INTRODUCTION:

Breast cancer refers to the erratic growth and proliferation of cells that originate in the breast tissue.

1 Worldwide, breast cancer is the most common invasive cancer in women. It affects about 12% of women around the world.

2 Women who had breast cancer an increased risk of getting breast cancer in other breast.

3 Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer.

4 Post mastectomy exercise done by patients who underwent mastectomy or the surgical removal on one or both of breasts.

5 Generally, exercises are essential to the prevention of shortening of the muscles, prevention of contracture of joints and improvement in lymph and blood circulation after mastectomy.

6 Exercise has a role in the management or rehabilitation of cancer patients recover from treatment.

7 The length of follow-up period is important in demining whether a reduction in shoulder pain related to breast cancer in women receiving exercise therapy is short-term or long- lasting.

8 Early shoulder mobilization has been shown to aid in the prevention of shoulder pain, dysfunction after total mastectomy.

9 The causes of shoulder pain related to breast cancer are thought to include muscle tightness, neurogenic pain due to lymph node removal, axillary cording and edema formation resulting from restricted shoulder motion.

10 The investigator, during her oncology ward posting, observed that many mastectomy surgery patients were not do regularly for the post mastectomy exercises. The experiences of health professionals working among these patients has further contributed to the need for this study.

STATEMENT OF THE PROBLEM:

A study to assess the effect of post mastectomy exercises on shoulder pain among patients who had undergone mastectomy surgery for women in International cancer centre, Neyyoor.

OBJECTIVES OF THE STUDY:

· To assess the effect of post mastectomy exercises in terms of difference in the pre-test and post-test shoulder pain scores as measured by universal pain assessment scale.

· To determine the association between pre test scores of shoulder pain with selected demographic variables.

Hypotheses of the study:

H₁: There is significant reduction in the level of pain among patients after practicing post mastectomy exercises.

H₂: There significant association between post-test pain scores with selected demographic variables.

Conceptual frame work:

This study is based on Von Bertalanffy general system theory. The main concept of the general system theory is input throughout and output. In this study the main purpose refers to reducing shoulder pain among mastectomy surgery women regards post mastectomy exercises.

Materials (Methods):

A quantitative approach with one group pretest posttest pre experimental research design was adopted to carry out the study.

Settings:

The study was conducted at International Cancer Centre Neyyoor, Kanyakumari District..

Sample:

The sample consisted of mastectomy surgery women admitted in International Cancer Centre Neyyoor.

Sampling method:

Purposive sampling was used to select the sample. Mastectomy surgery women who met the inclusion criteria were selected.

Inclusion criteria for sample selection:

Mastectomy surgery women who:

· Can understand and speak Tamil.

· Were willing to participate in this study.

Measures:

The tool consisted of two sections. Section I addressed the demographic variables of mastectomy surgery women. Section II addressed the pain assessment scale and questionnaire on breast self-examination was prepared by the investigator after extensive review of literature and discussion with the experts in nursing and medical field.

Validity:

Content validity was determined by obtaining the opinion of experts from medical nursing and statistical field. A pilot study was done and the questionnaire was found to be relevant to the settings of the study.

Protection of the study participants:

The study was conducted after getting permission from the concerned authority in the Medical superintendent and head of the department of International Cancer Centre Neyyoor. Oral permission was obtained from the mastectomy surgery women after explaining the purpose of the study.

Data collection procedure:

The data collection procedure was done for a period of 6 weeks. Sixty mastectomy surgery women were personally interviewed with prepared interview guide. Each day the researcher interviewed 3 to 4 patients based on the inclusion criteria. The data collections were done as follows:

Step 1

The tools used were Universal pain assessment scale and prepared to assess the practice by self-reported checklist which was administered by using interview technique. Post mastectomy exercises such as wall climbing, rod or broomstick lifting, rope turning and pulley tugging were taught for 10 minutes on the second post operative day and instructed to the patient perform daily morning and evening for 30 minutes for four weeks.

Step 2

After forth week during follow-up post test was done with the same tool and practice of exercises was reported with self-report checklist. The scoring was done based on the scoring procedure.

RESULTS AND DISCUSSION:

The data collected was analyzed using descriptive and inferential statistics. The demographic variables of patients showed more than half 22(55%) of shoulder pain patients were in the age group of 41 to 60 years and 29(72.5%) were rural area, 28(70%) of the samples were housewives, 30(75%) of the samples were Hindu religions. Majority of the samples 33(82.5%) were married.

Frequency and percentage distribution of pre-test and post-test level of shoulder pain (N=40)

S. No	Level of pain	Mastectom surgery women
		Pretest		Posttest
		F	%	f	%
1. 2. 3.	Mild Moderate Severe	0 5 35	0 12.5 87.5	23 17 0	57.5 42.5 0

The above table shows that frequency distribution and percentage of pre-test and post-test level of shoulder pain. During pre-test, 12.5% had moderate pain and 87.5% of samples had severe pain. After post mastectomy exercises, none of them had severe pain, 57.5% had mild pain and 42.5% had moderate pain.

Comparison between mean pain level scores in pre and post assessment of shoulder pain among the samples:

The above figure indicates that the mean pre-test score of shoulder pain was 7.78 and post-test score was 3.18. This reveals that post mastectomy exercises was effective in reducing shoulder pain.

Association between Post-test shoulder pain level scores by universal pain assessment scale with selected demographic variables:

Among 40 mastectomy surgery women that calculated values of chi square at1 degree of freedom was less than the table value (3.84). So there was no significant association between Post-test pain score and selected demographic variables; age.

CONCLUSION:

Based on findings of the study the following conclusions were obtained. In the present of the study the average score of Universal pain assessment scale among the shoulder pain patients was 7.78 in pre-test level, when compared to the score of 3.18 in the post-test level score. The effect was computed by paired “t” test (26.334) and found to be effective. There was no association between pre-test pain level score with demographic variables. Hence it is concluded that the post mastectomy exercises programme was effective in reducing mild to moderate shoulder pain without analgesics.

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Received on 02.10.2020 Modified on 03.11.2020

Asian J. Nursing Education and Research. 2021; 11(1):68-70.

DOI: 10.5958/2349-2996.2021.00018.5