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Community-based outpatient rehabilitation for the treatment of breast cancer-related upper extremity disability: an evaluation of practice-based evidence

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To evaluate the impact and acceptability of outpatient physical or occupational therapy (PT/OT) for breast cancer survivors (BCS) with varying levels of upper extremity disability (UED).


We retrospectively extracted patient and therapy characteristics, UED measured by quick-disabilities of the arm, shoulder and hand (QuickDASH, 0–100 pts.), and patient-rated acceptability (1-item, 0–10 pts) from rehabilitation charts of BCS who completed cancer-specialized PT/OT provided by a single national institution in 2019. We summarized characteristics and acceptability using descriptive statistics, then used established parameters to group BCS by baseline UED severity: high- (QuickDASH > 31.5), moderate- (QuickDASH = 18.5–31.5), or low-UED (QuickDASH = 13–18.5). To evaluate within-group pre-to-post QuickDASH change, we used paired samples t test (p < 0.01), then calculated the proportion who achieved the minimally clinical important difference (MCID, 15.9 points). To compare between-groups difference in QuickDASH improvement, we used Kruskal–Wallis test and Chi-squared test.


Patients (N = 417) were 59.89 ± 12.06 years old, 99% female, and attended approximately 10 PT/OT sessions (IQR = 6.0–16.0). Most had high baseline UED (62%), followed by moderate (25%) or low UED (13%). For each severity group, mean pre-to-post change in QuickDASH was significant: high-UED (M∆ = 25.13 ± 20.33, d = 1.24, p < 0.01), moderate-UED (M∆ = 11.36 ± 11.9, d = 0.95, p < 0.01), and low-UED (M∆ = 4.84 ± 9.15, d = 0.53, p < 0.01). Most with high UED achieved the MCID (n = 176, 68.2%). In the moderate- and low-UED groups 44% (n = 46) and 4% (n = 2) achieved the MCID, respectively. Acceptability was high (n = 167, Median = 10).


Outpatient cancer rehabilitation is associated with significant improvement in UED for BCS and was acceptable to patients regardless of UED severity at baseline.

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We would like to thank the individuals who participated in rehabilitation services and our partners: Baylor Scott & White Institute for Rehabilitation, SSM Health Physical Therapy, Banner Physical Therapy, NovaCare Rehabilitation, and KORT Physical Therapy.


The authors declare no additional funds, grants or other support were received during the preparation of this manuscript.

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Authors and Affiliations



KCW: led data extraction, analysis and initial manuscript preparation with support from MH, TK and MP. All authors reviewed and advised on the study and manuscript at each stage.

Corresponding author

Correspondence to Kelley Covington Wood.

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Conflict of interest

Authors, Wood, Pergolotti, and Kendig receive salaries from Select Medical. Author, Hidde, is an hourly employee of Select Medical. The authors have no other relevant financial or non-financial interested to disclose. The content is solely the responsibility of the authors and does not necessarily represent the official views of Select Medical.

Ethical approval

This retrospective study was approved by the Colorado State University Institutional Review Board (Protocol #19-9379H).

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Wood, K.C., Hidde, M., Kendig, T. et al. Community-based outpatient rehabilitation for the treatment of breast cancer-related upper extremity disability: an evaluation of practice-based evidence. Breast Cancer 29, 1099–1105 (2022).

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