Building a Bridge to Community: A Pragmatic Randomized Trial Examining a Combined Physical Therapy and Resistance Exercise Intervention for People after Head and Neck Cancer.

BACKGROUND: Established barriers to general exercise and physical activity among individuals with head and neck cancer include dry mouth, difficulty eating, weight loss, fear of injury, comorbidities, and treatment-related symptoms of pain and fatigue. METHODS/DESIGN: A 12-week pragmatic randomized controlled trial was conducted followed by an optional supported exercise transition phase. Eligible participants were individuals with head and neck cancers who had undergone surgery and/or radiation therapy to lymph node regions in the neck. Participants were randomized to a comparison group involving a shoulder and neck physiotherapeutic exercise protocol, or to a combined experimental group comprising the shoulder and neck physiotherapeutic exercise protocol and lower-body resistance exercise training. The primary outcome of this study was fatigue-related quality of life. RESULTS: Sixty-one participants enrolled, 59 (97%) completed the randomized trial phase, 55 (90%) completed the 24-week follow-up, and 52 (85%) completed the one-year follow-up. Statistically significant between-group differences were found in favor of the combined experimental group for the fatigue-related quality of life, fitness outcomes, and overall physical activity. Paired comparisons confirmed significant within-group improvements for both groups from baseline to one-year follow-up across most outcomes. DISCUSSION: A group-based combined physiotherapeutic and lower-body resistance exercise program was feasible and effective. Findings are limited to individuals who had undergone a surgical neck dissection procedure. Given the complexity of head and neck cancer, further pragmatic interdisciplinary research is warranted.

A Scoping Review of Physiotherapeutic Interventions for Trismus in Head and Neck Cancer: Where Is the Manual Therapy?

Purpose: Trismus, or restricted mouth opening, is a common side effect of treatment for head and neck cancer. This scoping review examined the characteristics, extent, and nature of existing research on manual therapy and jaw-mobilizing devices to prevent and manage trismus related to head and neck cancer. Method: Six electronic databases were searched using the terms trismus, head and neck cancer, and physical therapy and the associated MeSH terms. The review focused on the factors related to intervention delivery: timing, adherence, completion rates, and adverse events. Results: Nine studies were included. Eight examined the use of a jaw-mobilizing device, and one explored the benefit of remote telephone support. Two studies involved cancer survivors at risk of trismus, five involved survivors with trismus, and two included survivors both with and at risk of trismus. No studies were found examining physiotherapist provision of manual therapy. Within-group comparisons supported the benefit of using a jaw-mobilizing device to manage trismus, whereas significant between-groups differences were found only in non-randomized controlled trials. Survivor symptoms and intervention burden were reported reasons for poor adherence and completion rates. Conclusions: No benefit was found for the use of jaw-mobilizing devices for the prevention of trismus. Given the potential of manual therapy to enhance outcomes, physical therapist-led research is warranted.

Objectif : le trismus, ou ouverture restreinte de la bouche, est un effet secondaire courant du traitement du cancer de la tête et du cou. La revue exploratoire a porté sur les caractéristiques, l'ampleur et la nature des recherches sur la thérapie manuelle et les dispositifs de mobilisation mandibulaire pour prévenir et traiter le trismus lié au cancer de la tête et du cou. Méthodologiee : les auteurs ont fouillé six bases de données électroniques à l'aide des termes trismus, head and neck cancer et physical therapy et des termes associés du MeSH. La revue a porté sur les facteurs liés à la prestation des interventions, le moment, le respect, le taux d'achèvement et les événements indésirables. Résultats : neuf études ont été retenues. Huit portaient sur l'utilisation d'un dispositif de mobilisation mandibulaire et un, sur les avantages d'un soutien téléphonique à distance. Deux études étaient consacrées à des survivants du cancer à risque de trismus, cinq sur des survivants atteints de trismus et deux, sur des survivants atteints du trismus ou à risque. Aucune étude n'abordait la thérapie manuelle effectuée par un physiothérapeute. Les comparaisons intragroupes confirment les avantages d'un dispositif de mobilisation mandibulaire pour traiter le trismus, et seules des études témoins non aléatoires ont décelé des différences importantes entre les groupes. Les symptômes des survivants et le fardeau de l'intervention étaient les raisons signalées pour le peu d'adhésion au traitement et le faible taux d'achèvement. Conclusion : l'utilisation de dispositifs de mobilisation mandibulaire pour prévenir le trismus ne comportait pas d'avantages. Puisque la thérapie manuelle a le potentiel d'améliorer les résultats cliniques, il est justifié de réaliser des recherches dirigées par physiothérapeutes.

Feasibility of a Remotely Delivered Strength and Balance Training Program for Older Adults with Cancer.

Falls are a major issue among older adults with cancer and lead to interruptions in cancer treatment. Resistance and balance training can prevent falls in older adults, but minimal evidence is available regarding the older cancer population, who often have unique risk factors. We used a pre-post design to assess the feasibility of a remotely delivered exercise program that progressed in difficulty and its efficacy on lower body strength, balance, and falls in older adults with cancer who had prior in-person exercise experience. Twenty-six older adults with cancer completed the intervention. Attendance rate for the virtual component was 97.6% and for the independent component was 84.7%. Participants perceived the program as rewarding and enjoyable (100%), felt this program prepared them to exercise on their own (92%), were confident to continue exercising on their own (81%), and would recommend the program to other patients (100%). The median balance score at baseline and end-of-study was 4 (IQR = 0). The median chair-stand time decreased from 9.2 s (IQR = 3.13) to 7.7 s (IQR = 4.6). A statistically significant difference in lower body strength (r = 0.68, p = 0.001) was detected post-intervention. The findings from this study can inform the design of a larger randomized trial.