Association of upper limb lymphedema with handgrip strength, balance, and gait mobility in women following mastectomy: A cross-sectional study at the National Cancer Institute, Sri Lanka

Abstract

Upper limb lymphedema (ULL) is a common post-mastectomy complication, characterized by swelling, pain, and discomfort in the arm, which subsequently diminishes patients' quality of life. This condition is attributed to the blockage or disruption of lymphatic vessels due to breast cancer treatments, resulting in fluid accumulation in the affected arm. This study aimed to assess ULL, handgrip strength, balance, and gait mobility among post-mastectomy women with ULL and to explore the associations between ULL and these functional outcomes. A descriptive cross-sectional study was conducted, recruiting 64 women aged 18-60 with unilateral ULL within one year post-mastectomy, from the National Cancer Institute, Maharagama. ULL was assessed using the inter-limb volume (ILV) ratio derived from circumferential measurements. Handgrip strength and gait mobility were evaluated using a handheld dynamometer and the Timed Up and Go (TUG) test, respectively. Balance was measured with the Single Leg Stand Test (SLST) and Fullerton Advanced Balance Scale (FABS). Correlations Participants exhibited a mean ILV ratio of 29.55±13.28%. The mean handgrip strength was 7.42±5.00 kgf (affected side) and 10.05±4.24 kgf (unaffected side). Mean SLST times were 19.06±15.38 seconds (eyes-open) and 4.90±2.08 seconds (eyes-closed) with a mean FABS score of 32.05±5.28. The mean TUG test time was 15.79±3.81 seconds. No significant correlation was observed between ILV ratio and handgrip strength (affected side: rs=-0.039; unaffected side: rs=-0.218; p>0.05). However, ILV ratio correlated negatively with SLST (eyes-open: rs=-0.394, p=0.001; eyes-closed: rs=0.296, p=0.018) and FABS scores (rs=-0.285, p=0.023), and positively with TUG (rs=0.305, p=0.014). ULL is not significantly associated with handgrip strength. However, it showed a significant negative impact on the balance and gait mobility of post-mastectomy women. Thus, rehabilitation should address both lymphedema reduction and improving the balance and mobility to improve functional capacity in these individuals.