewicz T, Hagner-Derengowska M, Goch A. Assessment of Postural Balance in Women Treated for Breast Cancer. Medicina. 2020; 56(10):505. https://doi.org/10.3390/medicina56100505
Chicago/Turabian StyleGłowacka-Mrotek, Iwona, Magdalena Tarkowska, Tomasz Nowikiewicz, Magdalena Hagner-Derengowska, and Aleksander Goch. 2020. "Assessment of Postural Balance in Women Treated for Breast Cancer" Medicina 56, no. 10: 505. https://doi.org/10.3390/medicina56100505