Evidence map›Paper›PMID 34759002›Full record

Trial reportBMJ (Clinical research ed.)2021

Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation.

Julie Bruce, Bruno Mazuquin, Alastair Canaway, Anower Hossain, Esther Williamson, Pankaj Mistry, Ranjit Lall, Stavros Petrou, Sarah E Lamb, Sophie Rees and 4 more

Open access · hybridAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 3 pooled it
4.6field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 71 citations in OpenAlex.

  1. Pooled it
  2. Physical activity and pain in people with cancer: a systematic review and meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024
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  7. The impact of age factors on postoperative limb function recovery in breast cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 3 countries.

Julie BruceWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK julie.bruce@warwick.ac.uk.ORCID 0000-0002-8462-7999
Bruno MazuquinFaculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.ORCID 0000-0003-1566-9551
Alastair CanawayWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.ORCID 0000-0002-4270-6808
Anower HossainInstitute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh.ORCID 0000-0002-1708-9940
Esther WilliamsonNuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-0638-0406
Pankaj MistryWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.ORCID 0000-0003-0351-3090
Ranjit LallWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.ORCID 0000-0003-1737-2866
Stavros PetrouNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID 0000-0003-3121-6050
Sarah E LambInstitute of Health Research, University of Exeter, Exeter, UK.ORCID 0000-0003-4349-7195
Sophie ReesWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.ORCID 0000-0003-4399-2049
Emma PadfieldWarwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK.ORCID 0000-0003-4832-9609
Raghavan VidyaRoyal Wolverhampton NHS Trust, Wolverhampton, UK.ORCID 0000-0002-6129-2444
Alastair M ThompsonDepartment of Surgery, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA.ORCID 0000-0003-0604-7267
Prevention of Shoulder Problems Trial (PROSPER) Study Group
University of Warwick · GBBaylor College of Medicine · USManchester Metropolitan University · GBNuffield Orthopaedic Centre · GBThe Royal Wolverhampton NHS Trust · GBUniversity of Dhaka · BDUniversity of Exeter · GBUniversity of Oxford · GB

Funding

Medical Research Council G0501681
6 · The paper itself

Abstract

objectiveTo evaluate whether a structured exercise programme improved functional and health related quality of life outcomes compared with usual care for women at high risk of upper limb disability after breast cancer surgery.

designMulticentre, pragmatic, superiority, randomised controlled trial with economic evaluation.

setting17 UK National Health Service cancer centres.

participants392 women undergoing breast cancer surgery, at risk of postoperative upper limb morbidity, randomised (1:1) to usual care with structured exercise (n=196) or usual care alone (n=196).

interventionsUsual care (information leaflets) only or usual care plus a physiotherapy led exercise programme, incorporating stretching, strengthening, physical activity, and behavioural change techniques to support adherence to exercise, introduced at 7-10 days postoperatively, with two further appointments at one and three months.

main outcome measuresDisability of Arm, Hand and Shoulder (DASH) questionnaire at 12 months, analysed by intention to treat. Secondary outcomes included DASH subscales, pain, complications, health related quality of life, and resource use, from a health and personal social services perspective.

resultsBetween 26 January 2016 and 31 July 2017, 951 patients were screened and 392 (mean age 58.1 years) were randomly allocated, with 382 (97%) eligible for intention to treat analysis. 181 (95%) of 191 participants allocated to exercise attended at least one appointment. Upper limb function improved after exercise compared with usual care (mean DASH 16.3 (SD 17.6) for exercise (n=132); 23.7 (22.9) usual care (n=138); adjusted mean difference 7.81, 95% confidence interval 3.17 to 12.44; P=0.001). Secondary outcomes favoured exercise over usual care, with lower pain intensity at 12 months (adjusted mean difference on numerical rating scale -0.68, -1.23 to -0.12; P=0.02) and fewer arm disability symptoms at 12 months (adjusted mean difference on Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) -2.02, -3.11 to -0.93; P=0.001). No increase in complications, lymphoedema, or adverse events was noted in participants allocated to exercise. Exercise accrued lower costs per patient (on average -£387 (€457; $533) (95% confidence interval -£2491 to £1718; 2015 pricing) and was cost effective compared with usual care.

conclusionsThe PROSPER exercise programme was clinically effective and cost effective and reduced upper limb disability one year after breast cancer treatment in patients at risk of treatment related postoperative complications.

trial registrationISRCTN Registry ISRCTN35358984.

Indexed as

AdultAgedAged, 80 and overBehavior TherapyBreast NeoplasmsCost-Benefit AnalysisDisability EvaluationExercise TherapyFemaleHumansMastectomyMiddle AgedPhysical Therapy ModalitiesQuality of LifeState MedicineTreatment Outcome

Identifiers

PMID34759002
PMCPMC8579424
OpenAlexW3212850889

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.