Association of Neck Range of Motion and Skin Caliper Measures on Dysphagia Outcomes in Head and Neck Cancer and Effects of Neck Stretches and Swallowing Exercises.
Alice K Silbergleit, Lonni Schultz, Gintas Krisciunas and 1 others
PMID 31317266WHAT IT FOUND
Better neck movement and skin pliability correlate with less severe swallowing issues in head and neck cancer survivors.
However, a 12-week program of neck stretches and swallowing exercises did not improve these physical measures or objective swallowing outcomes, despite patients reporting better quality of life.
Key findings
01Baseline cervical range of motion and skin caliper measures were significantly associated with swallowing outcomes, with greater motion and pliability linked to lower Penetration Aspiration Scale scores and better diet quality.
02After 12 weeks of neck stretches and swallowing exercises, there were no significant within-group changes in cervical range of motion or skin elasticity, nor any significant differences between the treatment groups.
03Changes in cervical range of motion were weakly associated with changes in patient-reported eating quality of life, but not with objective swallowing measures like the Penetration Aspiration Scale or oropharyngeal swallowing efficiency.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was a secondary analysis of a subset of participants (119 out of 170) from a larger randomized controlled trial, which may introduce selection bias. Participants were on average 4.5 years post-chemoradiation, meaning the findings may not apply to patients in the acute or subacute phases of recovery. The skin caliper measure used to assess fibrosis may have been too superficial to detect changes in deeper tissue layers where radiation fibrosis typically occurs. Multiple statistical comparisons were performed without correction for type I error, meaning some of the weak positive associations found could have occurred by chance.
Declared interests
The original primary trial was funded by the National Institutes of Health. The authors of this secondary analysis declared no conflicts of interest.
The easy way to misread this
Do not assume that patient-reported improvements in eating quality of life after neck and swallowing exercises indicate a physiological resolution of dysphagia. The study found no significant improvement in objective swallowing measures, and the perceived benefits may reflect psychological factors or natural variation rather than treatment efficacy.