Treatment with head-lift exercise in head and neck cancer patients with dysphagia: results from a randomized, controlled trial with flexible endoscopic evaluation of swallowing (FEES)

Abstract

Background This randomized study aimed to evaluate the effects of the Shaker head-lift exercise (HLE) to improve dysphagia following oncologic treatment for head and neck cancer (HNC). Methods Patients with dysphagia following oncologic treatment for HNC were randomly assigned to intervention (n = 23) or control (standard dysphagia management, n = 24) groups. Swallowing was evaluated at baseline and at 8-week follow-up using flexible endoscopic evaluation of swallowing (FEES) and self-perceived swallowing with the Eating Assessment Tool (EAT-10). Analysis was performed regarding secretion, initiation of swallow, residue after swallowing, and penetration/aspiration. Results Few statistically significant differences were found in the FEES analysis. Some improvement of self-perceived swallowing function was found in both groups. Adherence to training was high. Conclusions This randomized study regarding the effect of the HLE demonstrated that swallowing outcome measures used in assessment of FEES did not improve in patients treated with radiotherapy for patients with dysphagia following HNC.

Exercise-based rehabilitation on functionality and quality of life in head and neck cancer survivors. A systematic review and meta-analysis

“…The methodological quality of the studies included in our review was good (PEDro score = 6.38 out of 10, SD=1.09). During methodological quality assessment, 14 studies of good quality 45,47,48,[50][51][52][53][54][55][56]58,59,61,63 and 4 studies of acceptable methodological quality were identified 49,57,60,62 .…”

“…The risk of bias of the included randomized clinical trials, as measured by the ROB 2.0 tool, can be marked as low to moderate risk of bias. When analyzing each bias, we found a high risk of bias related to the deviations from intended interventions in most of the included studies 45,47,48,[50][51][52][53][54][55][56][57][58][59][60][61][62][63] , mainly due to lack of blinding of participants and personnel. In relation to the selection of the reported outcomes 45,54,57,[59][60][61][62][63] , we detected a high risk of bias since the researchers did not report the outcome in the study variables in detail.…”

“…When analyzing each bias, we found a high risk of bias related to the deviations from intended interventions in most of the included studies 45,47,48,[50][51][52][53][54][55][56][57][58][59][60][61][62][63] , mainly due to lack of blinding of participants and personnel. In relation to the selection of the reported outcomes 45,54,57,[59][60][61][62][63] , we detected a high risk of bias since the researchers did not report the outcome in the study variables in detail. With regard to the randomization process, there is a high risk of bias due to the lack of concealment-related errors in the random assignment sequence 48,49,52,54,57,62 .…”

“…For example, most studies included aerobic (AET) [44][45][46][47] , anaerobic resistance (RET) 45,[47][48][49][50][51][52][53][54][55] or endurance 56,57 , stretching 48,53,55,[58][59][60] , relaxation 61 and postural control exercises 55 and the goal of increasing joint range in shoulder 55,57,59 or in cervical spine 53 in their interventions to improve functionality and quality of life. Most of these developed a protocol of exercise in combination with biomedical education 48,51 , psycho-behavioral couching 28 , diet carried out during CHT 50,52,58,62 or RDT 47,49,54,58 alone or combinate radio-chemotherapy 45,63 or surgery 48,53,55,56,59,61 with follow-u...…”

“…Most of these developed a protocol of exercise in combination with biomedical education 48,51 , psycho-behavioral couching 28 , diet carried out during CHT 50,52,58,62 or RDT 47,49,54,58 alone or combinate radio-chemotherapy 45,63 or surgery 48,53,55,56,59,61 with follow-up ranging from 2 weeks to 12 months. The 18 studies included were conducted in Sweden 60,63 , Denmark [ 49,54 ], The Netherlands 56,62 , United States 47,52 , Canada 57,64 , Brazil 58 , India 45,59 , Taiwan 48,50,61 and Australia 53,55 .…”