AIM: To evaluate the best time (early or delayed) in the acute post-operative period to start physiotherapy for patients who have undergone axillary dissection for breast cancer. METHOD: Critical review of seven studies (six true and one quasi-experimental) reported in the literature and meta-analysis of the results of the six true studies. A questionnaire was sent to physiotherapists in 199 Dutch hospitals in order to compare everyday practice with the conclusion of the meta-analysis. RESULTS: The overall quality of the intervention studies ranged from 27% to 73% of the total score. The findings of the meta-analysis indicated that starting physical therapy within 5 to 7 days after surgery had a positive effect on wound drainage volume wound drainage duration in comparison to the effect of starting therapy within 2 days of surgery. Combination of the results of the studies showed that wound drainage volume was statistically significantly smaller (overall effect size 0.35; 95% CI 0.17-0.53; n = 7) in patients who started physical therapy 5 to 7 days after surgery, as was wound drainage duration (overall effect size 0.37; 95% CI 0.17-0.57; n = 5). Overall effect sizes could not be calculated for range of motion and the presence of wound infection and seromas because there was insufficient information provided in the individual studies. The findings of the questionnaire showed that in most Dutch hospitals physiotherapy (ie, patient education and exercise therapy) starts within 2 days of surgery. Physiotherapists are not always aware of articles on physiotherapy in the acute post-operative phase for patients who have undergone mastectomy and axillary dissection. CONCLUSION: Physiotherapy for these patients should be started 5 to 7 days after surgery. It is important to include research data in refresher courses for physiotherapists.

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