A Randomized Feasibility Trial to Evaluate Use of the Jaw Dynasplint to Prevent Trismus in Patients With Head and Neck Cancer Receiving Primary or Adjuvant Radiation-Based Therapy

Zatarain, Lauren Azure; Deng, Jie; Gilbert, Jill; Dietrich, Mary S.; Niermann, Kenneth J.; Ridner, Sheila H.; Murphy, Barbara A.

doi:10.1177/1534735418784363

Cited by 23 publications

(20 citation statements)

References 27 publications

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“…In the end, 11 eligible studies were included for systematic review. 18 - 28 Table 1 provides detailed characteristics of the included studies. All studies were published in English, used a randomized control design, and reported the effect of interventions to improve trismus following HNC treatment.…”

Section: Resultsmentioning

confidence: 99%

“…There were also a fair number of studies who did not have adequate follow-up (n = 5); either the mouth opening was not measured in at least 85% of the allocated subjects at any time point, or information was missing. 16 At 6 months follow-up, 19 , 23 2 studies reported attrition rates from 30% to 50% in either control or intervention groups and 1 study reported a 56% attrition rate that led to a premature cessation of the study. 21 …”

Section: Resultsmentioning

confidence: 99%

“…Six RCTs evaluated the effectiveness of a combination of jaw rehabilitation device and exercises. [18][19][20][21][22][23] Intervention periods ranged from 3 to 12 months, exercise frequency ranged from 3 to 5 times per day. All but 1 RCT studied patients in the acute period (<3 months) after treatment with surgery, RT, or CCRT; the other included patients >36 months after cancer treatment.…”

Section: Intervention Category 1: Exercise Regimen With Jaw Rehabilitation Devicementioning

confidence: 99%

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Interventions for Trismus in Head and Neck Cancer Patients: A Systematic Review of Randomized Controlled Trials

et al. 2021

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Background: Current treatment for head and neck cancers (HNCs) have led to an improved survival. However, the sequelae of cancer treatment often result in trismus, or reduced mouth opening. The purpose of this report is to identify interventional studies for trismus management in HNC patients. Methods: A search of PubMed, Embase, Cumulated Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted in March 2020 for randomized controlled trials (RCTs) involving interventions for trismus for head and neck cancer within 10 years. Intervention could involve the use of an exercise regime, jaw rehabilitation device, technological device, medication or massage therapy. The primary outcome was the measurement of mouth opening. Results: Eleven RCTs involving a total of 685 patients with HNC were included. Six RCTs evaluated the effectiveness of a jaw mobilization device with exercises; there was no significant benefit of an exercise regime with a jaw mobilization device either initiated before, during or after treatment compared to no exercise. Two RCTs compared 2 intervention groups that involved exercises only, with 1 study assessing the benefit of weekly supervised physical therapy with gum chewing and another evaluating the benefit of immediate (1-2 days) versus delayed (7-10 days) initiation of exercise post-surgery; there was no significant difference between groups in either study. One RCT that recruited only patients with trismus demonstrated that an exercise regime in combination with low-level laser therapy or low-intensity ultrasound had superior results in mouth opening measurements compared to exercise alone. Two RCTs compared intervention groups with and without follow-up reminders; both studies showed a significant improvement in mouth opening measurements in groups with follow-up reminders. Conclusion: This systematic review did not convey a clear consensus as to optimal intervention for trismus in HNC patients. A variety of exercise regimens and jaw rehabilitation devices appear to have comparable effectiveness. However, efforts focused on increasing adherence to a particular intervention protocol may positively impact mouth opening measures in head and neck cancer patients. Also, low-level laser therapy and low-intensity ultrasound coupled with exercise may be beneficial for patients with trismus.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Intervention Category 1: Exercise Regimen With Jaw Rehabilitation Devicementioning

confidence: 99%

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Interventions for Trismus in Head and Neck Cancer Patients: A Systematic Review of Randomized Controlled Trials

et al. 2021

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“…Feasibility of the use of PBM therapy in HNC survivors was supported as participants were recruited in a timely fashion and the enrollment rate (40.0%) was comparable to similar studies conducted in the HNC population. 37 , 38 Adherence to the study intervention was demonstrated as the participant attrition was low (8.3%), with only 1 participant unable to complete the study intervention due to an unexpected family obligation, unrelated to PBM therapy. To minimize the subject burden and to help facilitate participation, we designed the intervention to be convenient for patients, ensuring each treatment session did not exceed 30-minutes in duration.…”

Section: Discussionmentioning

confidence: 98%

Photobiomodulation Therapy in Head and Neck Cancer-Related Lymphedema: A Pilot Feasibility Study

et al. 2021

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Purpose: Lymphedema is a common debilitating late effect among patients post-head and neck cancer (HNC) treatment. Head and neck lymphedema was associated with symptom burden, functional impairment, and decreased quality of life. The objective of this study was to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema, symptom burden, and neck range of motion among HNC survivors. Methods: This was a single-arm, pre- and post-design clinical trial. Eligible patients included those with lymphedema after completion of complete decongestive therapy (CDT) and 3 to 18 months after completion of cancer therapy. The intervention included PBM therapy 2 times a week for 6 weeks for a total of 12 treatments. Lymphedema, symptom burden, and neck range of motion were measured at baseline, end-of-intervention, and 4-week post-intervention. Results: Of the 12 patients enrolled in the study, 91.7% (n = 11) completed the study intervention and assessment visits, and no adverse events were reported. When comparing the baseline to 4-week post-intervention, we found statistically significant improvements in the severity of external lymphedema, symptom burden, and neck range of motion (all P < .05). Conclusion: PBM therapy was feasible and potentially effective for the treatment of head and neck lymphedema. Future randomized controlled trials are warranted to examine the efficacy of PBM therapy for HNC-related lymphedema. Trial Registration Number and Date of Registration: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.

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“…Passive motion applied several times per day is suggested as more effective than static stretching providing a significant reduction in inflammation and pain. Ongoing exercise during the HNC person’s lifetime is recommended since fibrosis will continue to progress as soon as exercises stop [ 283 , 336 , 342 , 349 , 350 ]. A systematic review of the effects of exercise therapy for trismus secondary to HNC reported considerable differences in mouth opening ranges and no evidence that any stretching technique was superior for either prevention or treatment of trismus [ 351 ].…”

Section: Oropharyngeal Dysphagia Treatment In Head and Neck Cancermentioning

confidence: 99%

European white paper: oropharyngeal dysphagia in head and neck cancer

Baijens

Walshe

Aaltonen

et al. 2020

Eur Arch Otorhinolaryngol

102

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Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

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A Randomized Feasibility Trial to Evaluate Use of the Jaw Dynasplint to Prevent Trismus in Patients With Head and Neck Cancer Receiving Primary or Adjuvant Radiation-Based Therapy

Cited by 23 publications

References 27 publications

Interventions for Trismus in Head and Neck Cancer Patients: A Systematic Review of Randomized Controlled Trials

Interventions for Trismus in Head and Neck Cancer Patients: A Systematic Review of Randomized Controlled Trials

Photobiomodulation Therapy in Head and Neck Cancer-Related Lymphedema: A Pilot Feasibility Study

European white paper: oropharyngeal dysphagia in head and neck cancer

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