Non-Cochrane · intervention · PM42796255
Rehabilitation and Physiotherapy for Functional Sequelae in Adults with Head and Neck Cancer: A Systematic Review and Meta-Analysis.
Linero-Bocanegra Miriam, Fernández-Morales Carlos, Torres-Lagares Daniel, et al. · Medicina (Kaunas, Lithuania) · 2026 · PubMed · doi:10.3390/medicina62091648
Findings
Population Adults with head and neck cancer receiving radiotherapy
8 findings
| Preventive jaw rehabilitation | Usual care | Trismus (maximum mouth opening ≤35 mm) 12 months after radiotherapy · Modified Hartung–Knapp sensitivity analysis | RR 0.87 [0.25, 2.98] GRADE not reported 3 studies · 205 participants |
| Preventive jaw rehabilitation | Usual care | Mouth opening 12 months after radiotherapy · Sensitivity: other Bragante intervention arm | MD 2.81 [0.06, 5.56] GRADE not reported 3 studies |
| Preventive jaw rehabilitation | Usual care | Trismus (maximum mouth opening ≤35 mm) 12 months after radiotherapy · Primary analysis; combined active arms | RR 0.87 [0.53, 1.42] GRADE not reported 3 studies · 205 participants |
| Preventive jaw rehabilitation | Usual care | Mouth opening 12 months after radiotherapy · Primary analysis; combined active arms | MD 2.85 [0.38, 5.32] GRADE not reported 3 studies · 212 participants |
| Preventive jaw rehabilitation | Usual care | Mouth opening 12 months after radiotherapy · Sensitivity: one Bragante intervention arm | MD 3.03 [0.58, 5.48] GRADE not reported 3 studies |
| Preventive jaw rehabilitation | Usual care | Trismus (maximum mouth opening ≤35 mm) 12 months after radiotherapy · Sensitivity: Saghafi 6-month assessment Unresolved: the two extractors disagree on this row. | no estimate extracted GRADE not reported 3 studies |
| Preventive jaw rehabilitation | Usual care | Mouth opening 12 months after radiotherapy · Endpoint-only sensitivity analysis | MD 2.50 [-0.51, 5.51] GRADE not reported 3 studies |
| Preventive jaw rehabilitation | Usual care | Mouth opening 12 months after radiotherapy · Modified Hartung–Knapp sensitivity analysis | MD 2.85 [-2.58, 8.27] GRADE not reported 3 studies · 212 participants |
Included primary studies 27
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Baudelet 2024 Prophylactic Swallowing Therapy During Head-and-Neck Cancer Radiotherapy: Effect of Service-Delivery Mode and Overall Adherence Level on… PMID:37550571 | 2024 | this review only | not stated | not extracted yet |
| Bragante 2020 Efficacy of exercise therapy during radiotherapy to prevent reduction in mouth opening in patients with head and neck cancer: A randomized… PMID:31685429 | 2020 | this review only | Mouth opening; Trismus (maximum mouth opening ≤35 mm) | not extracted yet |
| Carnaby-Mann 2012 "Pharyngocise": randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during… PMID:22014959 | 2012 | this review only | not stated | not extracted yet |
| Govender 2020 SIP SMART: a parallel group randomised feasibility trial of a tailored pre-treatment swallowing intervention package compared with usual… PMID:32349693 | 2020 | this review only | not stated | not extracted yet |
| Hogdal 2015 Early preventive exercises versus usual care does not seem to reduce trismus in patients treated with radiotherapy for cancer in the oral… PMID:25229260 | 2015 | this review only | Mouth opening; Trismus (maximum mouth opening ≤35 mm) | not extracted yet |
| Karlsson 2015 Effects of voice rehabilitation on health-related quality of life, communication and voice in laryngeal cancer patients treated with… PMID:25615892 | 2015 | this review only | not stated | not extracted yet |
| Karlsson 2024 Do Effects of Voice Rehabilitation in Patients Irradiated for Laryngeal Cancer Remain 5 Years Postradiotherapy? PMID:38688777 | 2026 | this review only | not stated | not extracted yet |
| Krisciunas 2017 Impact of Compliance on Dysphagia Rehabilitation in Head and Neck Cancer Patients: Results from a Multi-center Clinical Trial. PMID:27848021 | 2017 | this review only | not stated | not extracted yet |
| Lazarus 2014 Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy… PMID:24332586 | 2014 | this review only | not stated | not extracted yet |
| Li 2025 The Effectiveness of an Esophageal Speech Rehabilitation Program for Total Laryngectomy Patients Based on Behavior Change Wheel Theory: A… PMID:40234121 | 2025 | this review only | not stated | not extracted yet |
| Loorents 2014 Prophylactic training for the prevention of radiotherapy-induced trismus - a randomised study. PMID:24635110 | 2014 | this review only | not stated | not extracted yet |
| Messing 2017 Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial. PMID:28444488 | 2017 | this review only | not stated | not extracted yet |
| Millgard 2020 Voice Quality in Laryngeal Cancer Patients: A Randomized Controlled Study of the Effect of Voice Rehabilitation. PMID:32389236 | 2020 | this review only | not stated | not extracted yet |
| Petersson 2023 A randomized controlled study evaluating the head-lift exercise in head and neck cancer patients with radiation-induced dysphagia: effect… PMID:37584752 | 2023 | this review only | not stated | not extracted yet |
| Saghafi 2026 Jaw exercise in head and neck cancer patients for prevention of temporomandibular disorders: a randomized controlled trial. PMID:39576571 | 2026 | this review only | Mouth opening; Trismus (maximum mouth opening ≤35 mm) | not extracted yet |
| Schipor-Diaconu 2024 Prophylactic Swallowing Exercises in Patients with Laryngeal Cancer Who Underwent Total Laryngectomy-A Randomized Trial. PMID:39590137 | 2024 | this review only | not stated | not extracted yet |
| Shanmugam 2024 Impact of Prehabilitation With Preoperative Swallowing Exercises on Postoperative Swallowing Morbidity in Oral Cavity Cancer: Randomized… PMID:39376764 | 2024 | this review only | not stated | not extracted yet |
| Tuomi 2014 Effects of voice rehabilitation after radiation therapy for laryngeal cancer: a randomized controlled study. PMID:25035200 | 2014 | this review only | not stated | not extracted yet |
| Tuomi 2017 Voice Range Profile and Health-related Quality of Life Measurements Following Voice Rehabilitation After Radiotherapy; a Randomized… PMID:27091469 | 2017 | this review only | not stated | not extracted yet |
| Tuomi 2022 The effect of the Shaker head-lift exercise on swallowing function following treatment for head and neck cancer: Results from a… PMID:35068016 | 2022 | this review only | not stated | not extracted yet |
| van der Geer 2020 The use of stretching devices for treatment of trismus in head and neck cancer patients: a randomized controlled trial. PMID:31701267 | 2020 | this review only | not stated | not extracted yet |
| Wang 2019 Effects of a mouth-opening intervention with remote support on adherence, the maximum interincisal opening, and mandibular function of… PMID:31229200 | 2019 | this review only | not stated | not extracted yet |
| Wu 2024 Early swallowing training after free flap surgery in oral cancer: A randomized controlled trial. PMID:37392422 | 2024 | this review only | not stated | not extracted yet |
| Yang 2025 The impact of different timing of mouth opening exercises on trismus in postoperative radiotherapy patients with oral cancer. PMID:39366485 | 2025 | this review only | not stated | not extracted yet |
| Zhang 2022 Effects of personalized swallowing rehabilitation in patients with oral cancer after free flap transplantation: A cluster randomized… PMID:36126603 | 2022 | this review only | not stated | not extracted yet |
| Zhang 2024 Effects of personalized oral exercises on swallowing function among patients with oral cancer after free flap transplantation: a cluster… PMID:38143220 | 2024 | this review only | not stated | not extracted yet |
| Zhang Y 2025 Normalcy of Swallowing in Head and Neck Cancer Patients Undergoing Particle Therapy Supported by Combined Swallowing Training and Feeding… PMID:40013496 | 2025 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with primary head and neck cancer treated with surgery, radiotherapy, chemotherapy, chemoradiotherapy, immunotherapy or combinations, with at least one functional, musculoskeletal or participation-related sequela | Adults with head and neck cancer during or after radiotherapy/chemoradiotherapy, after oral-cancer surgery with free-flap reconstruction, after total laryngectomy, before treatment, or as survivors with established dysphagia or trismus (n=21 trials) |
| Intervention | Conservative rehabilitation or physiotherapy: therapeutic exercise, manual therapy, electrotherapy, functional training, orofacial rehabilitation, cervical and shoulder rehabilitation, swallowing exercises, supervised home-based programs, telerehabilitation, rehabilitation devices within a conservative program | Preventive jaw rehabilitation (n=3 pooled), postoperative swallowing rehabilitation (n=2), early mouth-opening exercises, telephone-supported mouth-opening program, enhanced or prophylactic swallowing programs, prehabilitation, voice and esophageal speech rehabilitation, NMES, delivery-mode variants, stretching devices |
| Comparison | Usual care, standard education or instructions, no intervention, waiting list, placebo or sham, other active interventions, different rehabilitation modalities, intensities, frequencies or doses | Usual or routine care, delayed start of the same program, same program without support, basic rehabilitation, sham NMES, alternative delivery modes, alternative device |
| Outcomes | Validated functional outcomes: mouth opening, mandibular function, swallowing function, cervical mobility, shoulder function, voice, fatigue, lymphedema, health-related quality of life | Mouth opening (meta-analysis, n=3); trismus (meta-analysis, n=3); MASA-OC postoperative swallowing (n=2, not pooled); other swallowing, swallowing-related quality of life, voice and communication outcomes (individual estimates or narrative) |
| Study designs | Randomized controlled trials (individually or cluster randomized) | 21 randomized trials (27 reports), including 2 cluster-randomized trials (n=21) |
| Timing | Not specified (longest common follow-up within the same clinically relevant period) | 12 months after radiotherapy for mouth opening and trismus; 1 month after surgery for MASA-OC |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | Yes | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |