Structured physiotherapy after breast-cancer surgery

Evidence label: Positive randomized rehabilitation evidence · Clinical goal: preserve arm and shoulder function after breast-cancer surgery

Evidence at a glance

Population: 392 women at higher risk of shoulder problems after breast-cancer surgery across 17 English centers.
Intervention: early physiotherapist-supported mobility, stretching, strengthening, physical-activity and behavior-change work, added to usual written advice.
Result: upper-limb disability was lower at 12 months, without more adverse events or lymphedema.

What was studied

PROSPER randomized 392 women 1:1 to usual-care information alone or the same information plus an early structured program delivered through three to six physiotherapy appointments. Most participants had axillary node clearance, and 81% received radiotherapy.

What the evidence shows

At 12 months, mean Disabilities of the Arm, Shoulder and Hand scores were 16.3 with supported exercise and 23.7 with usual care; the adjusted mean difference was −7.81 points (95% CI −12.44 to −3.17; P=.001). Pain was lower and physical quality of life higher. Lymphedema and adverse-event rates did not differ.

This is supportive-care or rehabilitation evidence. It does not show that the intervention treats cancer, prevents recurrence or prolongs survival unless a record explicitly identifies a validated cancer-control endpoint.

Limits and uncertainty

Only 70% returned the 12-month questionnaire, although the trial remained adequately powered. Participants were selected for higher shoulder-risk, and this was a supported rehabilitation pathway—not unsupervised heavy lifting. The NIHR funded the trial.

Safety and practical context

Recovery should be paced around wound healing, drains, pain, range of motion and the operation performed. New swelling, redness, fever, wound problems or escalating pain need clinical assessment rather than simply more exercise.

Questions for the care team

Am I at higher risk of persistent shoulder problems after this operation?
When should mobility and strengthening begin, and what surgical restrictions apply?
Can I be referred to oncology physiotherapy rather than relying on a leaflet alone?

Sources

Literature searched: October 16, 2026 · Record appraised: October 16, 2026

Educational evidence summary, not personal medical advice. Research regimens describe what was studied; they are not personal prescribing instructions and should not replace cancer treatment or individualized supportive care.