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. 2022 Feb 26;10(3):442.
doi: 10.3390/healthcare10030442.

Exercise for Trismus Prevention in Patients with Head and Neck Cancer: A Network Meta-Analysis of Randomized Controlled Trials

Ya-Hui Wang  1 , Yi-Ai Huang  1 , I-Hui Chen  2 , Wen-Hsuan Hou  3   4   5   6 , Yi-No Kang  6   7   8   9   10
Affiliations

Exercise for Trismus Prevention in Patients with Head and Neck Cancer: A Network Meta-Analysis of Randomized Controlled Trials

Ya-Hui Wang et al. Healthcare (Basel). .

Abstract

A common side effect of managing head and neck cancer is trismus, which devastates patients' quality of life. The purpose of this study was to investigate prophylactic exercise interventions for preventing trismus and difficulty in mouth opening in head and neck cancer. Five databases were searched for randomized controlled trials. Network meta-analysis was performed with risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). This study finally included 11 randomized controlled trials (n = 805). Trismus risk in patients who received exercise with phone call follow up (E + P) was significantly lower than those received usual care (RR = 0.42; 95% CI: 0.29 to 0.61) and exercise alone (RR = 0.33; 95% CI: 0.18 to 6.22). Mouth opening in usual care was significantly lower than in the tri-integrated strategy group (MD = 15.22; 95% CI: 8.88 to 21.56). Exercise is recommended for preserving mouth opening distance in patients with head and neck cancer. Tri-integrated strategies could be an effective method for preventing trismus.

Keywords: laryngeal cancer; mouth opening; oral cancer; pharyngeal cancer; prophylactic; trismus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of evidence selection for the synthesis of exercise in preventing trismus among patients with head and neck cancer. HNC, head and neck cancers; RCT, randomized controlled trial.
Figure 2
Figure 2
Network geometry of the consistency model for (A) short-term trismus, (B) longer-term trismus, (C) short-term mouth opening level, and (D) longer-term mouth opening level.
Figure 3
Figure 3
Forest plots of (A) short-term trismus, (B) longer-term trismus, (C) short-term mouth opening level, and (D) longer-term mouth opening level. CI, confidence interval; E, exercise alone; E + P, exercise with phone call follow up; E + I, exercise and instrument; E + I + P, exercise and instrument and phone call follow up; MD, mean difference; RR, risk ratio; UC, usual care.
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