{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T18:31:00Z","timestamp":1774117860373,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,4,16]],"date-time":"2022-04-16T00:00:00Z","timestamp":1650067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Call for competitive competition, of research and innovation projects in the field of Primary Care, Regional Hospitals and High Resolution Hospital Centers of the Public Health System of Anda-lusia for the year 2021, of the Andalusian Public Foundation Pr","award":["AP-0160-2021-C2-F2"],"award-info":[{"award-number":["AP-0160-2021-C2-F2"]}]},{"name":"Grants for research projects in Occupational Therapy. Call 2020&quot;, granted by the Professional Association of Occupational Therapists of Extremadura (COPTOEX)","award":["No number"],"award-info":[{"award-number":["No number"]}]},{"name":"Research Group in Primary Health Care of Aragon","award":["GAIAP-B21-17R group"],"award-info":[{"award-number":["GAIAP-B21-17R group"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb\u2019s functionality. This study aims to verify the efficacy and efficiency in the upper limb\u00b4s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. Methods: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in C\u00f3rdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. Results: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder\u00b4s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (\u03b72 \u2264 0.080). In the rest of the variables, no significant differences were found. Conclusions: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.<\/jats:p>","DOI":"10.3390\/jcm11082234","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T04:21:28Z","timestamp":1650255688000},"page":"2234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5680-759X","authenticated-orcid":false,"given":"Mar\u00eda Nieves","family":"Mu\u00f1oz-Alcaraz","sequence":"first","affiliation":[{"name":"Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, C\u00f3rdoba and Guadalquivir Health District, Reina Sof\u00eda University Hospital, Andalusia Health Service, 14011 Cordoba, Spain"},{"name":"Maimonides Institute for Biomedical Research of C\u00f3rdoba, Reina Sof\u00eda University Hospital, University of C\u00f3rdoba, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2435-5397","authenticated-orcid":false,"given":"Antonio Jos\u00e9","family":"Jim\u00e9nez-V\u00edlchez","sequence":"additional","affiliation":[{"name":"Valle de los Pedroches Hospital, Andalusia Health Service, 14400 Pozoblanco, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4255-7355","authenticated-orcid":false,"given":"Mirian","family":"Santamar\u00eda-Pel\u00e1ez","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Burgos, 09001 Burgos, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8784-4905","authenticated-orcid":false,"given":"Luis A.","family":"P\u00e9rula-de Torres","sequence":"additional","affiliation":[{"name":"Maimonides Institute for Biomedical Research of C\u00f3rdoba, Reina Sof\u00eda University Hospital, University of C\u00f3rdoba, 14011 Cordoba, Spain"},{"name":"Multiprofessional Teaching Unit for Family and Community Care, C\u00f3rdoba and Guadalquivir Health District, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Victoria","family":"Olmo-Carmona","sequence":"additional","affiliation":[{"name":"Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, C\u00f3rdoba and Guadalquivir Health District, Reina Sof\u00eda University Hospital, Andalusia Health Service, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Teresa","family":"Mu\u00f1oz-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, C\u00f3rdoba and Guadalquivir Health District, Reina Sof\u00eda University Hospital, Andalusia Health Service, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Presentaci\u00f3n","family":"Jorge-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, C\u00f3rdoba and Guadalquivir Health District, Reina Sof\u00eda University Hospital, Andalusia Health Service, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jes\u00fas","family":"Serrano-Merino","sequence":"additional","affiliation":[{"name":"Maimonides Institute for Biomedical Research of C\u00f3rdoba, Reina Sof\u00eda University Hospital, University of C\u00f3rdoba, 14011 Cordoba, Spain"},{"name":"Multiprofessional Teaching Unit for Family and Community Care, C\u00f3rdoba and Guadalquivir Health District, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5054-3845","authenticated-orcid":false,"given":"Esperanza","family":"Romero-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Maimonides Institute for Biomedical Research of C\u00f3rdoba, Reina Sof\u00eda University Hospital, University of C\u00f3rdoba, 14011 Cordoba, Spain"},{"name":"Multiprofessional Teaching Unit for Family and Community Care, C\u00f3rdoba and Guadalquivir Health District, 14011 Cordoba, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2526-5489","authenticated-orcid":false,"given":"Lorena","family":"Rodr\u00edguez-Elena","sequence":"additional","affiliation":[{"name":"San Jose Health Center, Aragonese Health Service, 50013 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2770-6399","authenticated-orcid":false,"given":"Raquel","family":"Refusta-Ainaga","sequence":"additional","affiliation":[{"name":"San Jose Health Center, Aragonese Health Service, 50013 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7803-4820","authenticated-orcid":false,"given":"Mar\u00eda Pilar","family":"Lahoz-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"San Jose Health Center, Aragonese Health Service, 50013 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bel\u00e9n","family":"Mir\u00f3-Palacios","sequence":"additional","affiliation":[{"name":"Association of People with Lymphedema in Aragon (ADPLA), 50007 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayra","family":"Medrano-Cid","sequence":"additional","affiliation":[{"name":"Lozano Blesa University Clinical Hospital, Aragonese Health Service, 50013 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5494-6550","authenticated-orcid":false,"given":"Rosa","family":"Magall\u00f3n-Botaya","sequence":"additional","affiliation":[{"name":"Institute for Health Research Aragon (IIS Aragon), University of Zaragoza, 50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis A.","family":"M\u00ednguez-M\u00ednguez","sequence":"additional","affiliation":[{"name":"Department of Educational Sciences, University of Burgos, 09001 Burgos, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josefa","family":"Gonz\u00e1lez-Santos","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Burgos, 09001 Burgos, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-9060","authenticated-orcid":false,"given":"Jer\u00f3nimo J.","family":"Gonz\u00e1lez-Bernal","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Burgos, 09001 Burgos, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,16]]},"reference":[{"key":"ref_1","unstructured":"(2022, February 23). 2022 ICD-10-CM Diagnosis Code I97.2: Postmastectomy Lymphedema Syndrome. 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