Öncü H. Evaluation of the Reliability and Validity of the '6 Minute Pegboard and Ring Test' Unsupported Arm Function Exercise Test in Patients with Breast Cancer, Hacettepe University, Graduate School of Health Sciences, Cardiopulmonary Rehabilitation Program, Master Thesis, Ankara, 2022. Breast cancer is the most common type of cancer among women. Despite the increase in survival rates after breast cancer with the development of treatment opportunities in recent years, there are many side effects that reduce the quality of life and limit activities of daily living. Upper extremity functional limitations are one of the most common activity limitations in patients with breast cancer. The 6 minute pegboard and ring test (6PBRT) is a test that evaluates upper extremity functional capacity. The aim of this study was to investigate the validity and reliability of the 6PBRT in patients with breast cancer. Forty-eight patients with breast cancer (mean age=55.40 ±10.40 years) were included in the study. The demographic and physical characteristics and medical history of the individuals were recorded. Anthropometric evaluation of the upper extremity was done by length measurement. Evaluation of lymphedema was done by circumference measurement. Functional Impairment Test-Hand, and Neck/Shoulder/Arm (FIT-HaNSA) test was performed for upper extremity endurance assessment. Grip strength was measured with a hand dynamometer. Pain threshold was evaluated with an algometer. Upper extremity functional arm exercise capacity was evaluated with 6PBRT. Maximal arm exercise capacity was evaluated with the arm ergometer test. Upper extremity functionality of the patients was evaluated with the Quick Disabilities of the Arm, Shoulder and Hand Questionnare (Q-DASH-T). For the reliability of 6PBRT, the test was repeated at 30 min intervals under the same conditions. Peak workload (W) and oxygen consumption level (VO2) reached during arm ergometer test and Q-DASH-T score were determined as criteria method for the validity of the 6PBRT. To determine test-retest reliability, Bland-Altman analysis, ICC and 95% confidence Intervals (CI) were analyzed. There was a statistically significant, very strong positive correlation between the first and the second 6PBRT scores (r=0,866, p<0,001) as a result of the study. The ICC value for 6PBRT was 0,782 (95% CI=0,334-0,910). The standard error of measurement (SEM) was 17,39 and the minimal detectable change (MDC) was 48,06. According to the Bland-Altman analysis, the repeatable lower and upper limits of 6PBRT were -55,51 and -21,89 rings, respectively. There was a strong, statistically significant relationship in the positive direction peak VO2 (r=0,649, p=<0,001) and peak workload (W) (r=0,601, p=<0,001) on the arm ergometer with the 6PBRT score. There was a moderately strong, statistically significant negative correlation between the 6PBRT score and the Quick-DASH-T score (r=-0,466, p=0,003). This study showed that the 6PBRT has good test-retest reliability and is a valid test in patients with breast cancer. These results support that 6PBRT is a practical, useful, valid and reliable assessment tool in the evaluation of arm exercise capacity in patients with breast cancer.
xmlui.dri2xhtml.METS-1.0.item-citation1. Khan F, Amatya B, Pallant JF, Rajapaksa I. Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer. Breast. 2012;21(3):314-20.
2. Şencan İ, Keskinkılıç B. Türkiye kanser istatistikleri. TC Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. 2017:19-44.
3. Hayes SC, Rye S, Battistutta D, DiSipio T, Newman B. Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes. 2010;8:92.
4. Hidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW, Nijhuis-van der Sanden MW. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One. 2014;9(5):e96748.
5. Betty Smoot PT D, Meredith Wampler PT D, Topp KS. Breast cancer treatments and complications: implications for rehabilitation. Rehabilitation Oncology. 2009;27(3):16.
6. Pusic AL, Cemal Y, Albornoz C, Klassen A, Cano S, Sulimanoff I, et al. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv. 2013;7(1):83-92.
7. The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology. 2016;49(4):170-84.
8. Tiwari P, Coriddi M, Salani R, Povoski SP. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options. World J Surg Oncol. 2013;11:237.
9. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14(6):500-15.
10. Gebruers N, Verbelen H, De Vrieze T, Vos L, Devoogdt N, Fias L, et al. Current and future perspectives on the evaluation, prevention and conservative management of breast cancer related lymphoedema: A best practice guideline. Eur J Obstet Gynecol Reprod Biol. 2017;216:245-53.
11. Park JE, Jang HJ, Seo KS. Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients. Ann Rehabil Med. 2012;36(2):240-7.
12. Taghian NR, Miller CL, Jammallo LS, O'Toole J, Skolny MN. Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol. 2014;92(3):227-34.
13. Vassard D, Olsen MH, Zinckernagel L, Vibe-Petersen J, Dalton SO, Johansen C. Psychological consequences of lymphoedema associated with breast cancer: a prospective cohort study. Eur J Cancer. 2010;46(18):3211-8.
14. Herrera JE, Stubblefield MD. Rotator cuff tendonitis in lymphedema: a retrospective case series. Arch Phys Med Rehabil. 2004;85(12):1939-42.
15. Klernäs P, Johnsson A, Horstmann V, Kristjanson LJ, Johansson K. Lymphedema Quality of Life Inventory (LyQLI)-Development and investigation of validity and reliability. Qual Life Res. 2015;24(2):427-39.
16. Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, et al. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009;30(3):233-45.
17. Vardar-Yagli N, Sener G, Saglam M, Calik-Kutukcu E, Arikan H, Inal-Ince D, et al. Associations among physical activity, comorbidity, functional capacity, peripheral muscle strength and depression in breast cancer survivors. Asian Pac J Cancer Prev. 2015;16(2):585-9.
18. Luz CMD, Prim AC, Deitos J, Heck APF, Recchia TL, Mayer AF. Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery. Disabil Rehabil. 2022;44(15):4096-103.
19. Lima VP, Almeida FD, Janaudis-Ferreira T, Carmona B, Ribeiro-Samora GA, Velloso M. Reference values for the six-minute pegboard and ring test in healthy adults in Brazil. J Bras Pneumol. 2018;44(3):190-4.
20. Zhan S, Cerny FJ, Gibbons WJ, Mador MJ, Wu YW. Development of an unsupported arm exercise test in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2006;26(3):180-7; discussion 8-90.
21. Kulkarni MS, Alaparthi GK, Krishnan S, Ramakrishna A, Acharya V. Reference value for the six-minute peg board and ring test. A cross sectional study. Multidiscip Respir Med. 2020;15(1):670.
22. Calik-Kutukcu E, Tekerlek H, Bozdemir-Ozel C, Karaduz BN, Cakmak A, Inal-Ince D, et al. Validity and reliability of 6-minute pegboard and ring test in patients with asthma. J Asthma. 2022;59(7):1387-95.
23. Takeda K, Kawasaki Y, Yoshida K, Nishida Y, Harada T, Yamaguchi K, et al. The 6-minute pegboard and ring test is correlated with upper extremity activity of daily living in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2013;8:347-51.
24. Wang X, Lai Q, Tian Y, Zou L. Effect of evidence-based nursing intervention on upper limb function in postoperative radiotherapy patients with breast cancer. Medicine (Baltimore). 2020;99(11):e19183.
25. Pandya S, Moore RG. Breast development and anatomy. Clin Obstet Gynecol. 2011;54(1):91-5.
26. Meserret C. Temel Anatomi. Metu Pres, Ankara. 2001:323-4.
27. M. HASPOLAT And İ. KESER, "The relationship between kinesiophobia pain shoulder limitation lymphedema and anxiety in breast cancer survivors," International Istanbul Breast Cancer Conference , 2016
28. Bland KI, Copeland III EM, Klimberg VS. Anatomy of the breast, axilla, chest wall, and related metastatic sites. The breast: Elsevier; 2018. p. 20-36. e2.
29. Goetz MP, Gradishar WJ, Anderson BO, Abraham J, Aft R, Allison KH, et al. NCCN guidelines insights: breast cancer, Version 3.2018: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2019;17(2):118-26.
30. De Grève J, Sermijn E, De Brakeleer S, Ren Z, Teugels E. Hereditary breast cancer: from bench to bedside. Current opinion in oncology. 2008;20(6):605-13.
31. Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain. 2003;104(1):1-13.
32. Fawcett DW, Bloom W. A textbook of histology: WB Saunders company; 1986.
33. Turner-Warwick RT. The lymphatics of the breast. Br J Surg. 1959;46:574-82.
34. Lockhart RD, Fyfe FW, Hamilton GF. Anatomy of the human body: London: Faber & Faber; 1959.
35. de la Pared Torácica A, y Mama A. Anatomy of the thoracic wall, axilla and breast. Int J Morphol. 2006;24(4):691-704.
36. DeSantis C, Siegel R, Jemal A. Breast cancer facts & figures, 2013–2014. Atlanta: American Cancer Society. Surveillance and Health Services Research. 2013.
37. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2021;71(3):209-49.
38. Türkiye Kanser Kontrol Programı. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Yayın Komisyonu: Ankara; 2021
39. Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Prz Menopauzalny. 2015;14(3):196-202.
40. Cokkinides V, Albano J, Samuels A, Ward M, Thum J. American cancer society: Cancer facts and figures. Atlanta: American Cancer Society. 2005.
41. Koçak S, Çelik L, Özbaş S, Sak SD, Tükün A, Yalçın B. Meme Kanserinde Risk Faktörleri, Riskin Değerlendirilmesi Ve Prevansiyon: İstanbul 2010 Konsensus Raporu. Meme Sagligi Dergisi/ J Breast Health. 2011;7(2).
42. Sun YS, Zhao Z, Yang ZN, Xu F, Lu HJ, Zhu ZY, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci. 2017;13(11):1387-97.
43. Reeves GK, Kan SW, Key T, Tjønneland A, Olsen A, Overvad K, et al. Breast cancer risk in relation to abortion: Results from the EPIC study. Int J Cancer. 2006;119(7):1741-5.
44. Kim JA, Jang JH, Lee SY. An Updated Comprehensive Review on Vitamin A and Carotenoids in Breast Cancer: Mechanisms, Genetics, Assessment, Current Evidence, and Future Clinical Implications. Nutrients. 2021;13(9).
45. Gao CM, Ding JH, Li SP, Liu YT, Tang JH, Tajima K. Intake of freshwater fish and associated fatty acids and risk of breast cancer. Asian Pac J Cancer Prev. 2014;15(18):7879-84.
46. Hilakivi-Clarke L. Maternal exposure to diethylstilbestrol during pregnancy and increased breast cancer risk in daughters. Breast Cancer Res. 2014;16(2):208.
47. Mahdavi M, Nassiri M, Kooshyar MM, Vakili-Azghandi M, Avan A, Sandry R, et al. Hereditary breast cancer; Genetic penetrance and current status with BRCA. J Cell Physiol. 2019;234(5):5741-50.
48. Patel BK, Pepin K, Brandt KR, Mazza GL, Pockaj BA, Chen J, et al. Association of breast cancer risk, density, and stiffness: global tissue stiffness on breast MR elastography (MRE). Breast Cancer Res Treat. 2022;194(1):79-89.
49. Lynch BM, Milne RL, English DR, Brown KA, Drummond AE, Swain CTV, et al. Linking Physical Activity to Breast Cancer: Text Mining Results and a Protocol for Systematically Reviewing Three Potential Mechanistic Pathways. Cancer Epidemiol Biomarkers Prev. 2022;31(1):11-5.
50. Phipps AI, Li CI. Breast cancer biology and clinical characteristics. Breast cancer epidemiology: Springer; 2010. p. 21-46.
51. AÇIKGÖZ A, YILDIZ EA. Meme kanseri etiyolojisi ve risk faktörleri. Ergoterapi ve Rehabilitasyon Dergisi. 2017;5(1):45-56.
52. Youn HJ, Han W. A Review of the Epidemiology of Breast Cancer in Asia: Focus on Risk Factors. Asian Pac J Cancer Prev. 2020;21(4):867-80.
53. Tanday S. Drinking alcohol before first pregnancy ups breast cancer risk. The Lancet Oncology. 2013;14(11):e442.
54. Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat. 2019;177(3):537-48.
55. Akyolcu N, ÖZHANLI Y, Kandemir D. Meme kanserinde güncel gelişmeler. Sağlık Bilimleri ve Meslekleri Dergisi. 2019;6(3):583-94.
56. Sadiç E. Kadınların meme kanseri erken tanı, bilgi ve davranışları ile meme kanseri korkusu arasındaki ilişki: Sağlık Bilimleri Enstitüsü; Yüksek Lisans Tezi 2019.
57. Parlar S, Kaydul N, Ovayolu N. Meme kanseri ve kendi kendine meme muayenesinin önemi. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2005;8(1):72-83.
58. Pippin MM, Boyd R. Breast Self Examination. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
59. Bakanlığı TS, Müdürlüğü SHG, Başkanlığı STDD. TC Sağlık Bakanlığı Yayın Numarası: 1170 ISBN: 978-975-590-771-0.
60. Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio I, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(8):1194-220.
61. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population‐based to a more “personalized” approach to cancer staging. CA J Clin. 2017;67(2):93-9.
62. Karpisheh V, Ahmadi M, Abbaszadeh-Goudarzi K, Mohammadpour Saray M, Barshidi A, Mohammadi H, et al. The role of Th17 cells in the pathogenesis and treatment of breast cancer. Cancer Cell Int. 2022;22(1):1-13.
63. Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol. 2020;50(3):225-9.
64. Admoun C, Mayrovitz H. Choosing Mastectomy vs. Lumpectomy-With-Radiation: Experiences of Breast Cancer Survivors. Cureus. 2021;13(10):e18433.
65. Czajka ML, Pfeifer C. Breast cancer surgery. StatPearls [Internet]: StatPearls Publishing; 2021.
66. Tarver T. American cancer society. Cancer facts and figures 2014. J Consumer Health Internet. 2012;16:366-7.
67. Magnoni F, Galimberti V, Corso G, Intra M, Sacchini V, Veronesi P. Axillary surgery in breast cancer: An updated historical perspective. Semin Oncol. 2020;47(6):341-52.
68. Collins M, O'Donoghue C, Sun W, Zhou JM, Ma Z, Laronga C, et al. Use of axillary lymph node dissection (ALND) in patients with micrometastatic breast cancer. J Surg Res. 2017;215:55-9.
69. He L, Qu H, Wu Q, Song Y. Lymphedema in survivors of breast cancer. Oncol Lett. 2020;19(3):2085-96.
70. Noguchi M, Inokuchi M, Noguchi M, Morioka E, Ohno Y, Kurita T. Axillary surgery for breast cancer: past, present, and future. Breast Cancer. 2021;28(1):9-15.
71. Beederman M, Bank J. Post-Breast Surgery Pain Syndrome: Shifting a Surgical Paradigm. Plast Reconstr Surg Glob Open. 2021;9(7):e3720.
72. Belmonte R, Messaggi-Sartor M, Ferrer M, Pont A, Escalada F. Prospective study of shoulder strength, shoulder range of motion, and lymphedema in breast cancer patients from pre-surgery to 5 years after ALND or SLNB. Support Care Cancer. 2018;26(9):3277-87.
73. Aydin Özcan D. Meme Kanserinde Cerrahi Sonrası Radyoterapi Süresince Uygulanılan Egzersiz Eğitiminin Etkinliğinin Araştırılması. Hacettepe Üniversitesi Sağlik Bilimleri Enstitüsü Fizik Tedavi Ve Rehabilitasyon Programı Doktora Tezi 2021.
74. Sagen A, Kaaresen R, Sandvik L, Thune I, Risberg MA. Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil. 2014;95(5):875-81.
75. AKTAN R, ÖZALEVLİ S, Yalcinkaya G, ALPAYDIN AÖ, Sevinc C. Validation of the rapid assessment of physical activity questionnaire in older patients with chronic obstructive pulmonary disease. JABCS. 2021;5(3):100-6.
76. Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, et al. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol. 2021;39(13):1485-505.
77. Genç A, Oğuz S. Kanserli hastalarda progresif gevşeme egzersizlerinin kemoterapinin yan etkileri üzerine etkisi. IGUSABDER, 5 (2018); 5: 517-524
78 Shi K, Tang Y, He F, Xiao X, Zhang J, Jin Y, et al. The maintenance effect of acupuncture on the side effects of breast cancer endocrine therapy: A protocol for systematic review and meta analysis. Medicine (Baltimore). 2020;99(24):e20567.
79. Zhu Y, Loggia ML, Edwards RR, Flowers KM, Muñoz-Vergara DW, Partridge AH, et al. Increased Clinical Pain Locations and Pain Sensitivity in Women After Breast Cancer Surgery: Influence of Aromatase Inhibitor Therapy. Clinical J Pain. 2022;38(12):721-9.
80. Kunte S, Abraham J, Montero AJ. Novel HER2-targeted therapies for HER2-positive metastatic breast cancer. Cancer. 2020;126(19):4278-88.
81. Emens LA. Breast Cancer Immunotherapy: Facts and Hopes. Clin Cancer Res. 2018;24(3):511-20.
82. Lovelace DL, McDaniel LR, Golden D. Long‐term effects of breast cancer surgery, treatment, and survivor care. J Midwifery Womens health. 2019;64(6):713-24.
83. Rockson SG. Lymphedema. Am J Med. 2001;110(4):288-95.
84. Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg. 2007;59(4):464-72.
85. Bakar Y, Berdici B, Şahin N, Pala ÖO. Lymphedema after breast cancer and its treatment. J Breast Health. 2014;10:6-14.
86. Bao T, Iris Zhi W, Vertosick EA, Li QS, DeRito J, Vickers A, et al. Acupuncture for breast cancer-related lymphedema: a randomized controlled trial. Breast Cancer Res Treat. 2018;170(1):77-87.
87. Greene AK, Goss JA. Diagnosis and Staging of Lymphedema. Semin Plast Surg. 2018;32(1):12-6.
88. Pappalardo M, Starnoni M, Franceschini G, Baccarani A, De Santis G. Breast Cancer-Related Lymphedema: Recent Updates on Diagnosis, Severity and Available Treatments. J Pers Med. 2021;11(5).
89. Kilgore LJ, Korentager SS, Hangge AN, Amin AL, Balanoff CR, Larson KE, et al. Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions. Ann Surg Oncol. 2018;25(10):2948-52.
90. de Sire A, Losco L, Cigna E, Lippi L, Gimigliano F, Gennari A, et al. Three-dimensional laser scanning as a reliable and reproducible diagnostic tool in breast cancer related lymphedema rehabilitation: a proof-of-principle study. Eur Rev Med Pharmacol Sci. 2020;24(8):4476-85.
91. Vilholm O, Cold S, Rasmussen L, Sindrup S. Sensory function and pain in a population of patients treated for breast cancer. Acta anaesthesiologica scandinavica. 2009;53(6):800-6.
92. Forsythe LP, Alfano CM, George SM, McTiernan A, Baumgartner KB, Bernstein L, et al. Pain in long-term breast cancer survivors: the role of body mass index, physical activity, and sedentary behavior. Breast Cancer Res Treat. 2013;137(2):617-30.
93. Leysen L, Beckwée D, Nijs J, Pas R, Bilterys T, Vermeir S, et al. Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2017;25(12):3607-43.
94. Giacalone A, Alessandria P, Ruberti E. The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review. Cureus. 2019;11(12):e6416.
95. Behzadmehr R, Dastyar N, Moghadam MP, Abavisani M, Moradi M. Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review. Complement Ther Med. 2020;49:102318.
96. UÇURUM SG, POLAT K, GÜRŞAN İN, BAYRAM KB, Derya Ö. Meme Kanseri Cerrahisi Sonrası Ekstremite Hacmi ile Ağrı, Duyu ve Kavrama Kuvveti Arasındaki İlişki. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi.7(1):49-54.
97. Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, et al. Upper extremity impairments in women with or without lymphedema following breast cancer treatment. Journal of cancer survivorship. 2010;4(2):167-78.
98. Fisher MI, Capilouto G, Malone T, Bush H, Uhl TL. Comparison of Upper Extremity Function in Women With and Women Without a History of Breast Cancer. Phys Ther. 2020;100(3):500-8.
99. Schmidt T, Berner J, Jonat W, Weisser B, Röcken C, van Mackelenbergh M, et al. Influence of arm crank ergometry on development of lymphedema in breast cancer patients after axillary dissection: A randomized controlled trail. J Rehabil Med. 2017;49(1):78-83.
100. McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. Journal of clinical oncology. 2003;21(3):463-6.
101. Olsson Möller U, Beck I, Rydén L, Malmström M. A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews. BMC Cancer. 2019;19(1):472.
102. Harrington S, Padua D, Battaglini C, Michener LA. Upper extremity strength and range of motion and their relationship to function in breast cancer survivors. Physiotherapy theory and practice. 2013;29(7):513-20.
103. Zhu G, Zhang X, Wang Y, Xiong H, Zhao Y, Sun F. Effects of exercise intervention in breast cancer survivors: a meta-analysis of 33 randomized controlled trails. OncoTargets and Therapy. 2016:2153.
104. Vardar Yağlı N, Şener G, Arıkan H, Sağlam M, İnal İnce D, Savcı S, et al. Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors? Integrative cancer therapies. 2015;14(2):125-32.
105. Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015;15:77.
106. Chan DN, Lui LY, So WK. Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. J Adv Nurs. 2010;66(9):1902-14.
107. McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database Syst Rev. 2010(6):Cd005211.
108. Medicine ACoS. ACSM's guidelines for exercise testing and prescription: Lippincott williams & wilkins; 2013.
109. Samman E, Mkuu R, Zhang X, Scummings S, Burdine J. Body Mass Index and Breast and Cervical Cancer Screening. Womens Health Rep (New Rochelle). 2022;3(1):508-14.
110. Schmidt RT, Toews JV. Grip strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil. 1970;51(6):321-7.
111. Shechtman O, Gestewitz L, Kimble C. Reliability and validity of the DynEx dynamometer. J Hand Ther. 2005;18(3):339-47.
112. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74.
113. Kendall FP, McCreary EK. Muscles, testing and function: Williams & Wilkins; 1983.
114. Harrington S, Gilchrist L, Sander A. Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Pain. Rehabil Oncol. 2014;32(1):13-21.
115. Deltombe T, Jamart J, Recloux S, Legrand C, Vandenbroeck N, Theys S, et al. Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema. Lymphology. 2007;40(1):26-34.
116. Sukul DK, Den Hoed P, Johannes E, Van Dolder R, Benda E. Direct and indirect methods for the quantification of leg volume: comparison between water displacement volumetry, the disk model method and the frustum sign model method, using the correlation coefficient and the limits of agreement. J Biomed Eng. 1993;15(6):477-80.
117. De Vrieze T, Gebruers N, Nevelsteen I, Fieuws S, Thomis S, De Groef A, et al. Manual lymphatic drainage with or without fluoroscopy guidance did not substantially improve the effect of decongestive lymphatic therapy in people with breast cancer-related lymphoedema (EFforT-BCRL trial): a multicentre randomised trial. J Physiother. 2022;68(2):110-22.
118. Blair, Bonnie C.; Dellino, Gina M.; and Thomas, Jennifer E., "A Review of Health Related Quality of Life Assessments for Patients with Lymphedema" (2017). School of Occupational Master's Capstone Projects. 23. http://soundideas.pugetsound.edu/ot_capstone/23
119. Pina IL, Balady GJ, Hanson P, Labovitz AJ, Madonna DW, Myers J. Guidelines for clinical exercise testing laboratories. A statement for healthcare professionals from the Committee on Exercise and Cardiac Rehabilitation, American Heart Association. Circulation. 1995;91(3):912-21.
120. Glass S, Dwyer GB, Medicine ACoS. ACSM's metabolic calculations handbook: Lippincott Williams & Wilkins; 2007.
121. Koldas Dogan S, Ay S, Evcik D, Baser O. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30(2):185-91.
122. Michener LA, Leggin BG. A review of self-report scales for the assessment of functional limitation and disability of the shoulder. J Hand Ther. 2001;14(2):68-76.
123. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155-63.
124. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005;19(1):231-40.
125. Munro BH. Statistical methods for health care research: lippincott williams & wilkins; 2005.
126. Hayran M. Sağlık araştırmaları için temel istatistik: Omega Araştırma; 2011.
127. Yılmaz E, Coşkun T. Meme Kanserli Hastalarda Üst Ekstremite Sorunları ve Yaşam Kalitesi. Medical Journal of Bakirkoy. 2019;15:29-37.
128. Rangel J, Tomás MT, Fernandes B. Physical activity and physiotherapy: perception of women breast cancer survivors. Breast Cancer. 2019;26(3):333-8.
129. Katzmarzyk PT, Friedenreich C, Shiroma EJ, Lee IM. Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries. Br J Sports Med. 2022;56(2):101-6.
130. Dibekci S. Meme kanseri hastalarında fiziksel aktivite düzeyinin semptomlar ve yaşam kalitesi üzerine etkisi. Akdeniz Üniversitesi Sağlik Bilimleri Enstitüsü Hemşirelik Anabilim Dali Yüksek Lisans Tezi. 2017.
131. Liu L, Hao X, Song Z, Zhi X, Zhang S, Zhang J. Correlation between family history and characteristics of breast cancer. Sci Rep. 2021;11(1):6360.
132. Sharma N, Narayan S, Sharma R, Kapoor A, Kumar N, Nirban R. Association of comorbidities with breast cancer: an observational study. Trop J Med Res. 2016;19(2):168-71.
133. Fu MR, Axelrod D, Guth AA, Cleland CM, Ryan CE, Weaver KR, et al. Comorbidities and quality of life among breast cancer survivors: a prospective study. J Pers Med. 2015;5(3):229-42.
134. Kahraman BÖ, Özsoy İ, Tanrıverdi A, Akdeniz B, Özpelit E, Şentürk B, Acar S, Sevinç C, Savcı S. Validity and Reliability of the 6-Minute Pegboard Ring Test in Patients with Pulmonary Hypertension. Turk J Physiother Rehabil. 2020; 31(2):210-217. doi: 10.21653/tjpr.714503
135. Felisberto R, Barros C, Nucci K, Albuquerque AL, Paulin E, Brito C, et al. Is the 6-minute pegboard and ring test valid to evaluate upper limb function in hospitalized patients with acute exacerbation of COPD? Int J Chron Obstruct Pulmon Dis. 2018;Volume 13:1663-73.
136. van der Veen P, De Voogdt N, Lievens P, Duquet W, Lamote J, Sacre R. Lymphedema development following breast cancer surgery with full axillary resection. Lymphology. 2004;37(4):206-8.
137. Özkan M, Akın S. Kanserli hastalarda yorgunluğun fonksiyonel yaşam kalitesi üzerindeki etkisinin değerlendirilmesi. Florence Nightingale Hemşirelik Dergisi. 2017;25(3):177-92.
138. Lee TS, Kilbreath SL, Refshauge KM, Herbert RD, Beith JM. Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Res Treat. 2008;110(1):19-37.
139. Barranger E, Dubernard G, Fleurence J, Antoine M, Darai E, Uzan S. Subjective morbidity and quality of life after sentinel node biopsy and axillary lymph node dissection for breast cancer. J Surg Oncol. 2005;92(1):17-22.
140. Devoogdt N, Van Kampen M, Christiaens M, Troosters T, Piot W, Beets N, et al. Short‐and long‐term recovery of upper limb function after axillary lymph node dissection. Eur J Cancer Care. 2011;20(1):77-86.
141. Ernst MF, Voogd AC, Balder W, Klinkenbijl JH, Roukema JA. Early and late morbidity associated with axillary levels I–III dissection in breast cancer. J Surg Oncol. 2002;79(3):151-5.
142. Hauth F, De-Colle C, Weidner N, Heinrich V, Zips D, Gani C. Quality of life and fatigue before and after radiotherapy in breast cancer patients. Strahlenther Onkol. 2021;197(4):281-7.
143. De Jong N, Candel M, Schouten H, Abu-Saad HH, Courtens A. Prevalence and course of fatigue in breast cancer patients receiving adjuvant chemotherapy. Ann Oncol. 2004;15(6):896-905.
144. Abrahams H, Gielissen M, Schmits I, Verhagen C, Rovers M, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol. 2016;27(6):965-74.
145. Manir KS, Bhadra K, Kumar G, Manna A, Patra NB, Sarkar SK. Fatigue in breast cancer patients on adjuvant treatment: course and prevalence. Indian J Palliat Care. 2012;18(2):109.
146. Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long‐term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106(4):751-8.
147. Deli T, Orosz M, Jakab A. Hormone Replacement Therapy in Cancer Survivors - Review of the Literature. Pathol Oncol Res. 2020;26(1):63-78.
148. Ugras SK, Layeequr Rahman R. Hormone replacement therapy after breast cancer: Yes, No or maybe? Mol Cell Endocrinol. 2021;525:111180.
149. Orhan C, Özgül S, Naki̇p G, Baran E, Üzelpasaci E, Çi̇nar GN, et al. Effects of Lymphedema Severity on Quality of Life, Upper Limb Function, and Physical Activity Level in Patients with Breast Cancer Treatment-related Lymphedema. Anadolu Klin. 2019;24(3):189-98.
150. Basha MA, Aboelnour NH, Alsharidah AS, Kamel FH. Effect of exercise mode on physical function and quality of life in breast cancer–related lymphedema: a randomized trial. Supportive Care in Cancer. 2022;30(3):2101-10.
151. Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. CA Cancer J Clin. 2016;66(1):43-73.
152. Baran E, Yildiz Tİ, Gursen C, Üzelpasaci E, Özgül S, Düzgün İ, et al. The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function. J Biomech. 2021;121:110432.
153. Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol. 2011;50(2):187-93.
154. Korucu TS, Ucurum SG, Tastaban E, Ozgun H, Kaya DO. Comparison of shoulder-arm complex pain, function, and scapular dyskinesia in women with and without unilateral lymphedema after breast cancer surgery. Clin Breast Cancer. 2021;21(3):e285-e93.
155. Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. Bmj. 2012;344:e70.
156. Janaudis-Ferreira T, Hill K, Goldstein RS, Wadell K, Brooks D. Relationship and responsiveness of three upper-limb tests in patients with chronic obstructive pulmonary disease. Physiotherapy Canada. 2013;65(1):40-3.
157. Ozsoy I, Ozcan Kahraman B, Ozsoy G, Ilcin N, Kahraman T, Acar S, et al. Determinants of the 6-minute pegboard and ring test as an unsupported upper-extremity exercise capacity measure in older adults with chronic obstructive pulmonary disease. Eur Geriatr Med. 2018;9(6):863-70.
158. Baran E. Unilateral Meme Kanseri Tedavisi ile İlişkili Üst Ekstremite Lenfödeminde Kompleks Boşaltıcı Fizyoterapinin Duyusal Parametreler Üzerine Etkisinin İncelenmesi. Hacettepe Üniversitesi Sağlik Bilimleri Enstitüsü Fizik Tedavi ve Rehabilitasyon Programı Doktora Tezi 2021.
159. Rasmussen GHF, Kristiansen M, Arroyo-Morales M, Voigt M, Madeleine P. Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment. PLOS ONE. 2020;15(6):e0234118.
160. Hayes SC. Role of exercise in the prevention and management of lymphedema after breast cancer. Exerc Sport Sci Rev. 2010;38(1):2.
161. Hayes S, Cornish B, Newman B. Comparison of methods to diagnose lymphoedema among breast cancer survivors: 6-month follow-up. Breast Cancer Res Treat. 2005;89(3):221-6.
162. LeBlanc M, Stineman M, DeMichele A, Stricker C, Mao JJ. Validation of QuickDASH outcome measure in breast cancer survivors for upper extremity disability. Arch Phys Med Rehabil. 2014;95(3):493-8.
163. Akyüz E. Meme Kanseri Cerrahisi Geçiren Kadinlarda Kol Aktivite Anketi’nin Türkçe'ye Uyarlanmasi, Geçerlik-Güvenirliği Ve Lenfödemin Klinik Özelliklerine Göre Sonuç Ölçümlerinin İncelenmesi Hacettepe Üniversitesi Sağlik Bilimleri Enstitüsü Fizik Tedavi ve Rehabilitasyon Programı Yüksek Lisans Tezi 2020.
164. Leite HR, Queiroz IP, Santos JG, Barroso de Souza FL, Scheidt Figueiredo PH, de Cordoba Lanza F, et al. Measurement properties of the six-minute pegboard and ring test (6PBRT) in healthy adolescents. J Bodyw Mov Ther. 2021;28:56-61.