Effects of personalized swallowing rehabilitation in patients with oral cancer after free flap transplantation: A cluster randomized controlled trial

Rehabilitation Interventions in Head and Neck Cancer: A Scoping Review

OBJECTIVE

The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer.

DESIGN

A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type.

RESULTS

Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9).

CONCLUSIONS

Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.

Clinical practice guideline appraisal and algorithm development to identify recommendations related to nursing practice for post-stroke dysphagia

AIMS AND OBJECTIVES

To assess the methodological quality of current clinical practice guidelines related to post-stroke dysphagia and develop an algorithm using nursing process as a framework for clinical nursing.

BACKGROUND

Dysphagia is a serious complication of stroke. Yet the recommendations related to nursing in guidelines have not been systematically sorted out, so they are difficult for nurses to use to guide clinical nursing practice.

DESIGN

Systematic review.

METHODS

A systematic review of literature was performed using the PRISMA Checklist. A systematic search for relevant guidelines published between 2017 and 2022 was conducted. Appraisal of Guidelines for Research and Evaluation II instrument was used to assess methodological quality. Recommendations related to nursing practice from high-quality guidelines were summarised and developed into an algorithm to provide reference for the standardised construction of nursing practice scheme.

RESULTS

991 records were initially identified from database searches and other sources. Finally, 10 guidelines were included, of which 5 were rated as high quality. A total of 27 recommendations from the 5 highest-scoring guidelines were summarised and used to develop an algorithm.

CONCLUSIONS

This study indicated deficiencies and variability in current available guidelines. Based on five high-quality guidelines, we developed an algorithm to facilitate nurses' adherence to guidelines and contribute to evidence-based nursing. In the future, high-quality guidelines, together with large-sample and multi-centre clinical researches are suggested to give more scientific and convincing evidence to nursing of post-stroke dysphagia.

RELEVANCE TO CLINICAL PRACTICE

The findings indicate that nursing process may provide a unified framework for standardised nursing of different diseases. Nursing leaders are recommended to adopt this algorithm in their units. In addition, nursing administrators and educators should promote the application of nursing diagnosis to help nurses foster nursing thinking mode.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement in this review.