The Effect of Self-Management Interventions Among Patients With Breast Cancer Related-Lymphedema

The implemented protocol (self‐management interventions) includes several parts. Firstpart was informing in which patients were informed face‐face about the development andrisk factors of lymphedema before and after surgery (first and second day). Educationalthemes: symptoms and signs of lymphedema, development mechanisms and risk factors oflymphedema, evaluation of lymphedema, prevention of possible infections, skin care,protecting the arm and the breast from traumas, having ideal weight, and exercising.Second part include lymphedema evaluation, in which measuring for the upper extremitycircumference was done in the hospital using the metric measuring tape. The measurementwas taken at four locations; specifically, metacarpophalangeal joints, at the wrist, 10cm above and below the elbow joint. Third part was exercising program in which thepatients during the first 24 hours after surgery were instructed to perform handsqueezing exercises with a medium‐level stress ball four times a day, squeezing 15 timeseach. The researcher estimated the appropriate amount of exercise and start time for thepatient based on their physical state and general health all over the post‐operativeperiod. Patients were instructed to perform active and passive arm exercises three to sixtimes per day at start, gradually increasing to ten, shifting from passive to activewithin 30‐60 minutes. Patients were instructed to warm up before exercising to preventmuscular damage and divide activities into 10‐15‐minutes sessions in case of pain. Fourthpart was about simple lymphatic drainage where during patient massage, the researchershowed and taught deep diaphragmatic breathing exercises, neck drainage, afflicted sideaxillary drainage, and upper extremity drainage. Before the massage began, the patientspracticed breathing exercises. To activate the lymphatic system, breathing exercises wereinitially done 3 times a day for 3 minutes, then increased to 3 times a day for 5 minutesin the months following.