الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Modified radical mastectomy with or without reconstruction or breast preservation in addition to axillary lymph node dissection are common surgical procedures in breast cancer. Surgery of the axilla is associated with numerous complications, including shoulder dysfunction and seroma. The exact etiology of seroma formation remains controversial. Several interventions have been reported with the aim of reducing seroma formation including delaying shoulder exercises (Lumachi et al., 2004).
The aim of the current study was to examine the effect of early versus delayed shoulder exercises on seroma formation and shoulder function among women who had modified radical mastectomy.
:Research Design
The current study utilized the quesi experimental research design.
:Setting
The current study was conducted at the surgical department and surgical outpatient clinics of the Menoufiya University and Shebin El Kom Teaching Hospitals.
:Subjects
The study subjects composed of a convenient sample of 60 adult females’ patients with first or second stage of breast cancer and scheduled for modified radical mastectomy. They were selected according to the following criteria
• Adult female, conscious and with first or second stage of breast cancer.
• In the preoperative period and within 24 hours of admission.
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Summery
Exclusion criteria included:
• Breast cancer patients undergoing immediate reconstruction, regional radiation and neck surgery.
• Patients with sever deformity, or with any trauma or diseases affecting muscle and joints such as rheumatoid arthritis and myopathies.
• Patient with concurrent wide excision and skin grafting on or around the shoulder.
• Patient with any other types of cancer and on chemo/ or radiotherapy.
• Patient with past history of diabetes and osteoporosis
The study subjects were alternatively and randomly assigned into 2 equal groups each of 30 patients:
Group I: was exposed to early shoulder exercises in the first postoperative day.
Group II: was exposed to delayed shoulder exercises in the seventh postoperative day.
Both groups were matched as much as possible as regards to age, level of education and the stage of breast cancer.
Tools of the study:
Data for this study was collected through the following tools:
Tool I: Questionnaire to assess biosociodemographic and clinical data
Tool II: Modified radical mastectomy questionnaire for shoulder range of motion assessment (Appendix III).
Tool III: Modified radical mastectomy questionnaire for seroma assessment (Appendix IV).
Tool IV: Shoulder functional ability assessment questionnaire (Appendix V). ١٠٨
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Methods of data collection
1. Permission to carry out the study from responsible authorities after an explanation of the purpose of the study was done.
2. Tool I (Appendix II), tool II (Appendix III) and tool III (Appendix IV) was developed and used by the researcher. Tool IV (Appendix V) was adopted from American shoulder and elbow surgeons’ shoulder evaluation form (McRae, 2004). It was translated into Arabic by the researcher. The developed tools were tested for content validity by five experts in the field including nurse educators and a medical specialist to ascertain relevance and completeness. Modifications were done accordingly.
3. Reliability of the tools was done by using test-retest method.
4. Patients’ oral consent for the participation in the study was obtained after an explanation of the purpose of the study.
5. A pilot study was conducted on 10% of the study sample for evaluating the constructed tools for its clarity and applicability and necessary modifications were carried out before the main study. Results of pilot study were not included in the data collection.
6. Each patient who agreed to participate in the study and fulfilled the inclusion criteria was interviewed individually by the researcher before and after mastectomy at the surgical department and surgical outpatient clinics of the Menoufiya University, and Shebin El Kom Teaching Hospitals. (Data was collected from July 2009, till May 2011).
7. The sample was randomly and alternatively divided into two equal groups (study group 1 and study group 11).
8. The study was carried out in four consecutive phases namely: assessment, planning, intervention and evaluation.