N 19(2): 4 3 -4 7 , 2024 www.thebioscan.

com
Save Nature to Survive

The Efficacy of tele physiotherapy and comparison with routine physiotherapy

Kalpesh G. Vasani1, Dr. V. P. Hathila2, Arushi N. Bumtariya3

1
PhD Scholar, Faculty of Physiotherapy, Parul University, Vadodara, Gujarat, India
2
Dean, Faculty of Medicine, Parul Institute of Medical Science & Research, Vadodara, Gujarat, India
3
Arushi N. Bumtariya, Medical Officer (Ayu), General Hospital, Amreli, Gujarat, India

Email: kvasani30@yahoo.com
Phone No.: 8128908688

DOI: https://doi.org/10.63001/tbs.2024.v19.i02.pp43-47

KEYWORDS
Breast Cancer ABSTRACT
Modified Radical
Mastectomy Breast Cancer is a leading cause of women death in India and it is measured to have one out of every 28 Indian women are
Tele – Physiotherapy under risk of developing breast cancer. And as a part of treatment, Modified Radical Mastectomy can be considered as a
best treatment procedure. But that to have some complications like Decreased Shoulder ROM, Pain & Disabilities. To
overcome these complications we can have conventional physiotherapy protocol. But In India it is tough to have a
Received on: physiotherapist in every rural area. So, this study is mainly focuses on the tele physiotherapy protocol and helps us to find
out weather tele physiotherapy is helpful or not and if it is helpful, than comparison with the routine physiotherapy. So,
after having this research study we have found out that the tele physiotherapy is helpful for reducing the complications like
05-04-2024 pain, ROM & Disabilities but it is not as much beneficial as routine physiotherapy. So, for the patients who resides in rural
area where physiotherapy facilities are not available, those patients can be benefited by having tele physiotherapy than
Accepted on: compared to No Physiotherapy at all.
02-08-2024

Corresponding author

INTRODUCTION
Breast cancer is a growing concern in India, with increasing In conclusion, physiotherapy after a Modified Radical
incidence and mortality rates1.According to recent studies, Mastectomy is an essential component of comprehensive care for
breast cancer is the leading cause of mortality among women in individuals diagnosed with breast cancer in India5. It plays a vital
India1. In fact, it is estimated that one in every 28 Indian women role in improving physical function, emotional well-being, and
is at risk of developing breast cancer in her lifetime2. In light of overall quality of life after the surgery5. By integrating
the growing concern of breast cancer in India, it is essential to physiotherapy into the post-operative care plan, healthcare
explore treatment options that can offer the best chance of providers can support individuals in their journey towards
recovery and long-term survival. One such option is the Modified recovery and long-term well-being6.
Radical Mastectomy, a surgical procedure involving the removal Tele physiotherapy has emerged as a valuable option for
of the entire breast, including the breast tissue, nipple, and individuals undergoing post-operative care, especially in the
sentinel lymph nodes3. current global health crisis7. In India, tele physiotherapy offers a
convenient and effective way for individuals to receive
physiotherapy services remotely8. Through virtual consultations
After undergoing a Modified Radical Mastectomy, individuals may
and guided exercises, individuals can access professional support
experience various complications that could impact their
from experienced physiotherapists without the need for in-
recovery and long-term well-being4. These complications can
person visits8.Tele physiotherapy sessions can include guided
include lymphedema, a condition characterized by swelling in
exercises, movement assessments, and educational resources to
the arm on the side of the surgery, as well as limited mobility
empower individuals in actively participating in their recovery
and discomfort4. Additionally, some individuals may experience
process9.
psychological distress, body image issues, and emotional
In conclusion, tele physiotherapy has emerged as a valuable tool
challenges following the removal of the breast4.
for individuals undergoing post-operative care, particularly those
recovering from breast cancer treatment in India9. It provides
convenient access to professional support, especially for those in

43
 rural or remote areas10. Furthermore, it reduces the burden of mastectomy within last 3 months of period. Subjects were
travel and promotes a comfortable recovery environment at excluded from the study if they had a history of previous
home10. The use of tele physiotherapy in India has proven to be a shoulder and neck surgery, neuro muscular skeletal conditions
significant advancement in delivering comprehensive care to that may affect the shoulder and neck function, mental illness,
individuals undergoing breast cancer treatment11. subjects having any legal issues patients who did not understand
METHODOLOGY: the communication languages selected for the study (Gujarati,
Hindi English) patient having cognitive defects that may
Here we have conducted this study to check about the interfere with the intervention and outcome.
effectiveness of tele physiotherapy for patients underwent for Before starting the study, we have given an introduction to all
modified radical mastectomy as well as we have compared the participants about the research and had taken written consent
effectiveness of tele physiotherapy and the routine to participate in the study.
physiotherapy by the terms of ROM, Pain & Disability for the
patients underwent for modifiedradical mastectomy. A total of 69 patients had participated in the study and they had
For this study we have selected patients underwent for modified been given 2 choices;
radical mastectomyin the Amreli district of Gujarat during the 1. They can stay at their home and can join the tele
period of Jan 2022 to Dec 2023. physiotherapy session regularly for 1 hour – Tele
We have found total of 81 patients who underwent for the Physiotherapy Group – Group A
modified radical mastectomy but among of them we have 2. They can come regularly at the physiotherapy clinic for
selected only 69patients as 12 patients either didn’t match the the physiotherapy treatment - OPD group – Group B
inclusion criteria or they have denied to participate in the study.
Patients were selected for the study if they fulfil the following So, among of those 69 patients, 35 patients have selected to join
criteria. Female at the age of 25 to 70 years suffering with stage group A and 34 patients have selected to come regularly at
I -III breast cancer that was treated by modified radical physiotherapy department and joined group B.
INTERVENTION: 3. Strengthening of the muscles of the shoulder girdle
was provided either using manual resistance or
Group A – Tele Physiotherapy Group dumbbell and Thera bands.
4. Functional activities was be educated for the upper
limb like shifting objects from the floor to the
1. Active exercise and active mobilization to reduce
cupboard, grooming activities, dressing activities,
lymphedema and active muscle contraction of upper
occupational activities and all other decided activities
limb muscles.
of the patient’s choice which are feasible.
2. Active Exercises to improve the shoulder range of
5. General aerobic exercises were provided to increase
motion that includes Flexion, extension and hyper
the cardio respiratory endurance and also to increase
extension exercises either in sitting or in standing
the chest wall expansion which might be altered
position.
following the surgery.
3. Strengthening of the muscles of the shoulder girdle
6. Endurance exercises were provided with less weight
was provided either by using dumbbell and Thera
and more frequency of movement for of the upper
bands.
limb.
4. Functional activities were been educated for the upper
The treatment duration is for 60 minutes concentrating equally
limb like shifting objects from the floor to the
all the components for 10 minute each and 5 times in a week.
cupboard, grooming activities, dressing activities,
Rest was incorporated on a case-to-case basis as per the
occupational activities and all other decided activities
expertise of the researcher. – for both the groups. For the group
of the patient’s choice which are feasible.
A – A tele physiotherapy session has been conducted by zoom
5. General aerobic exercises were provided to increase
meeting every time.
the cardio respiratory endurance and also to increase
We have asked both the group patients to visit the physiotherapy
the chest wall expansion which might be altered
clinic at the end of 2nd week and at the end of 5th week of
following the surgery.
intervention for the further assessment.
6. Endurance exercises were provided with less weight
ANALYSIS:
and more frequency of movement for of the upper
limb.
Here in this research, we have analysed the data by means of
Group B – Routine Physiotherapy Group
withing group analysis to check the effectiveness of treatment
1. Exercise and mobilization to reduce lymphedema in
protocol and between group analysis to check which treatment
the form of massage, stockings and active muscle
protocol is superior among of two. For both the groups we have
contraction of upper limb muscles.
measured 3 different outcome measures of Pain, Flexion ROM &
2. Exercises to improve the shoulder range of motion that
SPADI Score at 3 different intervals:
includes scapular mobilization stretching of the
i. Baseline, before starting the treatment – Pre-Test
Latissimus dorsi, Serratus anterior, Deltoid and
ii. At 2 weeks of intervention – Post Test 1
Pectoralis major and based on case-to-case basis which
iii. At 5 weeks of intervention – Post Test 2
ever muscles are tight.
1.1. Within Group Analysis – Pain:
Paired Samples Test – TelePhysiotherapy Group
Sig. (2- Paired Sample t test had been performed for within group
Paired Differences tailed) analysis for the pain in tele physiotherapy group and routine
Std.
95% Confidence
T Df physiotherapy group and it showed the significant difference
Std. Interval of the between Pretest & Post test 1, Post Test 1 & Post test 2 and
Mean Error
Deviation Difference Pretest & Post Test 2 in both the groups with having p value of <
Mean
Lower Upper 0.005 in both the group at every interval.
Pretest - 11.96
Pair 1
Post Test 1
9.943 4.917 .831 8.254 11.632
4
34 .000 Aboveresult of within group Analysis shows that both the
Post Test 1 treatment protocol of tele physiotherapy & routine
13.50 physiotherapy is effective for the treatment of pain in the
Pair 2 – Post Test 14.971 6.560 1.109 12.718 17.225 34 .000
3 patients underwent for the modified radical mastectomy
2
Pretest – 21.36
Pair 3 24.914 6.900 1.166 22.544 27.285 34 .000
Post test 2 2

44
 1.3. Within Group Analysis – SPADI:
Paired Samples Test – Routine Physiotherapy Group
Paired Samples Test – Tele Physiotherapy Group

Paired Differences
Paired Differences
Std Sig.
Std 95% Confidence Interval of the Difference D (2-
. t
. f taile
95% Confidence Me Err
Dev d)
Interval of the t Df Sig. (2-tailed) an or
Std. iati Lower Upper
Std. Difference Me
Error on
Mean Deviati an
Mea P Pretes
on
n ai t- 24. 7.1 1.2 3
Lower Upper 21.849 26.780 20.041 .000
r Post 314 77 13 4
1 Test 1
Pretest - P Post
1.31 17.8 ai Test 1 15. 7.9 1.3 3
Pair 1 Post Test 23.529 7.684 20.848 26.211 33 .000 12.734 18.180 11.535 .000
8 55 r – Post 457 27 40 4
1
2 Test 2
Post Test P Pretes
1.03 16.5 ai t– 39. 6.0 1.0 3
Pair 2 1 – Post 17.088 6.017 14.989 19.188 33 .000 37.695 41.848 38.927 .000
2 60 r Post 771 44 22 4
Test 2
3 test 2
Pretest –
1.37 29.4
Pair 3 Post test 40.618 8.038 37.813 43.422 33 .000
8 66
2
Paired Samples Test – Routine Physiotherapy Group
1.2. Within group analysis – ROM:
Paired Differences
Paired Sample t test had been performed for within group
analysis for the flexion ROM in tele physiotherapy group and Std 95% Confidence Sig.
Std
routine physiotherapy group and it showed the significant . Interval of the (2-
. t Df
difference between Pretest & Post test 1, Post Test 1 & Post Test Me Err Difference tail
Dev
2 and Pretest & Post Test 2 in both the group p value of < 0.005 an or ed)
iati
in both the group at every interval. Me Lower Upper
on
an
Aboveresult of within group analysis shows that both the Prete
treatment protocol of tele physiotherapy & routine Pair st - 37. 7.2 1.2 .00
physiotherapy is effective for the treatment of improving flexion 35.358 40.407 30.530 33
1 Post 882 35 41 0
ROM in the patients underwent for the modified radical Test 1
mastectomy Post
Pair Test 1 24. 8.4 1.4 .00
21.776 27.695 17.003 33
2 – Post 735 83 55 0
Paired Samples Test – Tele physiotherapy Group Test 2
Prete
Paired Differences Pair st – 62. 8.0 1.3 .00
59.813 65.422 45.425 33
3 Post 618 38 78 0
95%
test 2
Confidence Sig. (2-
Std. Std. T df
Mean Deviat Error
Interval of the tailed)
Difference Paired Sample t test had been performed for within group
ion Mean analysis for the SPADI Score in tele physiotherapy group and
Lower Upper
routine physiotherapy group and it showed the significant
Pretes
- - - -
difference between Pretest & Post test 1, Post Test 1 & Post Test
Pai t- 3 2 and Pretest & Post Test 2 in both the group p value of < 0.005
r1 Post
16.42 7.582 1.282 19.03 13.82 12.81
4
.000
9 3 4 9 in both the group at every interval.
Test 1
Above result of within group comparison shows that both the
Post
Pai Test 1
- - - -
3
treatment protocol of tele physiotherapy & routine
r2 – Post
29.88 6.614 1.118 32.15 27.61 26.73
4
.000 physiotherapy is effective for the treatment of improving SPADI
6 8 4 0 Score in the patients underwent for the modified radical
Test 2
Pretes mastectomy
- - - -
Pai t– 3 2.1. Between Group Analysis – Pain:
r3 Post
46.31 8.109 1.371 49.10 43.52 33.79
4
.000
4 0 9 1 Independent Sample t Test had been performed to compare the
test 2 effectiveness of treatment by means of reducing pain in both the
groups and found no significance of difference in the valueof
pain at Pretest analysis with having F value of 2.74 and p value
Paired Samples Test – Routine Physiotherapy Group
of > 0.005.
Independent Sample t Test had been performed to compare the
Paired Differences effectiveness of treatment by means of reducing pain in both the
groups and found a significance of difference in the value of pain
95% Confidence Sig. at Post test 1 with having F value of 10.96 and p value of <
Std. Interval of the T df (2-
Std.
Error Difference tailed)
0.005.
Mean Deviati Independent Sample t Test had been performed to compare the
Mea
on Uppe
n Lower
r
effectiveness of treatment by means of reducing pain in both the
groups and found a significance of difference in the value of pain
Pretest - at Post test 2 with having F value of 2.09 and p value of < 0.005.
Pair
- Post -8.529 5.512 .945 -10.453 6.60 -9.024 33 .000 Above mentioned result showed that the routine physiotherapy
1
Test 1 6
group was much more effective in reducing the pain than
Post
Pair Test 1
-
1.52
-
- compared with tele physiotherapy group.
23.79 8.913 -26.904 20.6 33 .000
2 – Post 9 15.566
4 84
Test 2
Pretest - -
Pair 1.87 -
– Post 32.32 10.92 -36.134 28.5 33 .000
3 3 17.259
test 2 4 13

45
 Independent Samples Test Independent Samples Test

Levene's Levene's
Test for Test for
t-test for Equality of Means
Equality t-test for Equality of Means Equality of
of Variances
Variances 95%
Std.
Std 95% Mea Confidence
Sig. Erro
. Confidence n Interval of
Sig Mea (2- r
Err Interval of F Sig. t df Diff the
. n tail Diff
Sig d or the eren Difference
F T (2- Diff ed) eren
. f Dif Difference ce Low Upp
tail ere ce
fer er er
ed) nce Low Uppe Equal -
enc - -
er r variance 2. 1.22 -
e Pretest .054 .817 67 .034 2.65 5.10
Equal - - s 16 7 .209
Pret 2.73 .10 6 .67 - 1.6 2.56 8 7
variances .41 3.9 assumed 7
est 8 3 7 7 .680 25 5 Equal
assumed 8 24 7.
Post Equal Post variance 10.9 1.54 7.83 13.9
10.9 .00 9.2 6 .00 12.9 1.4 10. 15.7 .359 .551 07 67 .000
Test variances Test 1 s 10 2 3 87
55 2 09 7 0 07 01 109 04 7
1 assumed assumed
Post Equal Equal
2.09 .15 14. 6 .00 15.0 1.0 12. 17.1 14
Test variances Post variance 20.1 1.35 17.4 22.8
7 2 26 7 0 24 54 921 26 .189 .665 .9 67 .000
2 assumed Test 2 s 88 0 94 82
59
assumed
Independent Sample t Test had been performed to compare the
2.2. Between Group Analysis – FlexionROM: effectiveness of treatment by means of reducing SPADI Score in
both the groups and found no significance of difference in the
value of ROM at Pretest analysis with having F value of 0.54 and
p value of > 0.005.
Independent Samples Test Independent Sample t Test had been performed to compare the
effectiveness of treatment by means of reducing SPADI Score in
Levene's both the groups and found a significance of difference in the
Test for value of SPADI Score at Post test 1 with having F value of 0.36
Equality t-test for Equality of Means and p value of < 0.005.
of Independent Sample t Test had been performed to compare the
Variances effectiveness of treatment by means of reducing SPADI Score in
Si Std 95% both the groups and found a significance of difference in the
g. . Confidence value of SPADI Score at Post Test 2 with having F value of 0.19
Mea
(2 Err Interval of and p value of < 0.005.
n
D - or the Above mentioned result showed that the routine physiotherapy
F Sig. T Diff
f ta Dif Difference group was much more effective in reducing the SPADI Score than
ere
il fer compared with tele physiotherapy group.
nce Lowe Upp
e en
r er
d) ce DISCUSSION
Equal - .3 - -
.68 6 2.1 2.19
Pretest variances .411 .96 3 2.04 6.29 Here in this study, we have collected the data and analysed it
4 7 26 7
assumed 2 9 6 0 with having within group analysis and between group analysis
Equal .0 and found that both the treatment protocol waseffective by
Post 3.9 3.1 6 5.85 1.8 2.11 9.59
variances .052 0 means of improving in Pain, ROM & SPADI score but while
Test 1 05 24 7 3 74 3 3
assumed 3 compared both the group result at 3 intervals, we have found
Equal .0 the routine physiotherapy group was much more effective than
Post 5.1 6.1 6 11.9 1.9 8.06 15.8
variances .026 0 compared to tele physiotherapy group.
Test 2 52 44 7 45 44 4 25
assumed 0 In a developingcountry like India, we are facing a huge lack of
Independent Sample t Test had been performed to compare the healthcare workers especially in the rural areas. So, patients
effectiveness of treatment by means of improving ROM in both suffering from many conditions like having post operative
the groups and found no significance of difference in the value complication of modified radical mastectomy couldn’t receive a
of ROM at Pretest analysis with having F value of 0.68 and p proper treatment because they don’t have proper medical
value of > 0.005. facility available at their home town
Independent Sample t Test had been performed to compare the So, in the era of 21st century, when we are having a proper
effectiveness of treatment by means of improving ROM in both technology like tele medicine and when the health & family
the groups and found a significance of difference in the value of welfare department of government of India is also promoting the
pain at Post test 1 with having F value of 3.90 and p value of < tele physiotherapy. Then why can’t we as a physiotherapist take
0.005. a step forward in this direction & provide a tele physiotherapy to
patients who are unable to come at clinic regularly. So, these
Independent Sample t Test had been performed to compare the types of patients can have a batter life ahead.
effectiveness of treatment by means of improvingROM in both This study was to check the efficacy of tele physiotherapy in the
the groups and found a significance of difference in the value of patients underwent the modified radical mastectomy and had
ROM at Post Test 2 with having F value of 5.15 and p value of < been proved that a tele physiotherapy can be a batter option for
0.005. the patients who can’t go to the physiotherapy clinic regularly
Above mentioned result showed that the routine physiotherapy than having a no physiotherapy treatment at all.
group was much more effective in improving the ROM than No doubt a tele physiotherapy can’t be as much beneficial as the
compared with tele physiotherapy group. routing physiotherapy at physiotherapy clinic. But we can
provide batter life for those patients who can’t come for the
routine physiotherapy at clinic regularly.
2.3. Between Group Analysis – SPAD Score:

46
CONCLUSION
The results of the study suggest that
1. Tele Physiotherapy and Routine Physiotherapy both are
beneficial for reducing pain, improving ROM and
Reducing disability index for the patients underwent
for modified radical mastectomy.
2. Before starting the physiotherapy treatment, at
Pretest analysis, we have found both the group were
similar and have not found significantly different in
the terms of pain, ROM& SPADI.
3. Routine physiotherapy group was quite more beneficial
while compared to tele physiotherapy group at both
the intervals of Post Test 1&Post Test 2.
According to the result we got after having data analysis, routine
physiotherapy would always be having an upper hand than
compared to tele physiotherapy, and it is preferred for the
patients to take the physiotherapy regularly at physiotherapy
clinic whenever itis possible.
But while it is not possible for the patients to come at
physiotherapy clinic regularly, it is preferred to have a tele
physiotherapy at home and make a regular follow up at
physiotherapy clinic whenever asked.

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