OBJECTIVE: To systematically review the effectiveness of various postoperative physical therapy modalities and timing of physical therapy following treatment of breast cancer on pain and impaired range of motion of the upper limb. These modalities include passive mobilizations, manual stretching, myofascial therapy and active exercises. DATA SOURCES: We searched the following databases: PubMed/Medline, CINAHL, Embase, PEDro and Cochrane. Articles published until October 2012 were included. STUDY SELECTION: Only (pseudo-) randomized controlled trials and non-randomized experimental trials investigating the effectiveness of passive mobilizations, manual stretching, myofascial therapy and/or exercise therapy and timing of physical therapy, following treatment for breast cancer, are reviewed. Primary outcomes are pain of the upper limb and/or range of motion of the shoulder. Secondary outcomes are decreased shoulder strength, arm lymphedema, limitations in activities of daily life, decreased quality of life and wound drainage volume. Physical therapy modalities had to be started in the first 6 weeks following surgery. DATA EXTRACTION: Articles were selected by two independent researchers in 3 phases and compared for consensus. First the titles were analysed, then the selected abstracts and finally the full texts. DATA SYNTHESIS: Eighteen randomized controlled trials were included in the review. Three studies investigated the effect of multifactorial therapy: two studies proved that the combination of general exercises and stretching is effective for the treatment of impaired range of motion; another study showed that passive mobilizations combined with massage had no beneficial effects on pain and impaired range of motion. Fifteen studies investigated the effectiveness of a single physical therapy modality. One study of poor quality found evidence supporting the beneficial effects of passive mobilizations. The only study investigating the effect of stretching did not find any beneficial effects. No studies were found about the effectiveness of myofascial therapy in the postoperative phase. Five studies found that active exercises were more effective compared to no therapy or compared to information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder range of motion, while four studies supported the delay of exercises to avoid prolonged wound healing. CONCLUSION: Multifactorial physical therapy (ie, stretching and exercises) and active exercises were effective to treat postoperative pain and impaired range of motion following treatment for breast cancer. High-quality studies are necessary to prove the effectiveness of passive mobilizations, stretching and myofascial therapy as part of the multifactorial treatment. In addition, the appropriate timing and content of the exercise programs need to be further investigated.

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