| [Objective]1.Based on evidence-based and expert meeting methods,a shoulder and neck functional exercise program for patients with head and neck cancer after neck dissection was constructed.2.Through experimental research methods,the shoulder and neck functional exercise program is initially applied to the clinic to evaluate the application effect.3.Provide a more scientific and systematic shoulder and neck functional exercise program for patients with head and neck cancer after neck dissection.[Methods]1.Construction of shoulder and neck function exercise program for patients with head and neck cancer after neck dissection:Systematically searched domestic and international databases and guideline websites,such as Oncology Nursing Society,PubMed,CNKI,etc.,read relevant clinical guidelines,systematic evaluations and other literature,and constructed after the screening,quality evaluation and evidence extraction of the literature according to the steps of evidence-based nursing,and then discussed and organized and summarized by members of the group.Experts in this research field were invited to conduct an expert meeting to modify and improve the content of the program,forming a functional exercise program for the shoulder and neck of patients after neck dissection for head and neck cancer that is easy to implement clinically.2.Effect evaluation of shoulder and neck function exercise program for patients with head and neck cancer after neck dissection:88 patients with head and neck cancer surgery in a top-three hospital in Zhejiang Province from May 2021 to August 2021 were selected as research objects.Among them,44 patients admitted to the hospital from May to June 2021 were in the control group,and 44 patients admitted to the hospital from July to August 2021 were in the experimental group.Patients in the control group received postoperative routine nursing measures,and patients in the experimental group implemented the shoulder and neck exercise program constructed in this study based on routine nursing.The evaluation tool included the Constant-Murley Score,which included four parts:pain,activities of daily living(ADL),range of motion(ROM),and manual muscle testing(MMT);the Shoulder and Neck Active Range of Motion(AROM)Scale(homemade),and the Vancouver Scar Scale(VSS).The shoulder and neck dysfunction and the degree of neck scar contracture were evaluated 1 day before the operation,1 week after the operation,1 month after the operation,and 3 months after the operation.The data were statistically analyzed by t-test,x2 test,repeated measurement analysis of variance,and other statistical methods.The difference was statistically significant(P<0.05).The grouping of patients was not entirely randomized,but the relevant factors were balanced through covariance analysis to reduce the deviation to the greatest extent brought about by nonrandom grouping.[Results]1.Through systematic literature retrieval,quality evaluation,and evidence extraction,13 articles were finally included,with a total of 9 categories and 27 best evidence.A total of 16 experts participated in the expert meeting to make changes and deletions to the program.The expert authority coefficient is Cr=0.84(≥0.7),the expert authority is high,and the program is reliable.2.Evaluation of application effect of shoulder and neck functional exercise program(1)Baseline data of two groups of patients:a total of 79 patients completed the entire research process,39 cases in the experimental group and 40 cases in the control group,with a total loss-of-visit rate of 10.23%.The two groups of patients were statistically significant in the age group(P<0.05),and the other groups were not statistically significant(P>0.05).(2)Analysis of outcome indicators:① Comparison of CMS scores:at 1 month of intervention,the total CMS score and pain score of the experimental group were higher than those of the control group,and the differences were statistically significant(P<0.05);at 1 week and 1 month of intervention,the ADL scores of the experimental group were higher than those of the control group,and the differences were statistically significant(P<0.05);at 1 week of intervention,the ROM scores of the experimental group were higher than those of the control group(P<0.05);There was no significant difference between groups in MMT scores at the 4-time points(P>0.05).There were statistically significant differences in the withingroup comparisons of the total score,ADL,and ROM in both groups(P<0.001).There was a statistically significant difference in the intra-group comparison of pain scores in the control group(P<0.001);there was no statistically significant difference in the intra-group comparison of MMT scores between the two groups(P>0.05).② Comparison of shoulder AROM:at 1 week and 1 month of intervention,the AROM of shoulder joint posterior extension and abduction in the experimental group was greater than that in the control group,and the difference was statistically significant(P<0.05);at 1 month of intervention,the AROM of shoulder joint forward flexion in the experimental group was greater than that in the control group(P<0.05);there was no statistically significant difference in the AROM of horizontal adduction and horizontal abduction in the two groups(P>0.05).The intra-group comparison of AROM of the shoulder joint in both groups was statistically significant(P<0.001),indicating that shoulder joint mobility disorders tend to improve over time.③Comparison of neck AROM:At 1 week of intervention,the AROM of anterior neck flexion and right flexion in the experimental group was greater than that in the control group,and the differences were statistically significant(P<0.05);at 1 week,1 month and 3 months of intervention,the AROM of posterior neck flexion and left flexion in the experimental group was greater than that in the control group,and the differences were statistically significant(P<0.05).The intra-group comparison of neck AROM in both groups was statistically significant(P<0.001),indicating that neck mobility disorders tend to improve over time.④Comparison of VSS scores:At 1 month and 3 months of intervention,the VSS scores of the experimental group were lower than those of the control group,and the differences were statistically significant(P<0.05).The intra-group comparison of VSS scores was statistically significant in both groups(P<0.001).[Conclusion]1.This study constructs a more systematic and complete shoulder and neck functional exercise program for patients with head and neck cancer after neck dissection based on an evidence-based and expert meeting method,which provides a theoretical and practical basis for later clinical translation.2.The study protocol was able to reduce postoperative pain and improve shoulder and neck dysfunction,especially posterior and left flexion of the neck,and posterior extension,forward flexion and abduction of the shoulder joint.It also reduces the degree of neck scar contracture and improves the patient’s overall ability to perform activities of daily living.The shoulder and neck functional exercise program for patients with head and neck cancer after neck dissection has certain clinical applicability and scientific validity,and is worthy of further promotion and application. |
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