Ab. No. 24 Role of Physical Rehabilitation Strategies Used in Dysphagia Management in Head and Neck Cancer Survivors- A Systematic Review

Abstract

Introduction: Dysphagia is a common complication in head and neck cancer (HNC) patients who have undergone cancer treatment. Such patients have disrupted swallowing problems with decreased swallowing function even after 5 years post treatment. Rehabilitation strategies have been designed to enhance the mechanics of swallowing to achieve long lasting improvements. To quantitatively assess the previous research studies and to derive conclusion about various physical rehabilitation strategies focusing in decreasing dysphagia problems and improving Quality of Life (QOL) in Cancer survivors. Relevance: Systematic review shall help summarize existing research and contribute to informed, efficient, and reliable knowledge synthesis which will guide evidence-based decision-making in clinical practice, and research prioritization. Materials and Methods: Electronic search was conducted in Scopus, PubMed, PEDro, and COCHRANE databases. Studies that met the inclusion criteria were evaluated using PEDro scale and Modified McMaster Critical review form for quality appraisal. A descriptive synthesis was undertaken due to heterogeneity of the included studies. Analysis and Results: Total of 17 studies were assessed for Risk of Bias which comprised of 15 clinical trials, 1 Case Series, 1 Case Report that applied swallowing exercises, manoeuvres, Neuromuscular Electrical stimulation (NMES), to the HNC survivors. The outcomes highlighted improvement in swallowing, the oral intake status and QOL as assessed by various swallow/oral intake scales, radiographic examination and QOL scales. Conclusion: The review recommends application of swallowing exercises, manoeuvres, to HNC survivors however, authors speculate diminished use of NMES in such cases. It’s recommended that a well-designed larger sample size with randomization and double blinding would generate better evidence for combined utilization of NMES along with swallowing exercise for HNC survivors. Implications: This systematic review helps to know the lacunae in treatment and how we could strengthen the evidence.