Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands; Department of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, Amsterdam Public Health, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.
Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
Oral Oncol. 2020 Apr;103:104586. doi: 10.1016/j.oraloncology.2020.104586. Epub 2020 Feb 8.
To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL).
This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness.
Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness.
The guided self-help exercise program improves swallowing and communication.
NTR5255.
研究指导自助锻炼计划对全喉切除术（TL）治疗患者吞咽、言语和肩部问题的效果。
本随机对照试验纳入了过去 5 年内接受 TL 治疗的患者。患者被随机分为干预组（灵活性、活动度和淋巴水肿锻炼以及自我护理教育计划自助锻炼计划）或对照组（自我护理教育计划）。两组均在随机分组前和 3 个月、6 个月后进行测量。主要结局是吞咽问题（SWAL-QOL）。次要结局为言语问题（SHI）、肩部问题（SDQ）、自我管理（患者激活：PAM）和健康相关生活质量（EORTC QLQ-C30/H&N35）。如果患者每天锻炼 >1 次，则定义为中高度依从。线性混合模型分析用于研究干预的效果，并研究颈部清扫术、治疗指征（原发性/挽救性 TL）、治疗后时间、问题严重程度和首选格式（在线/手册）是否调节了效果。
锻炼计划的中高度依从率为 59%。与对照组（n=46）相比，干预组（n=46）在随访期间报告的吞咽和交流问题较少（p 值=0.013 和 0.004）。言语、肩部问题、患者激活和 HRQOL 无差异。治疗后时间调节了言语问题的效果（p 值=0.025）：手术后 6 个月内的患者从干预中获益最大。颈部清扫术、治疗指征、问题严重程度和格式不会调节效果。
指导自助锻炼计划可改善吞咽和交流。
NTR5255。
