Provision of physiotherapy rehabilitation following neck dissection in the UK

Robinson, M.; Ward, Lesley; Mehanna, Hisham; Paleri, Vinidh; Winter, Stuart C

doi:10.1017/s0022215118000671

Cited by 9 publications

(13 citation statements)

References 6 publications

(14 reference statements)

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“…Acting more proactively by providing good access to physiotherapy treatment early after, or alongside, breast cancer treatment could help to reduce the number of people with cancer (or a history of cancer) presenting with musculoskeletal complications. 48 Although our physiotherapist-participants felt very comfortable with aspects of the intervention such as improving shoulder mobility, they expressed a need for greater training, support and guidance in relation to specific issues such as cording and lymphoedema. The physiotherapists delivering the PROSPER intervention were musculoskeletal specialists with limited experience in treating individuals with breast cancer in the acute postoperative period.…”

Section: Discussionmentioning

confidence: 96%

“…Physiotherapists in the UK receive little training in rehabilitation following cancer treatment, reflected by the limited centres across the UK with physiotherapists specialised in oncology. 48 Given the increasing number of people surviving cancer and living with the consequences of cancer treatment, there is an urgent need in the UK to upskill physiotherapists in cancer-related rehabilitation to allow people with breast cancer better access to this type of rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

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Role of physiotherapy in supporting recovery from breast cancer treatment: a qualitative study embedded within the UK PROSPER trial

et al. 2021

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ObjectivesTo explore the experiences of women with breast cancer taking part in an early physiotherapy-led exercise intervention compared with the experiences of those receiving usual care. To understand physiotherapists’ experience of delivering the trial intervention. To explore acceptability of the intervention and issues related to the implementation of the Prevention Of Shoulder Problems (PROSPER) programme from participant and physiotherapist perspective.DesignQualitative semistructured interviews with thematic analysis.SettingUK National Health Service.ParticipantsTwenty participants at high risk of shoulder problems after breast cancer surgery recruited to the UK PROSPER trial (10 each from the intervention arm and control arm), and 11 physiotherapists who delivered the intervention. Trial participants were sampled using convenience sampling. Physiotherapists were purposively sampled from high and low recruiting sites.ResultsParticipants described that the PROSPER exercise intervention helped them feel confident in what their body could do and helped them regain a sense of control in the context of cancer treatment, which was largely disempowering. Control arm participants expressed less of a sense of control over their well-being. Physiotherapists found the exercise intervention enjoyable to deliver and felt it was valuable to their patients. The extra time allocated for appointments during intervention delivery made physiotherapists feel they were providing optimal care, being the ‘perfect physio’. Lessons were learnt about the implementation of a complex exercise intervention for women with breast cancer, and the issues raised will inform the development of a future implementation strategy.ConclusionsA physiotherapist-delivered early supported exercise intervention with integrated behavioural strategies helped women at risk of shoulder problems following breast cancer treatment to feel more confident in their ability to mobilise their arm post-surgery. A physiotherapist-delivered early supported exercise intervention with integrated behavioural strategies may address the sense of powerlessness that many women experience during breast cancer treatment.Trial registration numberISRCTN35358984.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Role of physiotherapy in supporting recovery from breast cancer treatment: a qualitative study embedded within the UK PROSPER trial

et al. 2021

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“…15 Currently, there is no national standard best practice for rehabilitation following HNC. Our study development work 16 and feedback from patient and public involvement (PPI) representatives has shown that physiotherapy practice varies across the UK. The findings suggested that rehabilitation in the form of physiotherapy is not routinely available to patients with HNC, in either inpatient or outpatient settings.…”

Section: Introductionmentioning

confidence: 99%

“…The findings suggested that rehabilitation in the form of physiotherapy is not routinely available to patients with HNC, in either inpatient or outpatient settings. 16 When rehabilitation is offered it is often not evidence based, and targets acute respiratory care, ROM exercises for the neck and shoulder, and advice on positioning of the upper limb and shoulder girdle. 15 A booklet may be provided to supplement this treatment.…”

Section: Introductionmentioning

confidence: 99%

Getting Recovery Right After Neck Dissection (GRRAND-F): mixed-methods feasibility study to design a pragmatic randomised controlled trial protocol

et al. 2021

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IntroductionWe will evaluate the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention on pain, function and health-related quality of life following neck dissection (ND) after head and neck cancer (HNC).Methods and analysisThis is a pragmatic, multicentred, feasibility study. Participants are randomised to usual care (control) or usual care plus an individualised, rehabilitation programme (Getting Recovery Right After Neck Dissection, GRRAND intervention). Adults aged over 18 with HNC for whom ND is part of their care will be recruited from specialist clinics. Participants are randomised in 1:1 ratio using a web-based service. The target sample size is 60 participants. Usual care will be received by all participants during their postoperative inpatient stay consisting standard National Health Service care supplemented with a booklet advising on postoperative self-management strategies. The GRRAND intervention programme consists of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion (ROM) and progressive resistance exercises, advice and education. Between sessions participants will be advised to complete a home exercise programme. The primary outcome is to determine recruitment and retention rates from study participants across sites. Outcomes will be measured at 6 and 12 months. Participants and physiotherapists will be invited to an optional qualitative interview at the completion of their involvement in the study. The target qualitative sample size is 15 participants and 12 physiotherapists. Interviews aim to further investigate the feasibility and acceptability of the intervention and to determine wider experiences of the study design and intervention from patient and physiotherapist perspectives.Ethics and disseminationEthical approval was given on 29 October 2019 (National Research Ethics Committee Number: 19/SC/0457). Results will be reported at conferences and in peer-reviewed publications.Trial registration numberISRCTN11979997.StatusTrial recruitment is ongoing and is expected to be completed by 30 August 2021.

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“…7 A recently published survey, of nine regional centres across the UK, revealed that the provision of post-operative physiotherapy is not standardised; it is provided in the majority of centres only when significant dysfunction is found, and was not available at all in 11 per cent of centres. 8…”

Section: Introductionmentioning

confidence: 99%

Do patients benefit from physiotherapy for shoulder dysfunction following neck dissection? A systematic review

Harris

2020

J. Laryngol. Otol.

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ObjectiveAccessory nerve palsy affects a proportion of patients following neck dissection, and results in shoulder dysfunction and regional pain. This project aimed to establish the evidence supporting post-operative physiotherapy for the shoulder following neck dissection.MethodA systematic review was conducted of prospective trials investigating the efficacy of rehabilitation for shoulder or upper limb dysfunction and pain following any type of neck dissection.ResultsA total of 820 papers were identified; through a staged review process, 7 trials were found that fulfilled the inclusion criteria. These included three randomised, controlled trials and four non-randomised studies. Five out of the seven trials demonstrated a statistically significant benefit of physiotherapy.ConclusionCurrent evidence shows a benefit from physiotherapy in patients with shoulder dysfunction following neck dissection. Some evidence suggests progressive resistance is superior to other types of physiotherapy. Long-term benefit and cost efficacy have not been studied.

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Provision of physiotherapy rehabilitation following neck dissection in the UK

Abstract: The provision of physiotherapy is most commonly reactive rather than proactive, and usually driven by patient request. There is little evidence of pre-arranged physiotherapy for patients to treat or prevent shoulder dysfunction in the UK.

Cited by 9 publications

References 6 publications

Role of physiotherapy in supporting recovery from breast cancer treatment: a qualitative study embedded within the UK PROSPER trial

Role of physiotherapy in supporting recovery from breast cancer treatment: a qualitative study embedded within the UK PROSPER trial

Getting Recovery Right After Neck Dissection (GRRAND-F): mixed-methods feasibility study to design a pragmatic randomised controlled trial protocol

Do patients benefit from physiotherapy for shoulder dysfunction following neck dissection? A systematic review

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