Rehabilitation Outcomes in Head and Neck Survivors
Condition: Head and Neck Cancer; Oral Cancer
MeSH terms: Mouth Neoplasms
Study type: Observational

Summary: 
      Head and neck cancer is prevalent in Taiwan, and oral cancer is the most common location.
      Patients with advanced stage of the disease need extensive tumor excision with neck
      dissection. Secondary reconstructive surgeries using free flap could improve the
      postoperative function or appearance of cancer survivors. Advanced treatments make survival
      rates increased. Effects of treatment for oral cancer develop shoulder dysfunction, speech,
      mastication, donor site morbidity and psychological issues. Physical therapy may have
      benefits for temporomandibular joint function, shoulder pain relief, muscle performance, and
      oral structures coordination. Return to work in the number of cancer survivors is a realistic
      outcome. Rehabilitation effects on functional restorations and quality of life for head and
      neck survivors are needed for further studied.

      The purpose of this project is to explore the rehabilitation effects following head and neck
      reconstructive survivors. The investigators measure temporomandibular joint function,
      shoulder function, pain monthly. Physical functions, self-reported quality of life, and the
      status of return to work are measured 3 and 6 months after surgery. This prospective study
      could help to predict the rehabilitation outcomes and benefits.
    

Detailed description: 
      Head and neck cancer is prevalent in Taiwan, and oral cancer is the most common location.
      Patients with advanced stage of the disease need extensive tumor excision with neck
      dissection. Secondary reconstructive surgeries using free flap could improve the
      postoperative function or appearance of cancer survivors. Oral functions include respiration,
      speech, mastication, deglutition, and cosmetics. Advanced treatments make survival rates
      increased, but might develop shoulder dysfunction, speech, mastication, donor site morbidity
      and psychological issues. The purpose of this project is to explore the effects of
      rehabilitation following reconstructive surgery in oral cancer survivors.

      This study design is an interrupted time-series design. The investigators will recruit 50
      subjects one week following reconstructive surgery. The measurements include manual muscle
      strength, joint range of motion, maximal mouth opening, pain status, hand-to-neck test,
      hand-to-scapula test, hand-to-opposite-scapula test, 6-minute walking test, timed up & go
      test, European Organization for Research and Treatment of Cancer (EORTC) quality of life
      questionnaire (QLQ)-C30, European Organization for Research and Treatment of Cancer (EORTC)
      quality of life questionnaire (QLQ)-H&N35 and return-to-work. These tests were done at the
      first visit (0 week post-operation), three months and six months after reconstructive surgery
      respectively. The intervention programs consist of edema control, scar management, pain
      management, respiration training, oral function training, neck and shoulder function
      training, donor site mobility training. Continuous variables were analyzed by descriptive
      statistics. One-way ANOVA was used to compare the difference between measurements. Binary
      logistic regression was used to predict the factors of return-to-work.
    

Intervention name(s): Physiotherapy
Intervention type(s): Other
Intervention description(s): Interventions of physical therapy will be implemented after reconstructive surgery including edema control, scar management, pain management, respiration training, oral function training, neck and shoulder function training, donor site mobility training.
Other intervention name(s): Rehabilitation
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Subjects receive physical therapy at Linkou Chang Gung Memorial Hospital will be invited to
        participate this study.
      
Keywords: Rehabilitation; Physiotherapy; Trismus; Pain; Return to work; Quality of life