M.Cestari, S.Amati, F.Appetecchi, L.Curti, De Rebotti, C.Tomassi

O.U. Territorial Rehabilitation Domus Gratiae Center - NHS Umbria2 - Terni, Italy

INTRODUTION
The author has decided to focus the attention on patients who underwent oncological breast surgery, without clinical evidence of oedema, and 5 years ago planned a preventive protocol which has highlighted during patients’ follow-up the importance of primary prevention in order to avoid lymphoedema onset.

MATERIALS AND METHODS
After lymphologist and physiotherapist join assessment consisted of clinical evaluation, a centimetrical measurement of compared arms, a clinical examination, a lymphoscintigraphy request and a shoulder functionality evaluation through Constant-Murley Shoulder Score, patient is included in different groups after the start up of a rehabilitative project:

-Informative Group (for all patients) whose end-point is the information on lymphedema, the behavioural rules and the listening to the patients’ problems.
-Individual Lymphological Early Treatment which includes patients with positive lymphoscintigraphy exam for a slower radiotracer flow and dermal back-flow.
After the treatment they are included in the Physical Activity Group.
-Individual Rehabilitation Treatment which includes patients with limited shoulder functionality who undergo specific treatment after physiatrical assessment.
After improvement they are included in the Physical Activity Group.
-Physical Activity Group, which includes patients without or with mild limited shoulder functionality, consists on gymnastics, breathing exercises, relaxation technique, music-therapy).
All patients evaluated were included in a follow-up.

RESULTS
The preventive protocol highlights the awareness of patients about the possibility of preventing lymphoedema onset (….%) the complete recovery of shoulder functionality when present, and the usefulness of Physical Active Group in order to achieve a physical-psychological well-being.

CONCLUSIONS
The preventive protocol highlighs the importance of primary prevention as well as the role of a multidisciplinary team.
All patients showed appreciation for the organized Groups and for the early and holistic approach of the team.
This preventive protocol was applied in 88 patients: I.G. all patients, I.L.E.T. 20 patients (then included in a P.A.G.), I.P.T. 8 patients (7 included in a P.A.G.) and P.A.G. 60 patients (included at once).