Chatterjee M1, Talole S2, Nair S3
1Advanced Centre for Treatment Research and Education in Cancer, Physiotherapy, Mumbai, India, 2Advanced Centre for Treatment Research and Education in Cancer, Epedimiology, Mumbai, India, 3Advanced Centre for Treatment Research and Education in Cancer, Surgical Oncology, Mumbai, India
Background: Significant shoulder dysfunction comprising of restricted shoulder abduction and pain persists in most of the post-surgery oral cancer patients even on performing active shoulder exercises. Neuropraxia of Spinal Accessory Nerve during neck dissection is a major cause for limited abduction which worsens due to Radiation Therapy (RT). A study was conducted by the authors to compare the effects of Progressive Resistive Exercise Training (PRET) with active exercises in treating shoulder dysfunction in post-surgery patients undergoing RT and published in 2017 in Indian Journal of Physiotherapy and Occupational Therapy. This study proved significant improvement in shoulder abduction Range of Motion (ROM) and shoulder pain and disability score after a 6 weeks intervention period with PRET. On conclusion of RT, all the patients who successfully participated in that study were asked to follow up after 6 months in the physiotherapy department.
Purpose: There was a need to see the long-term effect of PRET on shoulder abduction ROM as the participants in the trial were discharged from hospital only to follow up after 6 months. This study aimed to compare the results on the shoulder abduction ROM in the study and control arm following a uniform home exercise programme for 6 months.
Methods: Ninety four post surgery oral cancer patients undergoing radiotherapy were recruited in this trial. Patients in the control group (n=47) performed active shoulder exercises only. Patients in the trial group (n=47) performed both resistive and active exercises. Resistance was gradually progressed under supervision over 6 weeks according to the tolerance of patients in trial group. Active shoulder Range of Motion (AROM) was measured at week 0, 2, 4 and 6. After finishing the intervention period, all the patients were put on home exercise programme with active exercises only for next 6 months. Home exercise programme consisted of active shoulder ROM exercises in all planes and shoulder shrugs 10 repetitions and thrice daily. Active shoulder abduction ROM was measured after 6 months.
Results: Total 54 patients comprising of trial group (n=25) and control group (n=28) reported back to the physiotherapy OPD after 6 months. Greater improvement was found in shoulder abduction active ROM in the trial group (median =94.4°) than in control group (median=25.5°), P 0.0001, even after 6 months of finishing intervention with PRET.
Conclusion(s): Early intervention with PRET in combination with active exercises provided persisting long-term benefits to the patients compared to active exercises only.
Implications: PRET should be started as the standard of care alongside active exercises for post-operative oral cancer patients undergoing adjuvant RT to get long term benefit.
Keywords: Oral Cancer, PRET, Shoulder Abduction
Funding acknowledgements: No fund was required
Purpose: There was a need to see the long-term effect of PRET on shoulder abduction ROM as the participants in the trial were discharged from hospital only to follow up after 6 months. This study aimed to compare the results on the shoulder abduction ROM in the study and control arm following a uniform home exercise programme for 6 months.
Methods: Ninety four post surgery oral cancer patients undergoing radiotherapy were recruited in this trial. Patients in the control group (n=47) performed active shoulder exercises only. Patients in the trial group (n=47) performed both resistive and active exercises. Resistance was gradually progressed under supervision over 6 weeks according to the tolerance of patients in trial group. Active shoulder Range of Motion (AROM) was measured at week 0, 2, 4 and 6. After finishing the intervention period, all the patients were put on home exercise programme with active exercises only for next 6 months. Home exercise programme consisted of active shoulder ROM exercises in all planes and shoulder shrugs 10 repetitions and thrice daily. Active shoulder abduction ROM was measured after 6 months.
Results: Total 54 patients comprising of trial group (n=25) and control group (n=28) reported back to the physiotherapy OPD after 6 months. Greater improvement was found in shoulder abduction active ROM in the trial group (median =94.4°) than in control group (median=25.5°), P 0.0001, even after 6 months of finishing intervention with PRET.
Conclusion(s): Early intervention with PRET in combination with active exercises provided persisting long-term benefits to the patients compared to active exercises only.
Implications: PRET should be started as the standard of care alongside active exercises for post-operative oral cancer patients undergoing adjuvant RT to get long term benefit.
Keywords: Oral Cancer, PRET, Shoulder Abduction
Funding acknowledgements: No fund was required
Topic: Oncology, HIV & palliative care; Disability & rehabilitation
Ethics approval required: Yes
Institution: Advanced Centre For Treatment Research and Education in Cancer
Ethics committee: Instituional Review Board of TMC -ACTREC
Ethics number: 25
All authors, affiliations and abstracts have been published as submitted.
