Association Between Objectively Measured Shoulder Kinematics and Fear Avoidance Beliefs in Women with Latissimus Dorsi Flap Breast Reconstruction

Breast reconstruction using the latissimus dorsi (LD) flap following mastectomy is an important management option in breast cancer. A common complication following LD flap, which is often ignored, is shoulder dysfunction. Fear avoidance stemming from the belief that movement will worsen symptoms or cause injury, may impact further on dysfunction or limit recovery. Whilst previous studies have demonstrated a link between fear avoidance and function in conditions such as osteoarthritis, to our knowledge, no prior study has examined whether LD flap patients who endorse fear-avoidant beliefs have impaired shoulder function, measured objectively. This study used questionnaire data from women (n = 159) who had undergone a LD flap breast reconstruction and combined with objective measures of shoulder kinematics, from accelerometry (n = 15), to assess how fear avoidance was associated with shoulder kinematics. The mean scores for the fear avoidance beliefs questionnaire indicated low fear avoidance beliefs. This was corroborated by the objective measures from accelerometry which indicated no difference in shoulder kinematics between the operated and non-operated shoulder. These results indicate that that women after breast reconstruction have less fear avoidance, when compared to other patients with shoulder problems, and are therefore likely to have better outcomes. Future work will seek to investigate the impact of LD flap breast reconstruction on activities of daily living using objective measurement through accelerometry.