AbstractBreast pain is a prevalent condition in the UK (52%) which can negatively impact women’s quality of life. Research identified that bras can effectively reduce breast pain in women with larger breasts, yet, no randomised controlled trial has been conducted, despite bras being recommended as a treatment. Previous research reports that one bra design may not be suitable for all women with larger breasts indicating that bras should be specific to the individual. Within a clinical environment, based on Medical Research Council guidelines, the overall aim of this thesis was to develop, pilot and evaluate a bra intervention for women with larger breasts who are experiencing breast pain.
As with other populations of women, the appropriateness of a bra for this cohort is likely to be multifactorial, influenced by both subjective and objective variables. Therefore, the first study, used a focus group and interviews to determine the performance variables for assessing bra appropriateness.
Due to the substantial choice available within the UK lingerie market, these bra performance variables were used to develop a novel bra selection criteria which was applied to the UK lingerie market in study two and resulted in the selection of six everyday bras for assessment within the bra intervention study.
Chapter Four, then identified four key bra performance variables from study one (comfort, support, fit and aesthetics) and used these to develop methods (subjective and objective) to individually prescribe one of the bras.
In Chapter Five, a review of literature and pilot investigations identified the methods for assessing the effectiveness of the bra intervention including determining three important outcome measures; the Patient’s Global Impression of Change Scale, a Numerical Rating Scale (breast pain intensity) and the SF-36 (quality of life).
Having developed all aspects of the bra intervention, study three then piloted this intervention using the Queen Alexandra Hospital Portsmouth as a recruitment site. Patients were randomly assigned to either the standard care group or the intervention group where patients had a bra individually prescribed, and then wore this bra for eight weeks. Outcome measures were assessed at four and eight weeks. Recruitment (n = 34) and retention of patients was poor (33% drop out in the bra prescription group and 50% drop out in the standard care group), however, a significant improvement in quality of life (χ2 = 8.667, P = 0.010) was identified within the bra prescription group. Evaluation of this bra intervention suggested that there were barriers to patient participation.
Study four investigated these barriers for this population. Less than half of patients surveyed (43%) were interested in the bra prescription, perhaps because 84% felt they were wearing a well-fitting bra, despite study three identifying that 91% of patients within the bra prescription group were not wearing a well-fitting bra. Aside from this, time constraints were the largest barrier to participation.
Study five was a comparative survey-based study with non-clinic cohorts. The pregnant and breastfeeding group (82%) and younger adults group (72%) were the most likely to report they would take up the bra prescription service. Fewer women felt they were wearing wellfitting bras (range = 55% to 83%), possibly explaining the high level of interest. Time constraints continued to be a barrier to participating. The outcomes of this study suggests that those within the clinical population need further education to ensure they understand the benefits of appropriately fitting bras.
In conclusion, this was the first study to develop, pilot and evaluate a bra intervention using a bra prescription for women with larger breasts and breast pain. This study established a framework for prescribing a bra, which could be applied to other populations. Although the efficacy of the intervention was inconclusive due to a low sample size, there was a positive impact on quality of life. The intervention should therefore be developed further. With the current population there should be a focus on educating patients on appropriate bra fit in order to encourage them to utilise such a service. The trial should then be re-run as an observation or patient-preference trial, to understand the effect of the bra prescription on breast pain, prior to re-running the randomised controlled trial. Alternatively, the bra intervention could be refocused on a non-clinic population, such as pregnant and breastfeeding women, who are more likely to take up the bra prescription.
|Date of Award||Aug 2018|
|Supervisor||Joanna Wakefield-Scurr (Supervisor), Jenny Burbage (Supervisor) & Avi Agrawal (Supervisor)|