Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait.
Department of Otolaryngology - Head and Neck Surgery, St. James's Hospital, Dublin, Ireland.
Head Neck. 2024 Oct;46(10):2632-2649. doi: 10.1002/hed.27906. Epub 2024 Aug 6.
Thyroidectomy can lead to significant challenges such as neck pain, disability, and limited range of motion. Therefore, our objective is to conduct a systematic review and meta-analysis of clinical trials to investigate the clinical effectiveness of neck stretching exercises in alleviating neck pain and self-reported disability immediately after thyroidectomy. We systematically searched PubMed, CENTRAL, Scopus, and Web of Science from inception until July 28th, 2023. We assessed the selected trials for the risk of bias using both the RoB-2 and ROBINS-I tools. Our specific outcomes were the severity of neck pain and self-reported disability after thyroidectomy. The results were synthesized using risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) in a random-effects model using Stata software. Nine clinical trials, comprising five randomized and four non-randomized trials, were included, with a total of 1026 patients. Neck stretching exercises were significantly associated with improved mean pain scores both after 1 week (n = 625 patients, SMD = -2.43, 95% CI [-4.65, -0.22], p = 0.03, I = 98%) and 1 month (n = 545 patients, SMD = -4.11, 95% CI [-8.12, -0.11], p = 0.04, I = 99%). Similarly, neck stretching exercises were significantly associated with improved mean self-reported disability scores both after 1 week (n = 298 patients, SMD = -0.70, 95% CI [-1.36, -0.04], p = 0.04, I = 87%) and 1 month (n = 298 patients, SMD = -0.42, 95% CI [-0.65, -0.19], p = 0.0004, I = 0%). The pooled analysis showed heterogeneity (chi-square p < 0.01, I > 80%), except for the mean self-reported neck disability score after 1 month, which showed homogeneity (chi-square p > 0.01, I = 0%). This systematic review and meta-analysis, involving 1026 patients, revealed the potential benefits of neck stretching exercises in alleviating neck pain and self-reported disability after thyroidectomy. However, further research is required to address methodological limitations, evaluate long-term outcomes, investigate potential moderators (i.e., the duration or intensity of the exercise program), and explore patients' analgesic consumption.
甲状腺切除术可导致显著的挑战，如颈部疼痛、残疾和运动范围受限。因此，我们的目标是进行系统综述和荟萃分析临床试验，以调查颈部伸展运动在缓解甲状腺切除术后即刻颈部疼痛和自我报告残疾方面的临床效果。我们系统地检索了 PubMed、CENTRAL、Scopus 和 Web of Science，检索时间从建库至 2023 年 7 月 28 日。我们使用 RoB-2 和 ROBINS-I 工具评估了所选试验的偏倚风险。我们的特定结局是甲状腺切除术后颈部疼痛和自我报告残疾的严重程度。使用 Stata 软件，在随机效应模型中，使用风险比 (RR) 和标准化均数差 (SMD) 及其 95%置信区间 (CI) 对结果进行综合分析。纳入了 9 项临床试验，包括 5 项随机对照试验和 4 项非随机对照试验，共纳入 1026 例患者。颈部伸展运动与术后 1 周（n=625 例患者，SMD=-2.43，95%CI[-4.65，-0.22]，p=0.03，I²=98%）和 1 个月（n=545 例患者，SMD=-4.11，95%CI[-8.12，-0.11]，p=0.04，I²=99%）时的平均疼痛评分的改善显著相关。同样，颈部伸展运动与术后 1 周（n=298 例患者，SMD=-0.70，95%CI[-1.36，-0.04]，p=0.04，I²=87%）和 1 个月（n=298 例患者，SMD=-0.42，95%CI[-0.65，-0.19]，p=0.0004，I²=0%）时的平均自我报告残疾评分的改善显著相关。荟萃分析显示存在异质性（卡方检验 p<0.01，I²>80%），但术后 1 个月时的自我报告颈部残疾评分的异质性除外（卡方检验 p>0.01，I²=0%）。这项涉及 1026 例患者的系统综述和荟萃分析显示，颈部伸展运动可能有助于缓解甲状腺切除术后的颈部疼痛和自我报告残疾。然而，需要进一步的研究来解决方法学局限性，评估长期结果，研究潜在的调节因素（即运动方案的持续时间或强度），并探讨患者的镇痛药物消耗。
