The objective of this study was to explore the effectiveness of an early-onset, self-administered rehabilitation protocol supported by a group-based educational program and visual material (GRV) in patients who had undergone axillary lymph node dissection (ALND). A total of 186 patients were randomly assigned either to the GRV (n = 93) or to the usual rehabilitation (UR) (n = 93). Patients in the GRV program received group education supported by visual information while the UR program was conducted on an individual basis, and it was not supported by visual information. Primary endpoint was adherence to treatment. Secondary endpoints were shoulder range of motion, lymphedema, disability, pain, quality of life, patient satisfaction, and time devoted to each patient. They were measured at baseline and at post-intervention. The groups did not significantly differ in any outcome measure at post-intervention. While both GRV and UR programs yielded similar high improvements, the average time devoted to each patient was significantly lower in the GRV program. The findings in this study suggest that the usual one-to-one education approach is not superior to a group approach in rehabilitation for breast surgery involving ALND. GRV may constitute a time-efficient alternative to traditional one-to-one approaches
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