Ha, K., & Choi, S. (2014). The effect of a PNF technique program after mastectomy on lymphedema patients’ depression and anxiety. Journal of Physical Therapy Science, 26, 1065–1067. 

DOI Link

Study Purpose

To examine the effects of exercise with proprioceptive neuromuscular facilitation (PNF) on depression and anxiety in women with postmastectomy lymphedema

Intervention Characteristics/Basic Study Process

Subjects performed the exercises for 30 minutes, three times weekly, for 16 weeks. Subjects were divided into three groups, a PNF plus super lizer group (which received light radiation as well), a PNF plus manual lymphatic drainage (MLD) group, and a PNF alone group. All groups received the same exercises. Study measures were obtained every four weeks.

Sample Characteristics

  • N = 52  
  • MEAN AGE 52.5 years
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Patients were selected from those who showed lymphedema following mastectomy.

Setting

  • SITE: Single-site    
  • LOCATION: Republic of Korea

Study Design

Three-group trial with a repeated-measures design

Measurement Instruments/Methods

  • Beck Depression Inventory (BDI)
  • Beck Anxiety Inventory (BAI)

Results

Although there was a group-by-time interaction effect on the results, depression scores declined significantly in all groups with no significant difference between the groups after 16 weeks. Anxiety scores also declined in all groups with no differences between them. At the end of the study, scores were lowest in the PNF plus MLD group. Scores declined more in this group over time.

Conclusions

The findings of this study are inconclusive regarding the impact of PNF exercise on depression and anxiety in women with lymphedema following a mastectomy.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Measurement validity/reliability questionable
  • Other limitations/explanation: Repeated-measures design has inherent testing potential as a threat to validity

Nursing Implications

Exercise and MLD have previously been shown to be of benefit for women with lymphedema, and exercise has been shown to be beneficial in terms of reducing anxiety and depression in patients with cancer. It is not clear whether the specific PNF technique in exercise has any greater benefit. This study had several design limitations.