Patient-Focused Management Of Shoulder Disability Post-Neck Dissection: A Pilot Study

Background: Shoulder disability, which includes pain, limitation of shoulder joint movementand anatomical abnormalities occurs at a high frequency in patients undergoing neck dissection for head and neck cancer. Very often, these patients require full physical ability to perform their jobs. Hence, physical rehabilitation is an important aspect to improve their post-operative quality of life (QoL). Studies have found that physiotherapy is well-tolerated in this patient group following surgery, and have the potential to improve the functional outcome and QoL. Aims & Objectives: The aim of this prospective pilot study was to obtain a subjective assessment of shoulder disability in patients operated for neck dissection at 1- and 6-months postoperatively, and to determine the role played by simple physiotherapy exercises in their rehabilitation. Methods: 15 patients who under went neck dissection were taught simple shoulder and neck exercises at the time of discharge, to be performed at home daily. At every post-operative follow-up visit, these exercises were reinforced. The patients were given a subjective shoulder disability questionnaire at the one-month and six-month follow up periods, which focused on the patient's perception of his/her own disability and limitations. These two questionnaires were then compared to assess improvement/worsening of shoulder disability and any further management was undertaken based on this outcome. Outcome: Selective neck dissection was found to have better outcomes as compared to radical/modified radical procedure, and patients who regularly followed the shoulder exercises were found to have significantly reduced disability at the end of 6-month postoperative period. Conclusion: Simple physiotherapy exercises can produce drastic improvements in physical rehabilitation of such patients, and hence should become an integral part of their follow up to improve the QoL