Assessment Tools for Upper Limb Function in Breast Cancer Patients Based on the COSMIN Guideline：a Systematic Review postprint

Abstract: Background　There are many tools for assessing upper limb function in breast cancer patients，but there is a lack of standardized comparative studies on the development and reporting quality of these tools，which hampers comprehensive appraisal and evidence-based recommendations. Objective　To systematically review upper limb function assessment tools for breast cancer patients，so as to provide guidance for clinicians and nurses in selecting appropriate instruments. Methods　We searched CNKI，Wanfang Data，VIP，CBM，PubMed，MEDLINE，Embase，the Cochrane Library，Web of Science，and CINAHL for studies of upper limb function assessment instruments in breast cancer patients，covering each database from inception through March 24，2025. Dual independent screening and data abstraction were undertaken，after which methodological quality and psychometric properties were assessed in line with COSMIN. A modified Grading of Recommendations Assessment，Development and Evaluation（GRADE） approach was then applied to rate the quality of evidence and formulate recommendations. Results　A total of 21 studies were included，comprising nine generic instruments and four breast cancer-specific instruments. The generic instruments included the Quick Disability of Arm，Shoulder and Hand（Quick-DASH），the Disability of Arm，Shoulder and Hand（DASH），Kwan's Arm Problem Scale（KAPS），the Upper Limb Functional Index（ULFI），the Norman Questionnaire（NQ），the Patient-Specific Functional Scale（PSFS），the Upper Extremity Functional Index （UEFI），the Oxford Shoulder Score（OSS），and the Shoulder Pain and Disability Index（SPADI）. The breast cancer-specific instruments included the Functional Assessment of Cancer Therapy-Breast+4 Upper Limb subscale（FACT-B+4-UL），the Lymphedema Functioning，Disability and Health Questionnaire（Lymph-ICF），the Lymphedema and Breast Cancer Questionnaire（LBCQ），and the LYMPH-Q Upper Extremity Module. The Lymph-ICF and the LYMPH-Q Upper Extremity Module were recommended as Category A. The ULFI was classified as Category C due to high-quality evidence demonstrating inadequate structural validity，and the LBCQ was also classified as Category C due to high-quality evidence of inadequate internal consistency. All remaining tools were recommended as Category B. Conclusion　Compared with the other assessment tools，the Lymph-ICF and the LYMPH-Q Upper Extremity Module demonstrated more comprehensive psychometric properties with good reliability and validity，and can be provisionally recommended for use. However，additional high-quality evidence is still required to further explore assessment tools for upper limb function in breast cancer patients.