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Outpatient Therapy
The FIM is a good tool for evaluating post-mastectomy patients’ self care in the outpatient setting because it assesses their activity level and need for assistance, which is important for ADLs.6 The four sub-scales are also important for this measure since they look at self care, transfer, locomotion, and sphincter control which are all important for taking care of oneself and performing activities of daily living. In a study performed by Khan et al., researchers used the FIM to assess functional recovery after breast cancer. Overall, they found that participants reported minimal change to their physical functioning as indicated by a high median motor FIM score of 78 (see all values in the list below). The researchers chose the FIM due to its high reliability and validity, which can be viewed in detail at the link below.
http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=889
http://www.udsmr.org/WebModules/FIM/Fim_About.aspx
Kristen Swain, SPT
The Barthel Index is a free and easy to administer assessment of an individual’s ability to care for him/herself. It takes 2-5 minutes via self-report to complete and no training or equipment is required to administer the test. The index can also be completed by observing the patient which takes about 20 minutes to finish. There are 10 activities of daily living (ADLs) and mobility items that are assessed. These include feeding, bathing, grooming, dressing, bowel & bladder control, toileting, chair transfer, ambulation and stair climbing. Each category has 2 or 3 choices. If there are 2 choices, 0 is dependent and 5 is independent. If there are 3 choices, 0 is dependent, 5 is needing assistance and 10 is independent. Populations that have already been tested with this tool include stroke, neurological, geriatric and brain injury patients. Individuals who have undergone a mastectomy have not yet been tested with the Barthel Index.
http://www.strokecenter.org/wp-content/uploads/2011/08/barthel.pdf
Melissa Youtzy, SPT
Home Care Setting
Following treatment for breast cancer, it is common for patients to experience functional limitations in their shoulder and arm. These patients often experience pain, decreased range of motion, movement impairment, swelling, neuropathy, fatigue and lymphatic cording in the affected arm. In the case of mastectomies, the majority of patients (7 out of 8) experience pain around the axilla, arm and shoulder, which can limit activities.
For the measurement of self-care in the home setting for patients recovering from breast cancer treatment (mastectomy, radiation and chemotherapy), it would be useful to administer a questionnaire that assesses upper extremity pain and function. While, there are no available tools that specifically assess the upper extremity function of patients post breast cancer, the the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) assess general shoulder and arm function. The DASH has been used in studies evaluating recovery from breast cancer treatment, as well as routinely in the outpatient clinic setting. This outcome tool measures upper extremity function, can be used over time, and takes less than 30 minutes to administer. The DASH consists of 30 items about upper extremity function and has been evaluated for use with patients with shoulder pain and after surgery, among others. This scale is widely available and readily used in the physical therapy setting.
For a full review of the DASH, see http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=1008.
The DASH an appropriate tool to measure functional limitations in the self-care domain as it is easy to administer in the home care setting and free to use. The DASH directly measures arm, shoulder and hand function, which is often the region of impairment that affects home self-care in patients recovering from breast cancer treatment. The fact that the DASH has been applied effectively across many populations suggests that it may be appropriate to apply it to this population. Further research would be helpful to demonstrate the appropriateness of the DASH in the home care setting with patients recovering from breast cancer.
Zoë Cooprider Randol, SPT
