Background:The current study assessed the level of reliability of ultrasound to assess dermal thickness, a clinical feature of breast lymphedema. Additionally, the relationship of dermal thickness to patient-reported outcomes was investigated.Methods: Women (n = 82) with unilateral breast edema secondary to treatment of breast cancer were randomized to an exercise or control group. Ultrasound measurements of the unaffected and affected breasts were taken at baseline and 12 weeks later at 3-4 cm superior, medial, inferior, and lateral to the nipple. Additionally, women completed breast-related questions from the European Organization Research and Treatment Committee Quality of Life breast cancer module (EORTC-BR23) and Lymphedema Symptom Intensity and Distress Questionnaire (LSIDS). Reliability of ultrasound measurements was determined on the unaffected breast.Results: Intraclass correlation coefficients (2,1) ranged from 0.66 (95% CI: 0.52-0.77) for the lateral location to 0.84 (0.77-0.90) for the superior location. Percent close agreement (80%) on the unaffected breast ranged from 0.20 to 0.27 mm compared to 0.57 to 0.93 mm on the affected breast. The standard error of measurement (%) on the unaffected breast varied from 9% to 13% with smallest real difference 0.34-0.41 mm. Dermal thickness of the affected breast was not-to-poorly associated with EORTC BR23 and LSIDS scores. Conclusion:Reliability of dermal thickness measurements of the breast was excellent for the superior, medial, and inferior locations, and fair to good for the lateral location.However, these measurements were not related to the symptom's women perceive and measured with the EORTC BR23 or LSIDS.

Aim: To explore the experiences of adults who completed a constraint-induced movement therapy (CIMT) programme, and the barriers and enablers to their participation. Methods: Qualitative design using semi-structured interviews. Stroke and brain injury survivors (n = 45) who had completed CIMT as part of their usual rehabilitation were interviewed 1 month post-CIMT. Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Inductive coding was used to identify initial themes. Themes were then deductively mapped to the Capability, Opportunity, Motivation – Behaviour system, a behaviour change model, to identify barriers and enablers to CIMT programme adherence and engagement. Results: Enablers influencing participation included being provided with education about the programme (Capability – psychological), seeing improvements in arm function (Motivation – reflective), being committed to the programme (Motivation – reflective) and having strong social support from staff, family and allied health students (Opportunity – social). The structured programme was a motivator and offered a way to fill the time, particularly during inpatient rehabilitation (Opportunity – physical). Barriers to participation included experiencing physical and mental fatigue (Capability – physical) and frustration early in the CIMT programme (Motivation – automatic), and finding exercises boring and repetitive (Motivation – automatic). Conclusion: Therapist provision of educational supports for CIMT participants and their families is important to maximise CIMT programme uptake. During CIMT delivery, we recommend the provision of positive feedback and coaching in alignment with CIMT principles, and the inclusion of social supports such as group-based programmes to enhance participant adherence.

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