Developing, testing and evaluating a web-based self-management intervention for upper limb rehabilitation after surgery for breast cancer

Abstract

Background
In 2017, Breast cancer (BC) had the highest incidence of all cancers in the United
Kingdom. Survival rates are increasing, but with breast surgery combined with radiotherapy, has been linked to increased long-term physical and functional limitations. After surgery for BC, patients are often given home exercises to
reduce this risk, but adherence to exercise can be an issue. Online self management rehabilitation may be an effective way to encourage patients to exercise. The aim of this project was to plan, develop, test and evaluate a webbased intervention for post-surgical self-management rehabilitation to reduce upper limb morbidity after BC surgery.

Methods
The Internet Exercise Modality after BReAst CancEr (iEMBRACE) intervention was developed in a phased process, using the person-based approach (PBA) by Yardley et al. (2015) and was informed by the Theory of Planned behaviour as a framework. This Process included:
1) A scoping synthesis of the literature identifying the most commonly experienced upper limb morbidities after surgery for BC and the perceived needs for post-surgical recovery and rehabilitation (planning phase).
2) A scoping of the literature to summarise the most common and effective types of exercises for upper limb rehabilitation after surgery for BC (planning phase).
3) A systematic literature review and narrative synthesis to summarise the evidence around adherence to self-management rehabilitation interventions after any cancer surgery and their common components and functions (planning
phase).

Results
All three literature syntheses and secondary data analysis informed the contents, the functionality and the structure of the iEMBRACE intervention. Subsequently, the iEMBRACE was built in collaboration with an IT Specialist and changes to the intervention PowerPoint and digital prototypes were made at each developmental and testing phases. These changes consisted of: advice in the post-operative module being delivered according to the type of surgery for BC; simplifying
language; including a healthcare professional in the exercise demonstration videos, with the patient-model; addition of reminders and rewards functions; changes or additions to the wording on some pages; further highlighting of
common post-operative musculoskeletal side effects and the importance of doing the warm-up and cool-down exercises. Additional changes to the appearance of the interface and the functionality of the navigation of the intervention were introduced, as suggested by the participants in the study.

Conclusions and Implications
The iEMBRACE was developed as an entirely automated self-management intervention, not requiring any additional input from healthcare professionals or researchers, and thus, providing autonomy for intervention users to actively participate in their post-operative cancer care. The inclusion of stakeholders and
the continuous role of study participants (with BC) throughout a number of iterative stages, helped to enhance the development of this web-based intervention. The iEMBRACE was created by and for survivors of BC and thus, it was tailored according to their needs. This intervention has the potential to improve quality of life in the post-surgical period and reduce long-term musculoskeletal upper limb complications.

Date of Award	Nov 2021
Original language	English
Supervisor	Nicole Blackburn (Supervisor), Daniel Kerr (Supervisor), Iseult Wilson (Supervisor), Eilis Mc Caughan (Supervisor), Carrie Flannagan (Supervisor) & Sean O'Connor (Supervisor)