Two Different Physiotherapy Programs in Lymphedema Following Head and Neck Cancer Treatment
Condition: Head and Neck Cancer; Lymphedema of Face; Fibrosis; Skin
MeSH terms: Head and Neck Neoplasms; Lymphedema
Study type: Interventional

Summary: 
      The aim of this study was to determine the effects of complex decongestive physiotherapy
      (CDP) and home programs on internal/external lymphedema, staging, fibrosis, and
      three-dimensional (3D) surface scanning and volume evaluation in head and neck lymphedema.
      Twenty-one patients were randomly divided into three groups: CDP; home program including self
      manual lymph drainage (MLD) and exercises; and control. CDP included MLD drainage,
      compression, exercise, and skin care. Self-MLD and exercises were performed by home program
      group patients. Assessment methods were applied at baseline and 4 weeks later for all groups.
      MD. Anderson Cancer Center Head and Neck Lymphedema Protocol was implemented to evaluate head
      and neck external lymphedema, staging, and fibrosis. An Artec Eva 3D scanner and the Autodesk
      ReCap Photo Studio software were used to determine and calculate the volume of the head and
      neck region via 3D surface scanning. Head and neck external lymphedema and fibrosis
      assessment criteria were performed to evaluate visible soft tissue edema and the degree of
      stiffness. To assess internal lymphedema, Patterson's scale was applied using fiber-optic
      endoscopic imaging.
    

Detailed description: 
      Head and neck cancer (HNC) have been seen in 13.3/100,000 males and 2.8/100,000 in females in
      Turkey. HNC related treatments such as lymph node dissection, tumor excision, chemotherapy,
      radiotherapy, and cancer itself can cause head and neck lymphedema (HNL). The incidence of
      HNL due to HNC treatments (surgery, chemotherapy and chemoradiation) has been reported to be
      between 48% and 90%.

      A recognition of HNL has been growing in recent years, but HNL is still much less recognized
      than upper and lower limb lymphedema and is easily ignored by both patients and health care
      providers. Therefore, in many cases, the diagnosis and treatment of HNL may be delayed, or
      patients cannot access treatment. In routine practice, after HNC, the self-absorption of HNL
      is generally expected. Clinical experiences have confirmed that HNL develops 2-6 months after
      cancer treatment and regresses in some patients over time.

      A variety of physiotherapy approaches have been shown to prevent and minimize physical,
      functional, emotional, and social disorders resulting from HNL. However, complex decongestive
      physiotherapy (CDP) is considered a gold standard treatment method for lymphedema. This
      method consists of manual lymph drainage (MLD), skin care, compression therapy, and
      therapeutic exercises. Although there are many studies about the effects of CDP on upper and
      lower limbs, there is only a limited number of studies about HNL and CDP in the literature.
    

Intervention name(s): Complex decongestive physiotherapy; Home program
Intervention type(s): Other; Other
Intervention description(s): MLD was administered 5 days a week for 4 weeks, with each session lasting 30 minutes [25]. Compression therapy was applied to the patients by wearing a compression mask (FM Velcro Fastener, LIPOELASTIC), made of polyamide, cotton, viscose, and elastane, that covered the submandibular region, the masseter region, and the neck. The compression mask is specifically designed for the healing and recovery of tissues after plastic and aesthetic surgeries. The patients were advised to wear the compression masks for at least 4-6 hours per day for 4 weeks and gradually increase wearing time according to their tolerance. The patients were asked to perform skin care by themselves. Skin care was applied using a low pH skin lotion to moisturize the skin. Neck, face/mimic, tongue, and posture exercises were performed by patients while the compression mask was worn and under the supervision of a physiotherapist, with 10 repetitions 5 times a week for 4 weeks.; Self-MLD and exercises (neck, face/mimic, tongue, and posture exercises) were shown to the patients in this group. Self-MLD included self-administered lymph drainage of the axillary, posterior, lateral, and anterior neck areas; the pre- and retro-auricular regions; the lateral and anterior regions of the face; and the lower jaw region. Then the order is reversed back to the starting point [3]. A video of self-MLD and a text including exercise descriptions were shared with patients and their relatives to ensure that the self-MLD and exercises were performed accurately and regularly at home. Self-MLD was recommended to be applied once a day, and the exercises were advised to be performed for 10 repetitions each, 10 times a day for 4 weeks. The patients were called by phone during the second week after their first evaluation as a control and to motivate the patient for performing self-MLD and home exercises properly.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Complex decongestive physiotherapy; Home program; Manual lymph drainage; Face mask; 3D analysis