McNeely Margaret L, Parliament Matthew B, Seikaly Hadi, Jha Naresh, Magee David J, Haykowsky Mark J, Courneya Kerry S
Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
Cancer. 2008 Jul 1;113(1):214-22. doi: 10.1002/cncr.23536.
Shoulder pain and disability are well recognized complications associated with surgery for head and neck cancer. This study was designed to examine the effects of progressive resistance exercise training (PRET) on upper extremity pain and dysfunction in postsurgical head and neck cancer survivors.
Fifty-two head and neck cancer survivors were assigned randomly to PRET (n = 27) or a standardized therapeutic exercise protocol (TP) (n = 25) for 12 weeks. The primary endpoint was change in patient-rated shoulder pain and disability from baseline to postintervention. Secondary endpoints were upper extremity strength and endurance, range of motion, fatigue, and quality of life.
Follow-up assessment for the primary outcome was 92%, and adherence to the supervised PRET and TP programs were 95% and 87%, respectively. On the basis of intention-to-treat analyses, PRET was superior to TP for improving shoulder pain and disability (-9.6; 95% confidence interval [95% CI], -16.4 to -4.5; P = .001), upper extremity strength (+10.8 kg; 95% CI, 5.4-16.2 kg; P < .001), and upper extremity endurance (+194 repetitions x kg; 95% CI, 10-378 repetitions x kg; P = .039). Changes in neck dissection impairment, fatigue, and quality of life favored the PRET group but did not reach statistical significance.
The PRET program significantly reduced shoulder pain and disability and improved upper extremity muscular strength and endurance in head and neck cancer survivors who had shoulder dysfunction because of spinal accessory nerve damage. Clinicians should consider the addition of PRET in the rehabilitation of postsurgical head and neck cancer survivors.
肩痛和功能障碍是头颈癌手术公认的并发症。本研究旨在探讨渐进性抗阻运动训练（PRET）对头颈癌术后幸存者上肢疼痛和功能障碍的影响。
52名头颈癌幸存者被随机分为PRET组（n = 27）或标准化治疗运动方案（TP）组（n = 25），为期12周。主要终点是患者自基线至干预后评定的肩痛和功能障碍的变化。次要终点包括上肢力量和耐力、活动范围、疲劳及生活质量。
主要结局的随访评估率为92%，对PRET和TP监督项目的依从率分别为95%和87%。基于意向性分析，PRET在改善肩痛和功能障碍方面优于TP（-9.6；95%置信区间[95%CI]，-16.4至-4.5；P = 0.001），在上肢力量方面（+10.8 kg；95%CI，5.4 - 16.2 kg；P < 0.001），以及在上肢耐力方面（+194次重复×千克；95%CI，10 - 378次重复×千克；P = 0.039）。颈部清扫损伤、疲劳和生活质量的变化有利于PRET组，但未达到统计学意义。
PRET方案显著减轻了因副神经损伤导致肩功能障碍的头颈癌幸存者的肩痛和功能障碍，并改善了上肢肌肉力量和耐力。临床医生在头颈癌术后幸存者的康复中应考虑增加PRET。
