Factors associated with body posture assessed by computerized photogrammetry in women undergoing surgical treatment for breast cancer

Abstract

Introduction: Breast cancer is the most common cancer among women and is considered a worldwide public health problem. After treatment for breast cancer some patients may experience changes in body posture related to sociodemographic, clinical, therapeutic characteristics or to post-operative complications. However, it is not well defined the relationship between these factors and posture changes. The reference values for the ideal posture are still controversial, having been used several methods in their assessment. Among them, it has highlighted the photogrammetric method called Postural Assessment Software (SAPO - Software de Avaliação Postural). Objective: This work aims to propose reference values for angles and distances of body segments in healthy adult women evaluated by SAPO (manuscript 1) and describe the sociodemographic, clinical, therapeutic characteristics and post-operative complications related to changes the posture of women undergoing surgery for breast cancer (manuscript 2). Methods: In the manuscript 1, a systematic review was performed in several electronic databases, using the following evaluation descriptors: posture, photogrammetry, physical therapy, postural alignment, posture, postural evaluation, photogrammetry and physiotherapy. Studies published between 2005-2014 were included. The values of the angles and distances were grouped two by two, repeatedly, with the aim of establishing mean, variance and final standard deviation. In the manuscript 2, a cross-sectional study was conducted in a public hospital in Rio de Janeiro, Brazil; including women undergoing surgical treatment for breast cancer with minimal period of one year post-operatively. Sociodemographic, clinical and therapeutic variables and post-operative complications were collected by interview, medical records and physical examination. Body posture was evaluated by SAPO. Results: In the manuscript 1, four studies were included. The reference values calculated for the anterior view: 1.35° ± 3.11° (horizontal alignment of the head); 0.83° ± 1.60° (horizontal alignment of acromiums), -0.22° ± 1.99° (horizontal alignment of the iliac spines anterossuperiors), -0.85° ± 2.49° (angle between the acromial and iliac spines anterossuperiors); to the right side view: 52.42° ± 5.40° (horizontal alignment the head), -1.41° ± 3.17° (vertical alignment of the trunk); left side view: 51.27° ± 4.53° (horizontal alignment of the head), -2.06° ± 2.20° (vertical alignment of the trunk); and the rear view: -1,27cm ± 21,69cm (horizontal alignment of the blades in relation to T3). In the manuscript 2, 57 patients were included which must of them showed low educational level (57.9%), houseworking (64.9%), underwent mastectomy (84.2%) and axillary lymphadenectomy (78.9%). Among the post-cirurgical complications, 50.9% developed seroma; 54.4% heaviness; 50.9% change in armpit sensitivity; 19.3% winged scapula and no patient developed lymphedema. Postural assessment showed head (mean: -0.11), stem (mean, -1.16) and pelvis (mean: -0.55) leaned to the left; shoulder (average: 0.61) leaned to the right and a difference of 3.73 cm between the shoulder blades. None of the variables was associated with change in position of the head and shoulder blades. However chemotherapy (p=0.025) and seroma (p=0.011) were associated with the position of the shoulders; age (p=0.035), body mass index (p=0.041) and arm sensitivity (p=0.003) associated with the position of the pelvis; and the position of the trunk was associated with age (p=0.008), net monthly family income (p=0.045), seroma (p=0.011) and arm sensitivity (p=0.019). The reference values proposed by the study may be used as parameters for scientific research and clinical practice. Conclusion: The lore about the factors associated with postural changes can aid the establishment of strategies for prevention and treatment of these changes.