Ask an answerable question (PICO)：
In recent years, due to changes in the diet and our environment，breast cancer occurrence has being increasing. With early diagnosis and treatment， the recovery rate of breast cancer patient is quite high；with such， more researches started to explore how can breast cancer patients maintain long-term surgical effectiveness. After the surgical removal of tumor tissue in the breast cancer patients, the limited mobility of affected limb has become the most common problems affecting patients’ quality of life。 If a patient’s shoulder lift range is only slightly affected, it can be rehabilitated with simple upper limb exercises；however, with severe case of limited shoulder lift， it requires a series of well-planned rehabilitation classes and significant amount of time to achieve recovery. Therefore, how to improve the angle range of cancer patient’s shoulder lift post -surgery has become extremely important.
This is to review the upper limb rehabilitation exercises, as a reference to the clinical application for shoulder lift angle range improvement of post-surgery breast cancer patient.
The Method and Analysis of Literature Review：
ln this paper, based on the PICO keywords, a systematic literature review method is used to research all domestic and international publications related to breast cancer postoperative shoulder lift angle range and breast cancer rehabilitation exercise.
The searched database included Huayi Online Library and Cochrane. Library, PubMed, CINAHL (EBSCO), Clinicalkey Nursing and others with the Boolean logic "OR" and "AND" with filters as “women”, “Chinese”, “English”, and “humans”. The search showed result of 2 records from the Cochrane Library， 19 records from the PubMed database， 0record from the CINAHL16 ，records from Clinicalkey Nursinguu, and 5 records from Huayi online library respectively. After screening, the two most relevant SR articles were selected and assessed with CASP tool for rigorous review. Their content were mainly assessed from three aspects，in short VIP, V is for validity or reliability， I is for importance or impact, and P for practice or clinical applicability.
Critical Appraisal：
Based on PICO question type，the suitable literature were selected and assessed as treatment-type question. The two articles have been undergone rigorous systematic review before been ranked as Level 1 according to the Oxford CEBN 2011 Levels of Evidence standard； The two articles were the studies of postoperative patients with breast cancer after the intervention of upper limb rehabilitation exercises； the results varied significantly (P=0.02; P<0.001) showing early implementation of shoulder joint rehabilitation exercise being helpful in improving patient's shoulder joint lifting range and pain reduction of the affected limb. The articles also refer to the early intervention of rehabilitation exercise of breast cancer patients on whether it increases the amount of drainage tubes used in the affected part. The results shows no difference from both comparing groups. There is consistency in the results of the two reviews； according to the GRADE scoring system， and the quality of evidence was graded as “high” with recommendation rating as “strong”.
Results, Conclusions and Recommendations：
After the comprehensive review of the two literature assessed with the GRADE system， it strongly recommends early implementation of upper limb rehabilitation exercise for the postoperative breast cancer patients for it is beneficial to improve the shoulder joint lifting range. The upper limb rehabilitation exercise， supported by the clinical evidence， should be standardized as policy for clinical implementation with the aim of improving the shoulder lift range of postoperative breast cancer patients.
