Effectiveness of detailed physiotherapy in perioperative rehabilitation of thyroid cancer_West China Medical Journal

Authors：

WANG Miaowei ^1,2 , WANG Ao ^1,2 , LI Guo ^1,2 , LIU Feng ³ , ZOU Jian ⁴ , LI Bo ⁴ ,  QU Yun ^1,2

1. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

QU Yun, Email: dr_yunqu@163.com

Keywords：

Thyroid cancer; neck dissection; rehabilitation; physiotherapy

DOI：

10.7507/1002-0179.202109196

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Objective To explore the effectiveness of detailed physiotherapy in perioperative rehabilitation of patients undergoing thyroid cancer surgery with lymph node dissection. Methods A total of 97 patients with thyroid malignancy who underwent surgical treatment in West China Hospital of Sichuan University between February and June 2021 were selected and randomly divided into the trial group (n=50) and the control group (n=47). The patients in the trial group received detailed physiotherapy, and the patients in the control group received routine perioperative rehabilitation. The degree of pain within the operation area and the degree of neck and shoulder discomfort associated with surgery within 4 weeks, and the scores of Neck Dissection Impairment Index 4 weeks after surgery were compared between the two groups. The pain score, which was non-normally distributed, was described by median (lower quartile, upper quartile) and compared by generalized estimation equation; the discomfort score and score of Neck Dissection Impairment Index, which were normally distributed, were described by mean ± standard deviation, and the former was compared by multivariate analysis of variance, and the latter was compared by Student’s t-test. Results In the 1st, 2nd, 3rd, and 4th week after surgery, the pain scores within the operation area were 2.2 (1.7, 3.3), 1.5 (1.0, 2.2), 1.5 (0.0, 2.3), and 0.0 (0.0, 1.2), respectively in the trial group, and 3.4 (2.7, 5.2), 2.6 (1.5, 3.5), 2.4 (1.1, 3.4), and 1.5 (1.1, 2.0), respectively in the control group; the surgery-related neck and shoulder discomfort scores were 8.72±4.14, 5.28±2.98, 5.89±2.78, and 3.57±1.83, respectively in the trial group, and 10.56±5.30, 7.54±4.51, 7.37±3.49, and 5.05±2.59, respectively in the control group. Within 4 weeks after operation, the surgical-area pain scores and surgery-related neck and shoulder discomfort scores in the trial group were lower than those in the control group, and the differences were statistically significant (Wald χ²=28.826, P<0.001; F=7.695, P=0.007). In the post-operative week 4, the Neck Dissection Impairment Index in the trial group was higher than that in the control group, and the difference was statistically significant (75.23±20.40 vs. 63.83±19.52; t=2.809, P=0.006). Conclusion For patients undergoing thyroid cancer surgery with lymph node dissection, detailed physiotherapy intervention is more effective than routine perioperative rehabilitation.

Citation： WANG Miaowei, WANG Ao, LI Guo, LIU Feng, ZOU Jian, LI Bo, QU Yun. Effectiveness of detailed physiotherapy in perioperative rehabilitation of thyroid cancer. West China Medical Journal, 2022, 37(5): 704-709. doi: 10.7507/1002-0179.202109196 Copy

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2.	秦元, 張浩. 國內外指南中甲狀腺癌頸淋巴結清掃手術范圍及指征變遷. 中國實用外科雜志, 2020, 40(6): 639-643.
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4.	Mitchell AL, Gandhi A, Scott-Coombes D, et al. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol, 2016, 130(S2): S150-S160.
5.	Doubleday A, Sippel RS. Surgical options for thyroid cancer and post-surgical management. Expert Rev Endocrinol Metab, 2018, 13(3): 137-148.
6.	Baldoman D, Vandenbrink R. Physical therapy challenges in head and neck cancer. Cancer Treat Res, 2018, 174: 209-223.
7.	Hirota K, Nishimoto K, Kumai Y, et al. Swallowing dysfunction following surgery for well-differentiated thyroid cancer with extrathyroid invasion. Int J Clin Oncol, 2020, 25(11): 1921-1927.
8.	Mizuno K, Takeuchi M, Kanazawa Y, et al. Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring. Laryngoscope, 2019, 129(8): 1954-1960.
9.	Yang S, Zhou L, Lu Z, et al. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. Int J Surg, 2017, 39: 104-113.
10.	Robinson M, Ward L, Mehanna H, et al. Provision of physiotherapy rehabilitation following neck dissection in the UK. Laryngol Otol, 2018, 132(7): 624-627.
11.	安常明, 李正江. 中國甲狀腺 ERAS 的實施和爭議. 腫瘤預防與治療, 2020, 33(10): 817-820.
12.	Maniakas A, Dadu R, Busaidy NL, et al. Evaluation of overall survival in patients with anaplastic thyroid carcinoma, 2000-2019. JAMA Oncol, 2020, 6(9): 1397-1404.
13.	Konrad A, Stafilidis S, Tilp M. Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties. Scand J Med Sci Sports, 2017, 27(10): 1070-1080.
14.	Konrad A, Budini F, Tilp M. Acute effects of constant torque and constant angle stretching on the muscle and tendon tissue properties. Eur J Appl Physiol, 2017, 117(8): 1649-1656.
15.	林淑芳, 徐穎, 李民, 等. 牽伸在運動與骨傷康復中的應用. 中國康復, 2017, 32(1): 77-80.
16.	Takamura Y, Miyauchi A, Tomoda C, et al. Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study. World J Surg, 2005, 29(6): 775-779.
17.	Goldstein DP, Ringash J, Bissada E, et al. Evaluation of shoulder disability questionnaires used for the assessment of shoulder disability after neck dissection for head and neck cancer. Head Neck, 2014, 36(10): 1453-1458.
18.	Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
19.	Soeters PB. The Enhanced Recovery After Surgery (ERAS) program: benefit and concerns. Am J Clin Nutr, 2017, 106(1): 10-11.
20.	朱維銘, 許奕晗, 黎介壽. 圍手術期處理進展—ERAS、圍手術期外科之家與圍手術期醫學. 中國實用外科雜志, 2019, 39(2): 118-121.
21.	謝芬, 米元元, 胡麗園. 三聯預康復策略在下肢外周動脈疾病圍術期患者的應用及效果評價. 護士進修雜志, 2020, 35(20): 1891-1895.
22.	邱田, 劉子嘉, 黃宇光. 預康復在加速術后康復中的價值. 臨床麻醉學雜志, 2018, 34(3): 296-298.
23.	王正珍. 運動處方的研究與應用進展. 體育學研究, 2021, 35(3): 40-49.
24.	Ayhan H, Tastan S, Iyigün E, et al. The effectiveness of neck stretching exercises following total thyroidectomy on reducing neck pain and disability: a randomized controlled trial. Worldviews Evid Based Nurs, 2016, 13(3): 224-231.
25.	Wu JX, Assel M, Vickers A, et al. Impact of intraoperative remifentanil on postoperative pain and opioid use in thyroid surgery. J Surg Oncol, 2019, 120(8): 1456-1461.
26.	Loh JW, Taib NA, Cheong YT, et al. A double-blind, randomized controlled trial of pre-incision wound infiltration using diclofenac versus bupivacaine for post-operative pain relief in open thyroid and parathyroid surgery. World J Surg, 2020, 44(8): 2656-2666.
27.	Imhoff A, Beitzel K, Stamer K, et al. Rebabilitation in orthopedic surgery. 2nd ed. Berlin: Springer, 2016: 3-4.
28.	Maxey L, Magnusson J. Rebabilitation for the postsurgical orthopedic patient. St Louis: Mosby, 2001: 6-7.
29.	Mackey AL, Kjaer M. Connective tissue regeneration in skeletal muscle after eccentric contraction-induced injury. J Appl Physiol (1985), 2017, 122(3): 533-540.
30.	Benson S, Hagen S, Hoffmann O, et al. Can a brief psychological expectancy intervention improve postoperative pain? A randomized, controlled trial in patients with breast cancer. Pain, 2019, 160(7): 1562-1571.
31.	Adu EJ. Management of contractures: a five-year experience at Komfo Anokye Teaching Hospital in Kumasi. Ghana Med J, 2011, 45(2): 66-72.
32.	Ylinen J, Kautiainen H, Wirén K, et al. Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. J Rehabil Med, 2007, 39(2): 126-132.
33.	H?kkinen A, Kautiainen H, Hannonen P, et al. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil, 2008, 22(7): 592-600.
34.	美國運動醫學學會. ACSM 運動測試與運動處方指南. 10 版. 王正珍, 譯. 北京: 北京體育大學出版社, 2019: 9-11.

1. Roman BR, Morris LG, Davies L. The thyroid cancer epidemic, 2017 perspective. Curr Opin Endocrinol Diabetes Obes, 2017, 24(5): 332-336.
2. 秦元, 張浩. 國內外指南中甲狀腺癌頸淋巴結清掃手術范圍及指征變遷. 中國實用外科雜志, 2020, 40(6): 639-643.
3. Twining CL, Lupo MA, Tuttle RM. Implementing key changes in the American Thyroid Association 2015 Thyroid Nodules/Differentiated Thyroid Cancer Guidelines Across Practice Types. Endocr Pract, 2018, 24(9): 833-840.
4. Mitchell AL, Gandhi A, Scott-Coombes D, et al. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol, 2016, 130(S2): S150-S160.
5. Doubleday A, Sippel RS. Surgical options for thyroid cancer and post-surgical management. Expert Rev Endocrinol Metab, 2018, 13(3): 137-148.
6. Baldoman D, Vandenbrink R. Physical therapy challenges in head and neck cancer. Cancer Treat Res, 2018, 174: 209-223.
7. Hirota K, Nishimoto K, Kumai Y, et al. Swallowing dysfunction following surgery for well-differentiated thyroid cancer with extrathyroid invasion. Int J Clin Oncol, 2020, 25(11): 1921-1927.
8. Mizuno K, Takeuchi M, Kanazawa Y, et al. Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring. Laryngoscope, 2019, 129(8): 1954-1960.
9. Yang S, Zhou L, Lu Z, et al. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. Int J Surg, 2017, 39: 104-113.
10. Robinson M, Ward L, Mehanna H, et al. Provision of physiotherapy rehabilitation following neck dissection in the UK. Laryngol Otol, 2018, 132(7): 624-627.
11. 安常明, 李正江. 中國甲狀腺 ERAS 的實施和爭議. 腫瘤預防與治療, 2020, 33(10): 817-820.
12. Maniakas A, Dadu R, Busaidy NL, et al. Evaluation of overall survival in patients with anaplastic thyroid carcinoma, 2000-2019. JAMA Oncol, 2020, 6(9): 1397-1404.
13. Konrad A, Stafilidis S, Tilp M. Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties. Scand J Med Sci Sports, 2017, 27(10): 1070-1080.
14. Konrad A, Budini F, Tilp M. Acute effects of constant torque and constant angle stretching on the muscle and tendon tissue properties. Eur J Appl Physiol, 2017, 117(8): 1649-1656.
15. 林淑芳, 徐穎, 李民, 等. 牽伸在運動與骨傷康復中的應用. 中國康復, 2017, 32(1): 77-80.
16. Takamura Y, Miyauchi A, Tomoda C, et al. Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study. World J Surg, 2005, 29(6): 775-779.
17. Goldstein DP, Ringash J, Bissada E, et al. Evaluation of shoulder disability questionnaires used for the assessment of shoulder disability after neck dissection for head and neck cancer. Head Neck, 2014, 36(10): 1453-1458.
18. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg, 2017, 152(3): 292-298.
19. Soeters PB. The Enhanced Recovery After Surgery (ERAS) program: benefit and concerns. Am J Clin Nutr, 2017, 106(1): 10-11.
20. 朱維銘, 許奕晗, 黎介壽. 圍手術期處理進展—ERAS、圍手術期外科之家與圍手術期醫學. 中國實用外科雜志, 2019, 39(2): 118-121.
21. 謝芬, 米元元, 胡麗園. 三聯預康復策略在下肢外周動脈疾病圍術期患者的應用及效果評價. 護士進修雜志, 2020, 35(20): 1891-1895.
22. 邱田, 劉子嘉, 黃宇光. 預康復在加速術后康復中的價值. 臨床麻醉學雜志, 2018, 34(3): 296-298.
23. 王正珍. 運動處方的研究與應用進展. 體育學研究, 2021, 35(3): 40-49.
24. Ayhan H, Tastan S, Iyigün E, et al. The effectiveness of neck stretching exercises following total thyroidectomy on reducing neck pain and disability: a randomized controlled trial. Worldviews Evid Based Nurs, 2016, 13(3): 224-231.
25. Wu JX, Assel M, Vickers A, et al. Impact of intraoperative remifentanil on postoperative pain and opioid use in thyroid surgery. J Surg Oncol, 2019, 120(8): 1456-1461.
26. Loh JW, Taib NA, Cheong YT, et al. A double-blind, randomized controlled trial of pre-incision wound infiltration using diclofenac versus bupivacaine for post-operative pain relief in open thyroid and parathyroid surgery. World J Surg, 2020, 44(8): 2656-2666.
27. Imhoff A, Beitzel K, Stamer K, et al. Rebabilitation in orthopedic surgery. 2nd ed. Berlin: Springer, 2016: 3-4.
28. Maxey L, Magnusson J. Rebabilitation for the postsurgical orthopedic patient. St Louis: Mosby, 2001: 6-7.
29. Mackey AL, Kjaer M. Connective tissue regeneration in skeletal muscle after eccentric contraction-induced injury. J Appl Physiol (1985), 2017, 122(3): 533-540.
30. Benson S, Hagen S, Hoffmann O, et al. Can a brief psychological expectancy intervention improve postoperative pain? A randomized, controlled trial in patients with breast cancer. Pain, 2019, 160(7): 1562-1571.
31. Adu EJ. Management of contractures: a five-year experience at Komfo Anokye Teaching Hospital in Kumasi. Ghana Med J, 2011, 45(2): 66-72.
32. Ylinen J, Kautiainen H, Wirén K, et al. Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. J Rehabil Med, 2007, 39(2): 126-132.
33. H?kkinen A, Kautiainen H, Hannonen P, et al. Strength training and stretching versus stretching only in the treatment of patients with chronic neck pain: a randomized one-year follow-up study. Clin Rehabil, 2008, 22(7): 592-600.
34. 美國運動醫學學會. ACSM 運動測試與運動處方指南. 10 版. 王正珍, 譯. 北京: 北京體育大學出版社, 2019: 9-11.

West China Medical Journal

Effectiveness of detailed physiotherapy in perioperative rehabilitation of thyroid cancer

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