将Range of motion内容操作规程化的探索与研究

目的提高本科护生Range ofmotion练习的手法技能.方法通过编制被动性Range ofmotion的操作规程,选择从头颈部屈曲、伸展、左、右侧屈、顺时针、逆时针旋转;肩关节屈曲、伸展、外展、外旋、内旋;肘关节伸直、屈曲、内旋、外旋;腕关节屈曲、伸展;手指关节屈曲、伸直;髋、膝关节屈曲、伸直、内收、外展;踝关节背屈、跖屈、内旋、外旋;脚趾关节屈曲、伸展的活动,结合患者病情,在合适的体位配合下,按一定的节拍、顺序、时间完成Range of motion的操作练习.结论使Range ofmotion的练习具有一定的操作性、规范性和指导性,让护生对被动性Range ofmotion的练习内容、操作程序、动作要领、手法、时间、注意事项都能全面掌握并正确予以实施,提高了护生对被动性Range of motion练习的技能.

Charge Couple Device-Based Systemfor3-di mensional Real Ti me Positioning on the Assessment of Segmental Range of Motion of Lumbar Spine

Objective： To observe the tested results of the segmental range of motion （ROM） of lumbar spine by charge couple device （CCD）-based system for 3-dimensional real-time positioning （CCD system）, and to analyze its clinical significance. Methods： Seven patients with lumbar joint dysfunction and 8 healthy subjects were tested twice by the CCD-based system with an interval of 10 min. Results： The ROM of the patients was obviously lesser than that of the healthy subjects. The measuring data of segmental ROM of lumbar spine by CCD system is correlated significantly to the same data checked later on the same subjects in every direction of the movements. The differences between two checks are usually less than 1 degree. Conclusion： Specially designed CCD based system for 3-dimensional real-time positioning could objectively reflect the segmental ROM of lumbar spine. The system would be of great clinical significance in the assessment of the biomechanical dysfunction of lumbar spine and the effect of the treatment applied.

Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected by initiation of early ROM, immobilization and other factors. We conducted a retrospective analysis of tibial plateau fractures treated using stable internal fixation between December 2003 and June 2007. The resulting degree of flexion and Rasmussen Clinical and Radiographic Scores were evaluated. Thirty-nine patients were included, and 23 patients underwent a lateral submeniscal arthrotomy for evaluation of joint surface reduction, with 6 lateral meniscus lesions identified via arthrotomy. Three lateral collateral ligament lesions, 3 medial collateral ligament lesions and 1 anterior cruciate ligament lesion were found. Meniscus and ligament lesions significantly and negatively affected the initiation of knee joint ROM. Early ROM was achieved in 26 cases and 13 patients underwent immobilization for 4 weeks. At the final evaluation, the early ROM group had 130.42° ± 5.50° of flexion, compared with 122.92° ± 5.28° in the immobilization group. Moreover, the final Rasmussen score was 25.69 ± 2.92 in the early motion group, compared with 22.61 ± 3.5 in the immobilization group. There was no difference between radiographic scores of the groups. Although the initiation of early ROM improved the clinical results, soft tissue lesions influenced initiation of early knee joint motion. Therefore, meniscus and ligament injuries should be considered as prognostic factors in similar cases.

The Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation Combined with Range of Motion Exercise on Paretic Hand Function in Female Patients after Stroke

Repetitive transcranial magnetic stimulation (rTMS) has recently been demonstrated to improve motor function after stroke. However, no study has yet tested the synergetic effects of physical exercise on rTMS in clinical settings. We investigated the effect of a 6-session course of low frequency rTMS on contralesional primary motor cortex combined with range-of motion (ROM) exercise on paretic hand function in female stroke patients. This was a single-blind study of the effects of rTMS with or without ROM exercise in female hemiplegic patients after stroke. All patients underwent rTMS on the contralesional primary motor cortex for 15 minutes and ROM exercise on the paretic hand. The cortical excitability determined by the amplitude and latency of the motor evoked potential (MEP) was measured in both first dorsal interosseous (FDI) muscles. We also evaluated arm function using Box and Block, arm reach, 9-hole pegboard, power grip, and pinch grip force tests. The rTMS-induced MEP amplitude of the paretic side significantly increased whereas the non-paretic side showed a decrease through every session. However, the MEP latency significantly increased on the non-paretic hand at post-rTMS with exercise, but a tendency of decrement on paretic hand at same application. Motor function showed improvement in the 9-hole pegboard and arm reach tests at post-rTMS with exercise on the paretic side compared with the non-paretic side. A significant correlation was especially noted between motor function and MEP on the paretic side of stroke patients. Low frequency rTMS with ROM exercise improved hand function after stroke. This may, in part, result in additional rehabilitation in stroke patients.

A Digital Photographic Technique for Knee Range of Motion Measurement: Performance in a Total Knee Arthroplasty Clinical Population

Background: Knee range of motion is an essential outcome measure following total knee arthroplasty and it is important to measure this outcome with a simple and accurate tool. Measurement from digital photographs could provide a superior clinical alternative to the common goniometer as devices for capturing digital photographs are becoming more accessible, measurement accuracy is assisted with the associated software and images can be saved and stored for later reference. This ability to store images with measurements could be particularly useful in research involving knee range of motion. This study evaluated the validity and reliability of a simple photographic measurement technique to measure knee flexion and extension of patients following knee arthroplasty.Methods: Knee flexion and extension of 38 subjects who had undergone total knee arthroplasty were assessed at the one year post-operative review with the digital technique and a universal goniometer as the criterion reference. Digital measurements were repeated one month later by the first assessor (intra-tester reliability) and another independent assessor (inter-tester reliability).Results: Validity: the digital technique was found to have a high level of agreement with the universal goniometer measurements (all MAD sion with almost perfect Intra-Class Correlations (Intra-tester;flexion 0.99, extension 0.96;inter-tester;flexion 0.97, extension 0.93).Conclusion: Measurement of knee range of motion from digital photographs can be used in routine clinical total knee arthroplasty follow-up instead of, or interchangeably with the universal goniometer.

Electrical Stimulation in Addition to Passive Exercise Has a Small Effect on Spasticity and Range of Motion in Bedridden Elderly Patients: A Pilot Randomized Crossover Study

Purpose: Belt electrode skeletal muscle electrical stimulation (B-SES) can stimulate large portions of muscles including deep sites without localisation of the stimulation area. The purpose of this study is to investigate both immediate treatment effects of B-SES and long-term treatment effects of B-SES with passive exercise on range of motion (ROM) and muscle tone of lower extremities in bedridden elderly patients. Methods: Outcome measures before and after B-SES treatment alone (4 Hz, 20 min, both lower extremities) were examined for the immediate effect. Outcome measures were: ROM and Modified Ashworth scale (MAS) of hip flexion and adduction;knee flexion and extension;and knee joint distance at position of flexion abduction in hip (distance of knee). A randomized crossover trial was conducted to examine the long-term effect of adding B-SES to passive exercise on ROM and MAS. Results and Discussion: The immediate effect study had 18 patients. ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved after B-SES treatment. The long-term effect study had 11 patients. Friedman test revealed ROM and MAS of 4 joint angles in 2 joints and distance of knee significantly improved during B-SES intervention but not control intervention. B-SES in addition to passive stretch has a more statistically significant effect on contracture and spasticity in large portions of the lower extremities of bedridden elderly patients than passive stretching alone. Conclusions: We consider B-SES a useful tool to improve the ROM in lower extremities of bedridden patients.

What Is the Accuracy of Shoulder Range of Motion Measurements on Physical Exam?

The purpose of this study is to investigate a new method for measuring shoulder range of motion (ROM) in an orthopedic practice utilizing a smartphone application to improve accuracy from physical exam typically used in research. Our aim is to evaluate the application, Physio2Go (P2G), which uses a virtual goniometer, assessing validity by comparing its measurements to those taken by a universal goniometer (UG). Two observers of varying clinical experience, a research assistant and research fellow, compared measurements. Statistically, we used the intra-class correlation coefficient (ICC), standard error of measurement (SEM), and the Pearson correlation coefficient (PCC). Following validation we tested P2G in symptomatic postoperative shoulder patients measuring forward flexion (FF) and external rotation (ER). We compared P2G measurements to visual estimation (VE) done by a fellowship trained orthopedic surgeon. Statistically we used ICC, Bland- Altman plots with 95% limits of agreement (LOA), and scatter plots. We examined the impact of the application using Welch’s t-test comparing pre-to-postoperative ROM improvements using the values obtained by P2G and VE. We found high intra-rater reliability of P2G for both observers, substantial correlation between UG and P2G measurements, highly correlated inter-observer reliability for UG and P2G, and statistically significant PCC values (p < 0.05). As expected, ROM measurements of symptomatic patients comparing P2G and VE measurements demonstrated lower correlation. Bland-Altman plots demonstrated wide confidence intervals;scatterplots and histograms confirmed low agreement among measurement methods. Clinical application demonstrated varying statistical significance depending on whether measurements were done by P2G or VE. Our study found that P2G provided superior reliability compared to the customary physical exam routinely used for orthopedic research. The value of using this application instead of a UG is the ease of use and the ability for any member of the healthcare team, regardless of clinical experience to be able to produce reliable and valid measurements.

Radiographic Circularity of Capitellum and Its Relation to the Range of Motion

Background: The shape of the capitellum has been traditionally described in anatomy books as part of a sphere. Alteration in the capitellar morphology following pathologies such as fractures, osteochondrosis, and degenerative arthritis has been associated with less optimum functional results. Aim: To define the relationship between the sphericity of the capitellar morphology as measured on trauma series plain radiographs and the elbow range of motion. Methods: 40 patients were included in the study. All patients recruited from the upper limb clinics presented with non-elbow joint-related complaints. The elbow range of motion was measured using a standardized technique. Digital anteroposterior and lateral radiographs of patients’ elbows were used to measure capitellar circularity using the ImageJ processing program and circularity calculation equation. Correlation analyses were conducted between the degree of capitellar sphericity and elbow range of motion. Results: The results of measurements from the anteroposterior radiographs showed a positive correlation between increased circularity and an increase in the range of flexion, pronation, and supination. The range of extension decreased with the increased circularity of the capitellum. This trend was repeated with measures of lateral radiographs but was statistically not significant. Conclusion: Native capitellar circularity has an impact on the elbow range of motion. This should be put into consideration when dealing with pathologies that affect capitellar morphology.

Multilevel Anterior Cervical Decompression and Fusion: Cervical Range of Motion and Clinical Outcomes

Background: Multiple level anterior cervical discectomy and fusion (ACDF) is indicated for those who suffer from multilevel stenosis or compression of the spinal canal. It was reported that this intervention would unfortunately lead to a loss of normal cervical range of motion (CROM). Although, fewer studies have demonstrated the exact impact of the procedure on CROM. In our study, short and midterm postoperative CROM was described. Methods: Ninety patients who underwent ACDF were followed up postoperatively for at least 3 months. Active CROM was measured in all patients preoperatively and in postoperative follow-ups by cervical spine X-rays in lateral dynamic view using Cobb’s angle method. Results: Unfortunately, postoperative CROM was significantly diminished. At the short-term (3 months) follow-up there was a great limitation in CROM. While an obvious increase in CROM at the midterm (6 months) follow-up was observed in flexion especially. The reduction in global ROM (calculated as preoperative global ROM – 6 months postoperative ROM) was 4.1 and the reduction rate (calculated as reduction ROM divided by preoperative ROM) was 9.5%. The recovery ROM (calculated as 6 months postoperative ROM – 1 month postoperative ROM) was 8.2. The recovery rate (calculated as recovery ROM divided by 1 month postoperative ROM) was 26.5%. Conclusion: Active CROM following multiple level ACDF was obviously diminished. The most affected motion after surgery was flexion. It was noticed that at the short-term follow-up CROM would be more limited while after further follow up CROM was obviously improved even in neck flexion motion.

Obesity Effect on Children Hip and Knee Range of Motion

The aim of this study was to characterize the obesity effect on children knee and hip joint range of motion. A randomized controlled trial was performed with goniometry evaluation for hip flexion, extension, abduction, adduction, external and internal rotation, and knee flexion in fifty male children (20 obese and 30 non obese), with age ranging from 6 to 12 years old. The obesity effect was found to be non-uniform across the joint range of motion. In the obesity group, a statistically significant reduction in the range of motion of hip flexion and adduction, and knee flexion was observed;and also an increase in external rotation in the hip was observed. Conclusion: Obese and overweight children present alterations in hip and knee joints mobility when compared to eutrophic children. The obesity/overweight associated with factors previously described in the literature, such as joint overload, postural deviation and sedentariness may influence the musculoskeletal development and, consequently, the motor function.

Measurement of cervical range of motion using smartphone compass in the healthy people:a cross-sectional pilot study

Objective:This study evaluates the reliability of smartphone compass software in measuring the cervical range of motion in healthy people.Methods:We selected 40 healthy intern college students from Tianjin Hospital from June to August 2022 to participate in this study.Two physiotherapists used a smartphone(iPhone 11256 Gb(model A2223))compass software to measure six directions of motion of the cervical spine in 40 subjects in a total of 3 rounds each.The intraclass correlation coefficient was used to compare the reliability intra-group,and the Pearson correlation coefficient was also used to compare the correlation between groups,with P<0.05 being statistically significant.Results:The intraclass correlation coefficient showed good reliability(>0.5)in cervical range of motion(CROM),especially in cervical flexion and right rotation(>0.9).In the correlation comparison between the two groups,the Spearman comparison was used,and the six directions of the cervical spine were significantly correlated(P<0.05).Conclusion:The built-in compass software in smartphones has good reliability in measuring CROM in healthy people.

The resistive range of motion exercise training in Duchenne muscular dystrophy:a case study

Background:To determine the effectiveness of resistive range of motion exercises in improving muscle strength and functional abilities in Duchenne muscular dystrophy.The study was also aimed to determine if resistive range of motion exercises can slow down the progression of the disease.Methods:A seven-year-old male child was diagnosed with Duchenne muscle dystrophy presented to outpatient physiotherapy clinic.The patient was presented with difficulty in stair climbing,sitting up from the floor,fatigue,and muscle weakness specifically weakness in the proximal limb muscles.The progressive resistive range of motion training was implemented for four years to improve muscle strength and functional abilities.The medical research council grading scale,north ambulatory assessment scale,and creatine kinase were used to evaluate muscle strength,functional abilities,and creatine kinase levels.Results:The muscular strength and functional abilities did not improve after four years of exercise training.The creatine kinase levels were decreased over the period of four years.Conclusion:Resistive range of motion exercises are helpful in maintaining the muscular strength and functional abilities in Duchenne muscular dystrophy.

The influence of head-neck and implant position on the range of motion after total hip arthroplasty

To study the influence of head-neck ratio and implant position on the range of motion (ROM) after total hip arthroplasty (THA).Methods In this study the author established a three-dimensional computerized model of hip joint and tested the range of motion of three different head-neck ratio after total hip arthroplasty.Results Range of motion after total hip arthroplasty depended on design parameters such as head-neck ratio,but also on the implantation parameters such as the cup’s inclination and antevertion,the stem’s antevertion and their combination of each other.Optimal range of motion required compliant position of total hip components.The range of motion increased with the enlarging of head-hnck ratio.Conclusion Higher head-neck ratio leads to optimal range of motion and decreased the prevalence of prosthetic impingement within compliant,well-defined combination of cup’s inclination,cup’s antevertion and stem’s antevertion depending on the intended ROM.Domestic magnesium-silicon jade total hip prosthesis has too low head-neck ratio to result in enough range of motion that fulfilled daily living after total hip arthroplasty.14 refs,4 figs,3 tabs.

A Method for Registering Multiple Range Images

This paper presents an algorithm for registering multiple range images, which is efficient and robust in the presence of noise and occlusion. The registration algorithm is an integration of the iterative closest point(ICP) algorithm with random sampling and least squares(LS) estimator. It iterates the processes of random sampling with conditional reject, estimation of motion parameters by using ICP algorithm and evaluation of the estimation. The algorithm first creates an octree spline of object surface to quickly compute point to surface distance and its closest point using trilinear interpolation. The advantages of the proposed method are the reduction of computational cost and robustness to outliers.

游泳运动对大鼠创伤性关节挛缩的影响及机制

背景:早期运动是预防创伤性关节挛缩的主要方式,也是近期研究热点。游泳运动借助水的特殊物理特性,可能是潜在有益的干预方式。目的:观察游泳运动对大鼠关节挛缩发展的影响,探究游泳运动预防关节挛缩的相关机制。方法:24只SD大鼠随机分为空白对照组(n=8)和关节挛缩造模组(n=16),手术制备膝关节挛缩模型后,再随机分为手术对照组(n=8)和游泳干预组(n=8)。游泳干预组在术后第2周开始游泳干预,共干预5周。在术后第6周,测试各组大鼠体质量、术侧膝关节活动度、股四头肌直径,计算直径-体质量指数;苏木精-伊红染色观察膝关节囊和股四头肌病理变化;Masson染色观察关节囊胶原纤维化改变;免疫组化检测膝关节囊中转化生长因子β1和Ⅰ型胶原蛋白表达;Western blot检测股四头肌中MuRF1蛋白的表达。结果与结论:①与空白对照组比较,手术对照组和游泳干预组大鼠膝关节活动度下降,总伸膝受限角度和关节源性伸膝受限角度均明显增加(P<0.01),股四头肌直径下降(P<0.01),关节囊出现明显纤维化表现,股四头肌萎缩,手术对照组直径-体质量指数降低(P<0.01);与手术对照组比较,游泳干预组大鼠膝关节活动度和股四头肌直径明显增加(P<0.01),关节囊纤维化病变和股四头肌萎缩明显改善;②与空白对照组比较,手术对照组和游泳干预组大鼠关节囊中胶原纤维含量、转化生长因子β1和Ⅰ型胶原蛋白表达均增加(P<0.01);与手术对照组比较,游泳干预组大鼠关节囊中胶原纤维含量、转化生长因子β1和Ⅰ型胶原蛋白表达均降低(P<0.01);③与空白对照组比较,手术对照组和游泳干预组大鼠股四头肌中MuRF1蛋白表达增加(P<0.05);与手术对照组比较,游泳干预组大鼠股四头肌中MuRF1蛋白表达降低(P<0.05)。结果表明:早期游泳干预能够降低创伤性挛缩大鼠关节囊中转化生长因子β1和Ⅰ型胶原蛋白表达,降低股四头肌中MuRF1蛋白表达,提高关节活动度和股四头肌直径,抑制关节挛缩的发展。

新型局部浸润麻醉应用于人工全膝关节置换的早期效果评估

背景:全膝关节置换后患者会经历明显的疼痛,这对功能恢复存在负面影响,探索并寻求有效的镇痛手段具有重要的临床价值。目的:为探求全膝关节置换患者有效的围术期镇痛策略,首次提出了一种由吗啡、氟比洛芬酯和复方倍他米松配置而成的新型局部浸润麻醉制剂,同时探讨该方案的有效性及安全性。方法:对2023年11月至2024年4月在安徽医科大学第一附属医院关节外科接受初次单侧全膝关节置换60例患者的临床资料进行回顾性分析,根据置换过程中是否使用局部浸润麻醉将患者分为对照组与研究组,每组30例。研究组在全膝关节置换过程中关节腔周围注射吗啡、氟比洛芬酯及复方倍他米松配置而成的局部浸润麻醉制剂,而对照组术中未使用任何镇痛药物作为空白对照。记录并比较两组患者在术后不同时间节点的疼痛目测类比评分、膝关节活动度、膝关节学会评分、术后膝关节肿胀程度及术后并发症的发生情况。结果与结论:①与对照组相比,研究组患者置换后6,12及24 h的疼痛目测类比评分更低,差异有显著性意义(Z=-2.367,-2.906,-4.199,P<0.05);但在术后48,72 h,两组患者的疼痛目测类比评分并无显著性差异(Z=-1.287,-1.478,P>0.05);②置换后第3天,研究组患者的膝关节活动度和膝关节学会评分均优于对照组,差异有显著性意义(t=-2.519,-8.027,P<0.05);③研究组患者术后的膝关节肿胀程度轻于对照组,差异有显著性意义(Z=-2.818,P<0.05);④在术后早期,两组患者的发热发生率相比无显著性差异(P>0.05),两组均未发生切口愈合不良及假体周围感染;⑤结果表明:在全膝关节置换过程中应用由吗啡、氟比洛芬酯及复方倍他米松组成的局部浸润麻醉制剂,可以明显减轻患者术后早期疼痛,并显示出较高的安全性,但仍需大样本的前瞻性研究提供数据支持。

Coda Motion运动分析系统测量健康人颈椎侧屈活动度的准确性分析

目的:探讨Coda Motion运动分析系统测量颈椎侧屈活动度的准确性,为临床及科研实践探索一种新的测量工具。方法:选择43名健康志愿者作为研究对象,采用Coda Motion运动分析系统和"金标准"X线两种工具同时测量其颈椎侧屈活动度。运用散点图、皮尔森相关系数r评估Coda Motion运动分析系统测量颈椎侧屈活动度的准确性。结果:Coda Motion运动分析系统与X线测量出的颈椎侧屈活动度差异无统计学意义(P>0.05)。两种工具在测量右侧屈、左侧屈以及总侧屈活动度呈正相关,皮尔森相关系数分别为0.72、0.85和0.90。结论:Coda Motion运动分析系统测量颈椎侧屈活动度的准确性好,可能作为一种新型测量工具用于临床及科研测量颈椎侧屈活动度的实践中。

银质针联合循经走罐法在神经根型颈椎病患者中医护理中的应用

目的探讨银质针联合循经走罐法在神经根型颈椎病(CSR)患者中医护理中的应用效果。方法选取2022年3月至2024年2月三门峡武强中医院收治的108例CSR患者,采用随机数字表按1∶1∶1比例分为对照1组、对照2组、联合组,各36例。均实施常规基础护理,在此基础上对照1组给予银质针中医护理,对照2组给予循经走罐法中医护理,联合组给予银质针联合循经走罐法中医护理,护理观察4周。比较三组疼痛视觉模拟法(VAS)评分、颈椎活动度、病情变化程度[颈椎病临床评价量表(CASCS)、颈椎功能障碍指数(NDI)]、不良反应。结果干预2周、4周后,联合组VAS评分低于对照1组、对照2组(P<0.05);干预4周后,联合组颈椎前屈、后伸、左旋、右旋活动度高于对照1组、对照2组(P<0.05);干预4周后,联合组CASCS评分高于对照1组、对照2组,NDI评分低于对照1组、对照2组(P<0.05);联合组不良反应发生率13.89%与对照1组8.33%、对照2组11.11%比较,差异无统计学意义(P>0.05)。结论银质针联合循经走罐法干预能显著改善CSR患者的疼痛程度和颈椎活动度,促进病情恢复,安全性较高。

梅花针组穴叩刺法联合定点旋转复位法治疗神经根型颈椎病的临床研究

目的分析梅花针组穴叩刺法联合定点旋转复位法治疗神经根型颈椎病的效果及对患者疼痛、肌电图的影响。方法选取河南省洛阳正骨医院2021年4月至2024年4月103例神经根型颈椎病患者临床资料,按治疗方案分组,其中行旋转复位法治疗的34例为复位组,行梅花针组穴叩刺法治疗的34例为叩刺组,行旋转复位联合梅花针组穴叩刺治疗的35例为联合组。对比三组治疗效果、疾病相关评分[颈椎功能障碍指数(NDI)、颈椎病临床评价量表(CASCS)、视觉模拟评分法(VAS)评分]、肌电图指标、颈椎活动度。结果治疗4周后联合组治愈率为80.00%,高于复位组52.94%、叩刺组55.88%(P<0.05);治疗4周后联合组NDI、VAS评分低于复位组、叩刺组,CASCS评分高于复位组、叩刺组(P<0.05);治疗4周后联合组正中神经、腋神经的潜伏期均低于复位组、叩刺组,运动传导速度均高于复位组、叩刺组(P<0.05);治疗4周后颈椎侧屈、前屈、后伸活动度高于复位组、叩刺组(P<0.05)。结论神经根型颈椎病经梅花针组穴叩刺联合定点旋转复位治疗可提高治愈率,纠正颈椎功能,恢复颈椎活动度,改善神经传导功能,提高神经运动传导速度。

Developing an Evidence-Based Exercise Guideline on Improving Shoulder Motion and Lessening the Severity of Lymphedema for Breast Cancer Patients after Axillary Lymph-Node Dissection

Exercise is proven to be effective, safe and the preferred intervention for improving the range of shoulder motion of breast cancer patients who have undergone surgery for axillary lymph-node dissection. The application of evidence-based guidelines to clinical practice can help healthcare professionals to provide good quality care to patients and, in turn, produce better patient outcomes. The purpose of the present paper is to describe the development process of an evidenced-based guideline. Challenges in the implementation of evidence-based practice are identi.ed and strategies for tackling them discussed.