VITENSKAPELIG ARTIKKEL 34 FYSIOTERAPEUTEN 2/25 Effect of Myofascial Therapy After Surgery and Radiotherapy in Breast Cancer Treatment Cecilie Erga, fysioterapeut, MHS, PhD kandidat, SHARE-senter for kvalitet og sikkerhet i helsetjenesten, Universitetet i Stavanger. cecilie.erga@uis.no. Ingvild Dalen, biostatistiker, PhD Forskningsavdelingen, Stavanger universitetssjukehus. Ylva Hivand Hiorth, spesialist i nevrologisk fysioterapi MNFF, PhD, Avdeling for fysikalsk medisin og rehabilitering og Senter for bevegelsesforstyrrelser, Stavanger universitetssjukehus. Denne vitenskapelige artikkelen er fagfellevurdert etter Fysioterapeutens retningslinjer, og ble akseptert 10. januar 2025. Ingen interessekonflikter oppgitt. Artikkelen ble først publisert på www.fysioterapeuten.no. Abstract Purpose: Many women experience physical late effects after surgery and radiotherapy as part of breast cancer treatment and need physiotherapy. Myofascial therapy is a commonly used treatment for these late effects, though scientific evidence is limited. This systematic review aimed to evaluate and summarize the existing research on the effects of myofascial therapy on physical late effects after breast cancer treatment with surgery and radiotherapy. Method: Systematic literature searches for randomized controlled trials investigating the effect of myofascial therapy on late effects after breast cancer were conducted in the databases Amed, Embase, Cinahl, Medline, PEDro, and Pubmed on February 27th, 2020, and February 6th, 2023. The Cochrane Collaboration’s tool for assessing risk of bias (RoB) was used. Meta-analyses of outcome measures on shoulder abduction and flexion (degrees), shoulder function (Disabilities of the Arm, Shoulder and Hand questionnaire, 0-100), and pain (logtransformed visual analogue scale, 0-100) were conducted to estimate mean differences with 95% confidence intervals (CIs). Results: 233 studies were identified, of which five were included in the meta-analyses with 245 participants. Myofascial therapy improved shoulder abduction immediately after intervention (13.0; 6.3 to 19.6; p=0.001) and at last follow-up (10.4; 3.0 to 17.8; p=0.006), improved shoulder function at last follow up (-5.8; -10.7 to -1.0; p=0.020), and reduced pain intensity at last follow up (-0.33; -0.54 to -0.12; p=0.003). Conclusion: This review indicates that myofascial therapy can have positive impact on late effects after breast cancer treatment regarding, shoulder abduction, shoulder function, and pain. More studies are needed to compare myofascial therapy with relevant alternative interventions, as well as investigating long-term effects, timing, frequency and duration of myofascial therapy, and other outcomes such as quality of life. Keywords: Breast cancer, myofascial treatment, late effects, physiotherapy. Introduction Breast cancer (BC) is the most common type of cancer in women worldwide. Due to improvements in diagnostic and treatment methods, BC has one of the highest survival rates among cancers (1–3). Consequentially, many women experience physical late effects in the cancerous upper body region after surgery and radiotherapy. These effects include skin changes, tissue adherence, lymphoedema, and nerve damage, resulting in shoulder- and upper-limb dysfunction and persisting pain (4–9). Myofascial therapy (MFT) is a commonly used physiotherapy modality for treating these late effects. MFT is a low load manual treatment, where slow, sustaining pressure is applied directly or indirectly to the areas of the skin that is restricted after radiotherapy and surgery (10). The purpose of MFT is to enhance fascia elastic properties in the radiated- and surgically affected area, improving conditions in tight skin and underlying soft tissue (10). While the Norwegian physiotherapy union guidelines acknowledge MFT as complementary to exercise for late effects after BC treatment, the current research on its effectiveness is insufficient (11), and the parameters for optimal MFT treatment intensity, application technique, amount of manual contact, and treatment settings are unclear (12). This systematic review aims to investigate the evidence for MFT effectiveness in randomized controlled trials (RCTs) for preventing, reducing late physical effects in the affected upper body following BC treatment. Methods Search strategy We systematically searched Amed, Cinahl, Embase, Medline, PEDro and Pubmed, limiting results to English, RCTs,
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