TY - JOUR
T1 - Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy
T2 - Results of a multi-center randomized controlled trial
AU - Jansen, Femke
AU - Eerenstein, Simone E.J.
AU - Cnossen, Ingrid C.
AU - Lissenberg-Witte, Birgit I.
AU - de Bree, Remco
AU - Doornaert, Patricia
AU - Halmos, György B.
AU - Hardillo, José A.U.
AU - van Hinte, Gerben
AU - Honings, Jimmie
AU - van Uden-Kraan, Cornelia F.
AU - Leemans, C. René
AU - Verdonck-de Leeuw, Irma M.
PY - 2020/4
Y1 - 2020/4
N2 - Objective: To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). Materials and methods: 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. Results: 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. Conclusion: The guided self-help exercise program improves swallowing and communication. Trial registration. NTR5255.
AB - Objective: To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). Materials and methods: 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. Results: 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. Conclusion: The guided self-help exercise program improves swallowing and communication. Trial registration. NTR5255.
KW - Exercise program
KW - Head and neck cancer
KW - Laryngeal cancer
KW - Quality of life
KW - Randomized controlled trial
KW - Shoulder functioning
KW - Speech
KW - Swallowing
KW - Total laryngectomy
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UR - http://www.scopus.com/inward/citedby.url?scp=85078993972&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.oraloncology.2020.104586
DO - https://doi.org/10.1016/j.oraloncology.2020.104586
M3 - Article
C2 - 32045734
SN - 1368-8375
VL - 103
SP - 1
EP - 9
JO - Oral Oncology
JF - Oral Oncology
M1 - 104586
ER -
