Author Names
Pattanshetty, R., & Patil, S.
Reviewer Name
Hope Reynolds, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background: Pain is the one the most dreadful side effects of head and neck cancers and cancer related treatments affecting patients during and after the treatment adding to the problems affecting their ability to speak, swallow, breath and feeding. Manual therapy is standard set of physiotherapy treatments used for alleviating neck pain. It has found to be effective in small subset of cancer patients for relieving pain. Objectives: To highlight the use of various manual therapy techniques focusing in decreasing neck pain and improving quality of life in Head and Neck Cancer survivors that may suggest its safe utilisation in oncology rehabilitation. Materials and Methods: Electronic search was conducted in PubMed, Google Scholar, CINAHL, Pedro, and COCHRANE databases. Reference lists of the included studies and relevant reviews were manually searched. Studies that met the inclusion criteria were evaluated using McMaster critical review form for quantitative studies. A descriptive synthesis was undertaken due to the heterogeneity of the included studies. Results: Seven studies were assessed for risk of bias that comprised of three clinical trials, one case series and three case reports that applied Maitland’s mobilisation, Myofascial release, Muscle Energy Techniques to head and neck cancer survivors in various clinical settings. The outcomes highlighted decrease in pain, improvement in cervical range of motion and quality of life. Conclusion: This review recommends application of manual therapy to head and neck cancer survivors. However, authors caution application of manual therapy in terms of choosing a particular technique. Further, well designed larger sample size with randomisation and double blinding would help to generate better evidence for head and neck cancer survivors.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Various manual therapy techniques, including Maitland’s mobilization, myofascial release, and muscle energy techniques, applied to the cervical, upper thoracic, and shoulder regions have been shown to be effective in decreasing pain and improving cervical range of motion and quality of life in head and neck cancer survivors.
Key Finding #2
Both mobilization and soft tissue techniques may induce relaxation and lead to both immediate and long-term analgesic effects in this patient population.
Key Finding #3
The utilization of manual therapy techniques is considered safe and is recommended to treat neck pain and enhance physical function in head and neck cancer survivors, however, care should be taken based on individual considerations in choosing and applying these techniques.
Please provide your summary of the paper
Due to the associated treatments, head and neck cancer survivors often experience post-surgical scar tissue formation and muscle dysfunction leading to motion deficits in the neck and shoulder. Additionally, 80% of head and neck cancer survivors report pain as being the most disabling symptom leading to a decreased quality of life. Studies have shown that manual therapy techniques such as myofascial release (MFR) and muscle energy techniques (MET) can lead to improvements in shoulder movements, pain management, and quality of life. However manual therapy techniques are sometimes considered contraindicated in patients with cancer. Therefore, this systematic review sought to clarify the effectiveness of various manual therapy techniques on neck pain and its effect on quality of life in head and neck cancer survivors. The results showed that manual therapy techniques when applied to the shoulder and neck region are safe and effective in reducing pain and improving quality of life in head and neck cancer survivors. Specifically, MFR, MET, and Maitland’s mobilizations were shown to have direct impacts on patients’ pain thresholds, mobility restrictions, and mental health through their alleviating effects on complications related to radiation, post-operative scarring, and muscle guarding. However, more research and larger sample size clinical trials are needed to determine the specifics of how best to implement manual therapy interventions in this patient population and care should be taken when utilizing these techniques based on individual patient considerations.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
It is recommended that manual therapy techniques such as Maitland’s mobilizations, myofascial release, and muscle energy techniques be utilized to reduce neck pain and improve range of motion and quality of life in head and neck cancer survivors. However, care should be taken in the choosing and application of these manual therapy techniques based on factors specific to each individual, their diagnosis, and their treatment history.
