{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:43:27Z","timestamp":1790228607788,"version":"4.1.0"},"reference-count":66,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T00:00:00Z","timestamp":1749340800000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Foundation-Flanders","award":["G075223N"],"award-info":[{"award-number":["G075223N"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,5,13]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Breast cancer-related lymphoedema (BCRL) at the arm and\/or trunk\/breast is a highly feared complication following breast cancer treatment and can be objectified using the state-of-the-art criteria based on volume, extracellular water ratio or skin thickness measurements. Although the incidence of objective BCRL is decreasing due to advances in breast cancer treatment, many patients report a sensation of swelling without the presence of objective BCRL, referred to as subjective BCRL. As little is known about the prevalence and the transitions between different BCRL states (no-subjective-objective) over time, as well as about the underlying mechanisms and contributing factors of subjective BCRL, this will be investigated in the LymphSens study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>230 patients with a new diagnosis of unilateral breast cancer will be included in a multicentre longitudinal study. Measurements are performed from presurgery to 12 months postsurgery. The primary objective (aim 1) is to determine the prevalence rate of subjective and objective BCRL at 1, 6 and 12 month(s) postsurgery, as well as transitions between BCRL states (no-subjective-objective BCRL) by a multinomial logistic regression model with generalised estimating equations and transition matrices, respectively. A second objective (aim 2) is to determine factors related to four potential underlying mechanisms (lymphatic, nociceptive, neuropathic and central sensory processing problems) that contribute to the occurrence of subjective BCRL in comparison with no self-reported swelling and objective BCRL. As a third objective (aim 3), within the group of patients with subjective BCRL, we will determine factors related to these four underlying mechanisms that contribute to the severity of subjective BCRL. The analyses for aim 2 and aim 3 will be conducted both at specific time points, that is, 1, 6 and 12 month(s) postsurgery using exploratory analysis and across all time points collectively using multivariable binary logistic regression models or multivariable longitudinal models for repeated measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The LymphSens study protocol received approval from the Ethics Committee of UZ Leuven (S68133) and UZ Antwerp\/University of Antwerp (5676-003252). The results of the LymphSens study will be presented at conferences and published in peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06324721\">NCT06324721<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-099990","type":"journal-article","created":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T15:45:18Z","timestamp":1749397518000},"page":"e099990","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["LymphSens study: the enigma of subjective lymphoedema \u2013 how often and why do patients report lymphoedema after breast cancer treatment without an objective measurable swelling? The role of lymphatic and sensory processing problems: a protocol for a multicentre prospective longitudinal study"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06324721","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06324721","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9204-8364","authenticated-orcid":false,"given":"Ceren","family":"Gursen","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"},{"name":"Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey"},{"name":"Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Meeus","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaat","family":"Verbeelen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"},{"name":"Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nieke","family":"Vets","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Spincemaille","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Smeets","sequence":"additional","affiliation":[{"name":"Department of Oncology, KU Leuven, Leuven, Belgium"},{"name":"Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8491-6264","authenticated-orcid":false,"given":"Sarah","family":"Thomis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"},{"name":"Department of Vascular Surgery, Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Fieuws","sequence":"additional","affiliation":[{"name":"Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Vanderheyden","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Gebruers","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium"},{"name":"Multidisciplinary Oedema Clinic, University Hospital Antwerp, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiebren","family":"Tjalma","sequence":"additional","affiliation":[{"name":"Multidisciplinary Oedema Clinic, University Hospital Antwerp, Edegem, Belgium"},{"name":"Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium"},{"name":"Multidisciplinary Breast Clinic, University Hospital Antwerp, Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5970-1958","authenticated-orcid":false,"given":"Karin","family":"Johansson","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaughan","family":"Keeley","sequence":"additional","affiliation":[{"name":"Lymphoedema Department, University Hospitals of Derby and Burton, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An","family":"De Groef","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"},{"name":"Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8117-7080","authenticated-orcid":false,"given":"Nele","family":"Devoogdt","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, KU Leuven, Leuven, Belgium"},{"name":"Department of Vascular Surgery, Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"key":"2025120721565454000_15.6.e099990.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2025120721565454000_15.6.e099990.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2022.08.010"},{"key":"2025120721565454000_15.6.e099990.3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.18.3517"},{"key":"2025120721565454000_15.6.e099990.4","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2020.00137","article-title":"The Unresolved Pathophysiology of Lymphedema","volume":"11","author":"Azhar","year":"2020","journal-title":"Front Physiol"},{"key":"2025120721565454000_15.6.e099990.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.07.035"},{"key":"2025120721565454000_15.6.e099990.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-022-06850-7","article-title":"Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines","volume":"198","author":"Shah","year":"2023","journal-title":"Breast Cancer Res Treat"},{"key":"2025120721565454000_15.6.e099990.7","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000023722","article-title":"Feasibility of segmental bioelectrical impedance analysis for mild- to moderate-degree breast cancer-related lymphedema: Correlation with circumferential volume measurement and phase angle","volume":"100","author":"Kim","year":"2021","journal-title":"Medicine (Baltimore)"},{"key":"2025120721565454000_15.6.e099990.8","first-page":"15","article-title":"Two-year follow-up of temporal changes of breast edema after breast cancer treatment with surgery and radiation evaluated by tissue dielectric constant (TDC)","volume":"27","author":"Johansson","year":"2015","journal-title":"Eur J of Lymphol"},{"key":"2025120721565454000_15.6.e099990.9","first-page":"125","article-title":"Tissue dielectric constant ratios as a method to characterize truncal lymphedema","volume":"51","author":"Mayrovitz","year":"2018","journal-title":"Lymphology"},{"key":"2025120721565454000_15.6.e099990.10","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s11136-019-02337-z","article-title":"Development and clinimetric properties of the Dutch Breast Edema Questionnaire (BrEQ-Dutch version) to diagnose the presence of breast edema in breast cancer patients","volume":"29","author":"Verbelen","year":"2020","journal-title":"Qual Life Res"},{"key":"2025120721565454000_15.6.e099990.11","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70076-7"},{"key":"2025120721565454000_15.6.e099990.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2015.01.014"},{"key":"2025120721565454000_15.6.e099990.13","article-title":"Self\u2010reported signs and symptoms of secondary upper limb lymphoedema related to breast cancer treatment: Systematic review","volume":"30","author":"Gursen","year":"2021","journal-title":"Eur J Cancer Care"},{"key":"2025120721565454000_15.6.e099990.14","doi-asserted-by":"crossref","first-page":"2186","DOI":"10.1093\/ptj\/pzaa162","article-title":"Integrating symptoms into the diagnostic criteria for breast cancer-related lymphedema: applying results from a prospective surveillance program","volume":"100","author":"Brunelle","year":"2020","journal-title":"Phys Ther"},{"key":"2025120721565454000_15.6.e099990.15","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.ejso.2014.12.006","article-title":"Self-perceived, but not objective lymphoedema is associated with decreased long-term health-related quality of life after breast cancer surgery","volume":"41","author":"Sackey","year":"2015","journal-title":"Eur J Surg Oncol"},{"key":"2025120721565454000_15.6.e099990.16","doi-asserted-by":"crossref","DOI":"10.3390\/cancers14235998","article-title":"Do patient-reported upper-body symptoms predict breast cancer-related lymphoedema: results from a population-based, longitudinal breast cancer cohort study","volume":"14","author":"Hayes","year":"2022","journal-title":"Cancers (Basel)"},{"key":"2025120721565454000_15.6.e099990.17","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200311000-00004"},{"key":"2025120721565454000_15.6.e099990.18","doi-asserted-by":"crossref","DOI":"10.3390\/cancers15061774","article-title":"Early disturbance of lymphatic transport as a risk factor for the development of breast-cancer-related lymphedema","volume":"15","author":"Thomis","year":"2023","journal-title":"Cancers (Basel)"},{"key":"2025120721565454000_15.6.e099990.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0038182","article-title":"Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs","volume":"7","author":"Mihara","year":"2012","journal-title":"PLoS One"},{"key":"2025120721565454000_15.6.e099990.20","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1089\/lrb.2019.0090","article-title":"Correlation between clinical assessment and lymphofluoroscopy in patients with breast cancer-related lymphedema: a study of concurrent validity","volume":"18","author":"Thomis","year":"2020","journal-title":"Lymphat Res Biol"},{"key":"2025120721565454000_15.6.e099990.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2007.01.004"},{"key":"2025120721565454000_15.6.e099990.22","first-page":"345","article-title":"Symptom report in detecting breast cancer-related lymphedema","volume":"7","author":"Fu","year":"2015","journal-title":"Breast Cancer (Dove Med Press)"},{"key":"2025120721565454000_15.6.e099990.23","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ejon.2009.01.005","article-title":"Lymphedema and quality of life in Chinese women after treatment for breast cancer","volume":"13","author":"Mak","year":"2009","journal-title":"Eur J Oncol Nurs"},{"key":"2025120721565454000_15.6.e099990.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0193915","article-title":"An evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool): Concurrent, face and content validity","volume":"13","author":"De Groef","year":"2018","journal-title":"PLoS One"},{"key":"2025120721565454000_15.6.e099990.25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0179116","article-title":"An evaluation tool for myofascial adhesions in patients after breast cancer (MAP-BC evaluation tool): Development and interrater reliability","volume":"12","author":"De Groef","year":"2017","journal-title":"PLoS One"},{"key":"2025120721565454000_15.6.e099990.26","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1080\/09638288.2020.1800835","article-title":"The association between upper limb function and variables at the different domains of the international classification of functioning, disability and health in women after breast cancer surgery: a systematic review","volume":"44","author":"De Groef","year":"2022","journal-title":"Disabil Rehabil"},{"key":"2025120721565454000_15.6.e099990.27","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1093\/pm\/pnab343","article-title":"Absolute and relative reliability of a comprehensive quantitative sensory testing protocol in women treated for breast cancer","volume":"23","author":"Dams","year":"2022","journal-title":"Pain Med"},{"key":"2025120721565454000_15.6.e099990.28","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1097\/AJP.0000000000000940","article-title":"Quantitative sensory testing in women after surgery for breast cancer","volume":"37","author":"Dams","year":"2021","journal-title":"Clin J Pain"},{"key":"2025120721565454000_15.6.e099990.29","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1007\/s11764-021-01100-z","article-title":"Sensory signs and symptoms in women with self-reported breast cancer-related lymphedema: a case-control study close up","volume":"16","author":"De Groef","year":"2022","journal-title":"J Cancer Surviv"},{"key":"2025120721565454000_15.6.e099990.30","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1097\/j.pain.0000000000001398","article-title":"What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer","volume":"160","author":"Mustonen","year":"2019","journal-title":"Pain"},{"key":"2025120721565454000_15.6.e099990.31","first-page":"6545","article-title":"Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy","volume":"29","author":"Baran","year":"2021","journal-title":"Support Care Cancer"},{"key":"2025120721565454000_15.6.e099990.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2012.06.016"},{"key":"2025120721565454000_15.6.e099990.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2009.01938.x"},{"key":"2025120721565454000_15.6.e099990.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.math.2011.04.005"},{"key":"2025120721565454000_15.6.e099990.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.09.030"},{"key":"2025120721565454000_15.6.e099990.36","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70106-5"},{"key":"2025120721565454000_15.6.e099990.37","first-page":"18","article-title":"Lymphedema secondary to breast cancer: how choice of measure influences diagnosis, prevalence, and identifiable risk factors","volume":"41","author":"Hayes","year":"2008","journal-title":"Lymphology"},{"key":"2025120721565454000_15.6.e099990.38","doi-asserted-by":"publisher","DOI":"10.1006\/jsre.2000.6021"},{"key":"2025120721565454000_15.6.e099990.39","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.16.3725"},{"key":"2025120721565454000_15.6.e099990.40","first-page":"3073","article-title":"Screening for breast cancer-related lymphoedema: self-assessment of symptoms and signs","volume":"28","author":"Svensson","year":"2020","journal-title":"Support Care Cancer"},{"key":"2025120721565454000_15.6.e099990.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"2025120721565454000_15.6.e099990.42","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s12609-017-0237-8","article-title":"Diagnostic methods, risk factors, prevention, and management of breast cancer-related lymphedema: past, present, and future directions","volume":"9","author":"Sayegh","year":"2017","journal-title":"Curr Breast Cancer Rep"},{"key":"2025120721565454000_15.6.e099990.43","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-017-3824-3"},{"key":"2025120721565454000_15.6.e099990.44","doi-asserted-by":"crossref","first-page":"63","DOI":"10.4048\/jbc.2021.24.e9","article-title":"Association between number of retrieved sentinel lymph nodes and breast cancer-related lymphedema","volume":"24","author":"Kim","year":"2021","journal-title":"J Breast Cancer"},{"key":"2025120721565454000_15.6.e099990.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2006.01.041"},{"key":"2025120721565454000_15.6.e099990.46","first-page":"129","article-title":"Pain assessment: global use of the brief pain inventory","volume":"23","author":"Cleeland","year":"1994","journal-title":"Ann Acad Med Singap"},{"key":"2025120721565454000_15.6.e099990.47","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1589\/jpts.27.1361","article-title":"Assessing the impact of pain on the life of breast cancer survivors using the Brief Pain Inventory","volume":"27","author":"Ferreira","year":"2015","journal-title":"J Phys Ther Sci"},{"key":"2025120721565454000_15.6.e099990.48","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(86)90026-6"},{"key":"2025120721565454000_15.6.e099990.49","doi-asserted-by":"publisher","DOI":"10.1348\/014466505X29657"},{"key":"2025120721565454000_15.6.e099990.50","article-title":"Reliability and validity of a Dutch lymphoedema questionnaire: cross\u2010cultural validation of the norman questionnaire","volume":"29","author":"De Groef","year":"2020","journal-title":"Eur J Cancer Care"},{"key":"2025120721565454000_15.6.e099990.51","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/00002820-200505000-00007","article-title":"Age differences in post-breast cancer lymphedema signs and symptoms","volume":"28","author":"Armer","year":"2005","journal-title":"Cancer Nurs"},{"key":"2025120721565454000_15.6.e099990.52","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206074463"},{"key":"2025120721565454000_15.6.e099990.53","doi-asserted-by":"crossref","unstructured":"Rubin DB . Multiple imputation for nonresponse in surveys. New York: John Wiley and Sons, 1987.","DOI":"10.1002\/9780470316696"},{"key":"2025120721565454000_15.6.e099990.54","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-097X.2007.00708.x"},{"key":"2025120721565454000_15.6.e099990.55","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1093\/ptj\/82.12.1201","article-title":"Upper-extremity volume measurements in women with lymphedema: a comparison of measurements obtained via water displacement with geometrically determined volume","volume":"82","author":"Sander","year":"2002","journal-title":"Phys Ther"},{"key":"2025120721565454000_15.6.e099990.56","first-page":"401","article-title":"A new device to measure upper limb circumferences: validity and reliability","volume":"29","author":"Devoogdt","year":"2010","journal-title":"Int Angiol"},{"key":"2025120721565454000_15.6.e099990.57","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1177\/0269215519835907","article-title":"What is the best method to determine excessive arm volume in patients with breast cancer-related lymphoedema in clinical practice? Reliability, time efficiency and clinical feasibility of five different methods","volume":"33","author":"De Vrieze","year":"2019","journal-title":"Clin Rehabil"},{"key":"2025120721565454000_15.6.e099990.58","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-019-5840-9","article-title":"Utilization of bioelectrical impedance analysis for detection of lymphedema in breast Cancer survivors: a prospective cross sectional study","volume":"19","author":"Lim","year":"2019","journal-title":"BMC Cancer"},{"key":"2025120721565454000_15.6.e099990.59","first-page":"85","article-title":"L-dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity","volume":"46","author":"Fu","year":"2013","journal-title":"Lymphology"},{"key":"2025120721565454000_15.6.e099990.60","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1111\/sms.14191","article-title":"Hamstring muscle activation strategies during eccentric contractions are related to the distribution of muscle damage","volume":"32","author":"Goreau","year":"2022","journal-title":"Scandinavian Med Sci Sports"},{"key":"2025120721565454000_15.6.e099990.61","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1089\/lrb.2020.0105","article-title":"The interrater reliability of the scoring of the lymphatic architecture and transport through near-infrared fluorescence lymphatic imaging in patients with breast cancer-related lymphedema","volume":"20","author":"Thomis","year":"2022","journal-title":"Lymphat Res Biol"},{"key":"2025120721565454000_15.6.e099990.62","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1002\/pmrj.12227","article-title":"Mechanical properties of muscles around the shoulder in breast cancer patients: intra-rater and inter-rater reliability of the MyotonPRO","volume":"12","author":"Yeo","year":"2020","journal-title":"PM R"},{"key":"2025120721565454000_15.6.e099990.63","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-084882","article-title":"Prognostic factors for the development of upper limb dysfunctions after breast cancer: the UPLIFT-BC prospective longitudinal cohort study protocol","volume":"14","author":"De Groef","year":"2024","journal-title":"BMJ Open"},{"key":"2025120721565454000_15.6.e099990.64","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.physio.2016.07.002","article-title":"Inter-rater reliability of shoulder measurements in middle-aged women","volume":"103","author":"De Groef","year":"2017","journal-title":"Physiotherapy"},{"key":"2025120721565454000_15.6.e099990.65","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/AJP.0000000000000512","article-title":"Sensitivity of the DN4 in screening for neuropathic pain syndromes","volume":"34","author":"VanDenKerkhof","year":"2018","journal-title":"Clin J Pain"},{"key":"2025120721565454000_15.6.e099990.66","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-021-03944-z","article-title":"Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain","volume":"22","author":"Nishigami","year":"2021","journal-title":"BMC Musculoskelet Disord"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-099990","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T05:57:40Z","timestamp":1765173460000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-099990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":66,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,8]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bmjopen-2025-099990"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-099990","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}