Very Low

GRADE

The evidence is very uncertain regarding the effect of dysphagia prehabilitation, utilizing exercises, on swallowing function, HRQOL, and nutritional status when compared to usual care or no exercise in adult patients scheduled for (chemo)radiotherapy

Sources: Mortensen, 2015; Zhang, 2022; Wu, 2023

No

GRADE

No evidence was found regarding the effect of dysphagia prehabilitation, utilizing exercises, on mental health in adult patients scheduled to be treated for head and neck cancer.

Source: -

No

GRADE

No evidence was found regarding the effect of dysphagia prehabilitation, utilizing exercises, on aspiration pneumonia in adult patients scheduled for (chemo)radiotherapy.

Source: -

Very low

GRADE

The evidence is very uncertain regarding the effect of dysphagia prehabilitation, utilizing exercises, on aspiration pneumonia when compared to usual care in adult patients after surgery for head and neck cancer and prior to the initiation postoperative (chemo)radiotherapy.

Source: Wu, 2023

Very low

GRADE

The evidence is very uncertain regarding the effect of dysphagia prehabilitation, utilizing exercises, on swallowing function, HRQOL, mental health, aspiration pneumonia, and nutritional status when compared to compensatory strategies, sham (placebo) exercise, usual care or no exercise in adult patients during (chemo)radiotherapy.

Sources: Carnaby-Mann, 2012; Kumar, 2016; Van den Berg, 2016; Messing, 2017; Hsiang, 2019; Fredslund Hadju, 2021

Very low

GRADE

The evidence is very uncertain regarding the effect of dysphagia rehabilitation, utilizing exercises, on swallowing function, HRQOL, mental health, aspiration pneumonia, and nutritional status when compared to compensatory strategies, sham (placebo) exercise, usual care or no exercise in adult patients after completion of (chemo)radiotherapy or total laryngectomy.

Source: Tang, 2011; Chen, 2018a; Jansen, 2020; Dotevall 2022; Tuomi 2022; Petersson, 2023;

Start of the intervention before the initiation of cancer treatment.

1

Wu, 2023

Oral cavity or oropharyngeal carcinoma – surgery

I/C: 59/62

Male/Female:

I: 40/19
C: 44/18

Mean age (SD):

I: 51.5 (13.8)

C: 49.4 (14.2)

Primary tumor location:

Buccal:

I: 8/59

C: 10/62

Mouth floor:

I: 2/59

C: 4/62

Tongue:

I: 13/59

C: 14/62

Root of tongue:

I: 0/59

C: 1/62

Palate:

I: 9/59

C: 9/62

Maxillary gingiva:

I: 10/59

C: 10/62

Mandibular gingiva:

I: 17/59

C: 14/62

Cancer stage grouping:

Stage I:

I: 10/59

C: 16/62

Stage II:

I: 17/59

C: 17/62

Stage III:

I: 11/59

C: 13/62

Stage IV:

I: 18/59

C: 16/62

Stage unclear/missing:

I: 2/59

C: 0/62

Stage not reported by authors:

I: 1/59

C:0/62

Surgery:

I: 59/59

C: 62/62

Content:

Nurses performed oral sensory and active motor training on patients once a day in the morning and afternoon; passive motor training was added on the eighth postoperative day.

The exercises began on the 6^th day after surgery and ended on the 15th day after surgery. So, before the start of (chemo)radiotherapy if this was indicated.

Frequency:

Two sessions/day.

Duration: unclear.

Total duration:

Ten days.

Adherence:

Guidance and supervision by expert nurse – no specific information.

Blinding:

No blinding of therapists, patients, and study staff.

Content:

The control group received routine nursing measures and swallowing- related health education after surgery; that is, patients were closely observed for changes in their condition after surgery to maintain their oral cavity hygiene and diet, and ensure effective coughing.

Frequency:

Unclear.

Total duration:

Unclear.

Adherence:

Unclear.

Blinding:

No blinding of therapists, patients, and study staff.

Battery of measures at baseline (6^th day after surgery) and 15^th day and 1 month after surgery before the start of (chemo)radiotherapy if this was indicated.

Clinical assessment of swallowing:

-Mann Swallowing Assessment-oral cancer (MASA-OC)

HRQOL:

HRQOL questionnaire:

-UW-QoL v4

Aspiration pneumonia:

-Chest X-ray

Nutritional status:

Weight:

-Kg

Tube feeding:

-Time of nasogastric tube removal

2

Zhang, 2022

Oral cavity or oropharyngeal carcinoma – surgery

I/C: 34/34

Male/Female:

I: 23/11
C: 22/12

Mean age (SD):

I: 51.00 (13.12)

C: 54.32 (12.04)

Primary tumor location:

Buccal:

I: 7/34

C: 4/34

Mouth floor:

I: 3/34

C: 2/34

Tongue:

I: 8/34

C: 7/34

Palate:

I: 6/34

C: 5/34

Maxillary gingiva:

I: 3/34

C: 5/34

Mandibular gingiva:

I: 7/34

C: 11/34

Cancer stage grouping:

Stage I:

I: 1/34

C: 2/34

Stage II:

I: 10/34

C: 11/34

Stage III:

I: 10/34

C: 8/34

Stage IV:

I: 9/34

C: 10/34

Stage unclear/missing:

I: 4/34

C: 3/34

Surgery:

I: 34/34

C: 34/34

Timing:

The exercises began on the 6^th day after surgery and ended on the 15th day after surgery. So, before the start of (chemo)radiotherapy.

Content:

Swallowing education, monitoring oral hygiene, guiding eating, carrying out effective coughing, and conducting supraglottic swallowing training for patients with coughing after eating and drinking and targeted oral sensory stimulation and targeted oral exercise training.

Frequency:

Two sessions/day.

Duration: unclear.

Total duration:

Ten days.

Adherence:

Guidance and supervision by expert nurse – no specific information.

Blinding:

No blinding of therapists, patients, and study staff.

Timing:

Unclear.

Content:

Swallowing education, monitoring oral hygiene, guiding eating, carrying out effective coughing, and conducting supraglottic swallowing training for patients with coughing after eating and drinking.

Frequency:

Unclear.

Total duration:

Unclear.

Adherence:

Unclear.

Blinding:

No blinding of therapists, patients, and study staff.

Battery of measures at baseline (6^th day after surgery) and 15^th day and 1 month after surgery before the start of (chemo)radiotherapy if this was indicated.

Swallowing function:

Clinical assessment of swallowing:

-Mann Swallowing Assessment-oral cancer (MASA-OC)

HRQOL:

HRQOL questionnaire:

-UW-QOLv4; only at 1 month after surgery

Nutritional status:

Weight:

-Kg

Tube feeding:

-Duration

3

Mortensen, 2015

Oral cavity, pharyngeal, laryngeal or unknown primary carcinoma – (chemo)radiotherapy

I/C: 19/20

Male/Female:

I: 17/2
C: 17/3

Median age (range):

I: 58 (39–77)

C: 59 (40–74)

Primary tumor location:

Oral cavity:

I: 0/19

C: 4/20

Pharynx:

I: 11/19

C: 10/20

Larynxc:

I: 3/19

C: 4/20

Unknown primary:

I: 5/19

C: 2/20

Cancer stage grouping:

Stage I:

I: 0/19

C: 1/20

Stage II:

I: 2/19

C: 1/20

Stage III:

I: 1/19

C: 3/20

Stage IV:

I: 16/19

C: 15/20

Conventional radiotherapy or IMRT (hyperfractionated):

I: 19/19

C: 20/20

Concomitant chemotherapy:

I: 12/19

C: 7/20

Timing:

Before the start of (chemo)radiotherapy and up to eight months after cancer treatment.

Content:

Range of motion drills to maintain and improve the range of motion of relevant structures and muscle groups, and resistance exercises to strengthen the same muscles.

Frequency:

Three sessions/day, seven days per week.

Duration: 10-15 min per session.

Total duration:

Approximately 10-11 months.

Adherence:

Patients were seen by an experienced and dedicated occupational therapist at nine different time points.

Study dairy/home records on exercise-execution were fully complete for 51% (n =22) of the exercise group.

Blinding:

No blinding of therapists and patients.

Blinding of study staff.

Timing:

Before the start of (chemo)radiotherapy and up to eight months after cancer treatment.

Content:

Usual care, i.e., individualized dietary advice and videofluoroscopic imaging as needed to determine the need for interventions, instructions to continue oral food intake.

Battery of measures at baseline (before (chemo)radiotherapy) and 1, 3, 5 weeks after the start of (chemo)radiotherapy), and 2 weeks, 2, 5, 8, and 11 months after the completion of (chemo)radiotherapy.

Swallowing function:

Dysphagia-specific questionnaire (Clinician-reported outcome):

-DAHANCA morbidity scoring system for dysphagia

Clinical assessment of swallowing:

-Mouth opening (baseline (before (chemo)radiotherapy) and 2, 5, 8, and 11 months after the completion of (chemo)radiotherapy)

Swallow imaging:

-Videofluoroscopic imaging: Swallowing Performance Status Scale (SPSS), aspiration (0-2), penetration, cough, residue (baseline (before (chemo)radiotherapy) and 2, 5, and 11 months after the completion of (chemo)radiotherapy)

HRQOL:

HRQOL questionnaire:

-EORTC QLQ-C30

-EORTC QLQ-H&N35

Nutritional status:

Weight

Tube feeding

Start of the intervention during cancer treatment.

4

Fredslund Hajdú, 2021

Oral cavity, oro- or hypopharyngeal, laryngeal or unknown primary carcinoma – (chemo)radiotherapy with or without surgery

I/C: 120/115

Male/Female:

I: 94/26
C: 97/18

Mean age (SD):

I: 63 (9)

C: 63 (9)

Primary tumor location:

Oral cavity:

I: 10/120

C: 5/115

Oropharynx:

I: 68/120

C: 72/115

Hypopharynx:

I: 11/120

C: 9/115

Larynx:

I: 26/120

C: 28/115

Unknown primary:

I: 5/120

C: 1/115

Cancer stage grouping (%):

Stage I:

I: 27/120

C: 28/115

Stage II:

I: 25/120

C: 17/115

Stage III:

I: 19/120

C: 24/115

Stage IVa:

I: 42/120C: 43/115

Stage IVb:

I: 7/120

C: 3/115

Upfront radiotherapy:

I: 45/120

C: 45/115

Upfront concurrent chemoradiotherapy:

I: 63/120

C: 63/115

Surgery+(chemo)radiotherapy:

I: 12/120

C: 7/115

Timing:

From the beginning of radiotherapy

Content:

Usual care + progressive resistance training (PRT) + supervised swallowing exercise intervention + self-administered swallowing exercises.

The PRT program involved 6 exercises covering lower limbs, upper body and core in a fixed progression model based on repetition maximum.

Exercise programs consisted of all or some of the following 14 exercises: reaching tongue back and forth; tongue to

cheek, tongue to mouth corners, resistance to tongue, gargle, yawn, mouth opening, jaw side-to-side, jaw undershot,

Valsalva, Shaker exercise, Mendelsohn maneuver, Masako

maneuver, Effortful swallow.

Frequency: Supervised swallowing exercise intervention three times weekly parallel with twice weekly physiotherapy-led PRT.

Self-administered swallowing exercises at three sessions/day, seven days per week.

Total duration: 5-6 weeks

Adherence:

From the beginning of radiotherapy supervised swallowing exercise sessions by occupational therapist (OT) were scheduled three times weekly parallel with twice weekly physiotherapy-led PRT.

Blinding: -

Content:

Usual care differed between the two treatment centers. At one center the control group did not receive any intervention (non-active control group). At the other center all head and neck cancer patients were offered an individually tailored exercise plan at beginning of radiotherapy with regular OT follow-up averaging to every other week until 2 weeks after end-of-treatment (active control group).

All outcomes were assessed at baseline, end-of-treatment and 2, 6, and 12 months after end-of-treatment except the primary outcome which was assessed at baseline, and 2 and 12 months after treatment.

Swallowing function:

Dysphagia-specific questionnaire

(Patient-reported outcome):

-MDADI

(Clinician-reported outcome ):

-FOIS

Clinical assessment of swallowing:

-Mouth opening

Swallow imaging:

Endoscopic imaging: baseline, 2, and 12 months: -- -Penetration Aspiration Scale

-YPRS

HRQOL:

HRQOL questionnaire:

-EORTC QLQ C-30

-EORTC QLQ-H&N35

Mental health:

Affective symptom questionnaire:

-MDI

- SCL-92 Anxiety subscale)

Nutritional status:

Tube feeding

-Duration

5

Hsiang, 2019

Oral cavity and oropharyngeal carcinoma – surgerywith or without (chemo)radiotherapy (adjuvant)

I/C:25/25

Male/Female:

I: 24/1
C: 24/1

Mean age (SD):

I: 55.6 (8.6)

C: 56.7 (9.0)

Primary tumor location:

Buccal:

I: 9/25

C: 5/25

Tongue:

I: 10/25

C: 7/25

Lip:

I: 0/25

C: 1/25

Upper gum:

I: 1/25

C: 2/25

Lower gum:

I: 2/25

C: 1/25

Retromolar:

I: 0/25

C: 2/25

Hard palate:

I: 1/25

C: 1/25

Mouth floor:

I: 2/25

C: 0/25

Tonsil (oropharynx):

I: 0/25

C: 4/25

Primary tumor location not reported by authors:

I: 0/25

C: 2/25

Cancer stage grouping:

Stage I:

I: 4/25

C: 6/25

Stage II:

I: 5/25

C: 4/25

Stage III:

I: 7/25

C: 3/25

Stage IV:

I: 9/25

C: 12/25

Surgery:

I: 25/25

C: 25/25

Adjuvant (post-surgery) radiotherapy:

I: 20/25

C: 15/25

Adjuvant (post-surgery) chemotherapy:

I: 18/25

C: 15/25

Timing:

The exercises began within three weeks after surgery and continued for three months. Probably for the majority of the patients during radio and/or chemotherapy – not clearly reported.

Content:

Oral exercises including: range of motion exercises of the lips, jaw, and tongue and resistance exercises of the tongue.

Frequency:

Three sessions/day, seven days per week.

Duration: unclear.

Total duration:

12 weeks.

Adherence:

Compliance in both groups was encouraged through weekly telephone advisement by the nurse specialist for 12 weeks.

Blinding:

No blinding of therapists, patients, and study staff.

Timing:

Unclear. Probably for the majority of the patients during radio and/or chemotherapy – not clearly reported.

Content:

Usual care with swallowing positions and bolus modification.

Frequency:

Unclear.

Total duration:

12 weeks.

Adherence:

Compliance in both groups was encouraged through weekly telephone advisement by the nurse specialist for 12 weeks.

Blinding:

No blinding of therapists, patients, and study staff.

Battery of measures at baseline (within three weeks after surgery and three months after the start of the exercise intervention.

Swallowing function:

Swallow imaging:

-Videofluoroscopic imaging: baseline and 3 months: Penetration Aspiration Scale; oral and pharyngeal residue.

6

Messing, 2017

Pharyngeal or laryngeal carcinoma - chemoradiotherapy

I/C: 30/30

Male/Female:

I: 28/2
C: 26/4

Median age (range):

I: 55 (44 - 78)

C: 58 (39 - 79)

Primary tumor location:

Oropharynx:

I: 24/30

C: 25/30

Hypopharynx:

I: 2/30

C: 2/30

Both (oro- and hypopharynx):

I: 0/30

C: 1/30

Supraglottic:

I: 3/30

C: 1/30

Glottic:

I: 1/30

C: 1/30

Primary tumor size:

T-stage:

T1:

I: 4/30

C: 5/30

T2:

I: 11/30

C: 13/30

T3:

I: 12/30

C: 10/30

T4:

I: 3/30

C: 2/30

Nodal stage:

N-stage:

N1:

I: 3/30

C: 7/30

N2a-b-c:

I: 17/30

C: 21/30

N3-N3b:

I: 2/30

C: 0/30

Conventional radiotherapy or IMRT (hyperfractionated):

I: 30/30

C: 30/30

Concomitant chemotherapy:

I: 30/30

C: 30/30

Timing:

During the course of chemoradiotherapy and up to three months after cancer treatment.

Content:

Oro-motor (mandibular, neck, lingual, labial, pharyngeal) strength/stretch exercises and swallow maneuvers combined with dietary modification.

Frequency:

Two sessions/day, seven days per week.

Duration: 20-30 min per session.

Total duration:

Approximately 4-5 months.

Adherence:

Patients attended a weekly swallow therapy session which included continued instruction on the exercise protocol and swallow interventions as indicated.

Study journals/home records on exercise-execution were fully complete for 66% (n = 19) of the exercise group.

Blinding:

No blinding of therapists and patients.

Blinding of study staff.

Timing:

During the course of chemoradiotherapy and up to three months after cancer treatment.

Content:

No exercises, instructions on prophylactic use of TheraBite without any monitoring/follow-up.

Frequency:

Unclear.

Total duration:

Approximately 4-5 months.

Adherence:

Unclear.

Battery of measures at baseline (before chemoradiotherapy) and 3, 6, 12, and 24 months after cancer treatment.

Swallowing function:

Dysphagia-specific questionnaire (Clinician-reported outcome):

-Functional Oral Intake Scale (FOIS 1-5 more impaired diet level); baseline, 3, 6, 12, 24 months

Clinical assessment of swallowing:

-Oro-motor assessment containing 69 tasks assessing strength and range of motion of the facial muscles, tongue, and palate

-Mouth opening

Swallow imaging:

-Videofluoroscopic imaging: baseline and 3 months: Oropharyngeal Swallow Efficiency (OPSE), Dysphagia Outcomes Severity Scale (DOSS), Penetration Aspiration Scale

HRQOL:

HRQOL questionnaire:

-EORTC QLQ-C30

-EORTC QLQ-H&N35

Nutritional status:

Tube feeding

7

Kumar, 2016

Oral cavity, pharyngeal, and laryngeal carcinoma – (chemo)radiotherapy (upfront or adjuvant)

I/C: 25/25

Male/Female:

I: 19/6
C: 19/6

Mean age (SD):

I: -

C: -

Primary tumor location:

Oral cavity:

I: 11/25

C: 12/25

Nasopharynx:

I: 1/25

C: 1/25

Oropharynx:

I: 6/25

C: 5/25

Hypopharynx:

I: 4/25

C: 5/25

Larynx:

I: 3/25

C: 2/25

Cancer stage grouping:

Stage I:

I: 0/25

C: 1/25

Stage II:

I: 0/25

C: 0/25

Stage III:

I: 11/25

C: 12/25

Stage IV:

I: 10/25

C: 10/25

Upfront IMRT/IGRT:

I: 2/25

C: 1/25

Upfront concomitant chemotherapy:

I: 11/25

C: 12/25

Adjuvant (post-surgery) IMRT/IGRT:

I: 9/25

C: 9/25

Adjuvant (post-surgery) concomitant chemotherapy:

I: 3/25

C: 3/25

Timing:

During the course of (chemo)radiotherapy and up to six months after cancer treatment.

Content:

Supervised exercises and instructions: (1) Jaw exercise (2) tongue exercise, (3) the Mendelsohn maneuver, (4) shaker exercises, (5) supraglottic exercises (6) tongue hold, (7) mouth opening exercise, (8) range of motion (ROM) exercises.

Frequency:

Two sessions/day, seven days per week.

Duration: unclear.

Total duration:

Approximately 7-8 months.

Adherence:

Unclear.

Blinding:

Unclear.

Timing:

Not applicable.

Content:

No treatment.

Battery of measures at baseline (before (chemo)radiotherapy) and 3 and 6 months after (chemo)radiotherapy.

Swallowing function:

Dysphagia-specific questionnaire (Patient-reported outcome):

-MDADI

Clinical assessment of swallowing:

-ASHA

Swallow imaging:

-Endoscopic imaging: Penetration Aspiration Scale

Nutritional status:

Tube feeding

8

Van den Berg, 2016

Oral cavity, pharyngeal, and laryngeal carcinoma – (chemo)radiotherapy (upfront or adjuvant)

I/C: 60/60

Male/Female:

I: 46/14
C: 43/17

Median age (range):

I: 63 (33-83)

C: 60 (40-86)

Primary tumor location:

Oral cavity:

I: 12/60

C: 12/60

Nasopharynx:

I: 3/60

C: 3/60

Oropharynx:

I: 20/60

C: 16/60

Hypopharynx:

I: 5/60

C: 10/60

Larynx:

I: 20/60

C: 19/60

Primary tumor size:

T-stage:

T1:

I: 0/60

C: 0/60

T2:

I: 22/60

C: 20/60

T3:

I: 9/60

C: 14/60

T4:

I: 29/60

C: 26/60

Cancer stage grouping:

Stage I:

I: 0/60

C: 0/60

Stage II:

I: 22/60

C: 20/60

Stage III:

I: 9/60

C: 14/60

Stage IV:

I: 29/60

C: 26/60

Upfront IMRT/conventional radiotherapy:

I: 38/60

C: 38/60

Upfront concomitant chemotherapy:

I: 9/60

C: 10/60

Adjuvant (post-surgery) IMRT/ conventional radiotherapy:

I: 9/60

C: 9/60

Adjuvant (post-surgery) concomitant chemotherapy:

I: 4/60

C: 3/60

Timing:

During the course of (chemo)radiotherapy and up to thirty weeks after the start of cancer treatment.

Content:

Personalized swallowing therapy: stretching exercises to maximize tongue, jaw and larynx mobility, depending on the specific dysfunction and limited mobility i.c.w. compensatory and swallowing maneuvers, bolus modification, swallowing education, and dietary counseling.

Frequency:

Three sessions/day, seven days per week.

Duration: at least five min. per session.

Total duration:

Approximately 30 weeks.

Adherence:

Patients were weekly seen by an SLP during cancer treatment and every two months i.c.w. weekly telephone sessions after cancer treatment.

Blinding:

No blinding of therapists, study staff, and patients.

Timing:

During (chemo)radiotherapy. Further timing information is unclear.

Content:

Standard care meaning dietary counseling.

Swallowing therapy was only given on indication following referral of the radiation oncologist.

Frequency:

Dietary counseling every week and during the rehabilitation period at least every two months (or more frequently as needed).

Total duration:

Unclear.

Adherence:

Unclear.

Battery of measures at week 0 (the first week of (chemo)radiotherapy), week 6 (the last week of treatment), week 10 (one month after treatment), week 18 (three months after (chemo)radiotherapy) and week 30 (six months after treatment).

Swallowing function:

Dysphagia-specific questionnaire (Patient-reported outcome):

-MDADI

Dysphagia-specific questionnaire (Clinician-reported outcome):

-Performance Status Scale-Head and Neck Cancer (PSS-H&N)

-Normalcy of Food Intake Scale for Head and Neck Logopedic Part (NFIS-HN-L)

Clinical assessment of swallowing:

-Swallowing capacity (swallowing velocity and swallowing volume test)

Nutritional status:

Clinician-reported outcome: Normalcy of food Intake Scale for Head and Neck Dietetic Part (NFIS-HN-F)

BMI:

-Kg/m²

9

Carnaby-Mann, 2012

Oropharyngeal carcinoma – (chemo)radiotherapy

I/C1/C2: 20/20/18

Male/Female:

I: 18/2
C1: 15/5

C2: 11/7

Mean age (SD):

I: 59.0 (10.4)

C1: 54.0 (11.3)

C2: 60.0 (12.2)

Primary tumor location:

Base of tongue:

I: 5/20

C1: 3/20

C2: 3/18

Tonsil:

I: 3/20

C1: 9/20

C2: 4/18

Unknown:

I: 12/20

C1: 8/20

C2: 11/18

Primary tumor size:

Median T-stage (range):

I: 2 (1-4)

C1: 2 (0-4)

C2: 2 (1-4)

Cancer stage grouping:

-

Conventional radiotherapy:

I: 9/20

C1: 9/20

C2: 6/18

IMRT:

I: 11/20

C1: 11/20

C2: 12/18

Concomitant chemotherapy:

I: 6/20

C1: 10/20

C2: 6/18

Neck dissection:

I: 8/20

C1: 8/20

C2: 6/18

Timing:

During the course of (chemo)radiotherapy.

Content:

Standardized high intensity swallowing therapy (“pharyngocise”: e.g., falsetto, tongue press, hard swallow, and jaw resistance/strengthening using the Therabite Jaw Motion Rehabilitation System and dietary modifications) and dietary modification.

Frequency:

Two sessions/day

Duration: 45 min per session.

Total duration:

Maximum of six weeks.

Adherence:

Direct therapy by the SLP.

Patients completed a daily home record of the exercises conducted between treatment sessions.

Blinding:

No blinding of therapists and patients.

Blinding of study staff.

C1:

Timing:

During the course of (chemo)radiotherapy.

Content:

Usual care –no exercise, supervision for feeding and precautions for safe swallowing (e.g., positioning, slowed rate of feeding) by the hospital speech pathology service.

Frequency:

Unclear.

Adherence:

Weekly telephone calls to monitor the swallowing outcome.

C2:

Timing:

During the course of (chemo)radiotherapy.

Content:

Standardized sham therapy (Buccal extension exercises + dietary modifications).

Frequency:

Two sessions/day - 14 sessions/week.

Total sessions: 84

Duration:

45 min per session (90 min/day).

Total duration:

63 hours in 6 weeks.

Adherence:

Direct therapy by the SLP.

Patients completed a daily home record of the exercises conducted between treatment sessions.

Battery of measures at baseline (before (chemo)radiotherapy) and 6 weeks, 6 months after randomization.

Swallowing function:

Dysphagia-specific questionnaire (Clinician-reported outcome):

-Functional Oral Intake Scale (FOIS)

Clinical assessment of swallowing:

-Mann Swallowing Assessment (MASA)

-Mouth opening

Swallow imaging:

-Videofluoroscopic imaging: scoring unclear

-Endoscopic imaging: scoring unclear

-MRI of swallowing muscles

Regarding videofluoroscopic evaluation and endoscopic imaging: No clear description of the measurement or outcome variables is provided; only pre- and post-intervention numerical values are reported. Due to the poor methodological quality, it is unclear what was actually measured, making the results unreliable.

Regarding MRI of swallowing muscles: The studies measured changes in muscle size but did not adequately explain whether these changes translated into functional improvements. The methodological quality is poor, suggesting a risk of reporting bias. The clinical relevance for swallowing function is unclear due to methodological limitations.

Aspiration pneumonia:

-Type of assessment unclear

Nutritional status:

Weight :

-Kg

Start of the intervention after completion of cancer treatment.

10

Petersson, 2023

Oropharyngeal, hypopharyngeal, and laryngeal carcinoma – (chemo)radiotherapy

I/C: 25/27

Male/Female:

I: 18/7
C: 21/6

Mean age (SD):

I: 63.7 (8.4)

C: 63.7 (6.7)

Primary tumor location:

Tonsil:

I: 11/25

C: 10/27

Base of tongue:

I: 10/25

C: 10/27

Hypopharynx:

I: 1/25

C: 3/27

Larynx:

I: 3/25

C: 4/27

Cancer stage grouping:

Stage I:

I: 1/25

C: 2/27

Stage II:

I: 4/25

C: 2/27

Stage III:

I: 1/25

C: 2/27

Stage IV:

I: 19/25

C: 21/27

Upfront radiotherapy:

I: 5/25

C: 5/27

Upfront brachytherapy:

I: 10/25

C: 7/27

Unclear who received IMRT or brachytherapy (with or without chemotherapy) in I and C as the brachytherapy patients are not representing a separate independent group – otherwise the total N of I/C would be more then 25/27

Upfront induction or concomitant chemoradiotherapy:

I: 20/25

C: 22/27

Unclear who received induction or concomitant chemotherapy in I and C

Timing:

More than 6 months post-(chemo)radiotherapy (range 6-36 months).

Time since completion of (chemo)radiotherapy (months):

I: 11.2 (5.9)

Content:

Shaker head-lift exercises (isometric & isokinetic) i.c.w. usual care, i.e., advice about food, drinking, head position, or swallowing maneuvers, such as the supraglottic swallow, effortful swallow, and the Mendelsohn maneuver during meals.

Frequency:

Three sessions/day, seven days per week.

Duration: unclear.

Total duration:

Eight weeks.

Adherence:

The patients in the intervention group documented the adherence to the recommended exercise in a diary.

The first 2 weeks, the study SLP met with the patient two times per week to monitor training technique. The remainder of the period, technique was supervised once every 2 weeks with follow-ups by telephone in between meetings. Only the intervention group had contact with the study SLP during the initial period.

The mean number of training sessions performed by the intervention group during the 8 weeks was 18.7 (89%). After the 8-week follow-up, participants were recommended to exercise once daily, or a minimum of three sessions per week for 12 months and the mean number of performed training sessions per week was 3.0.

Blinding:

No blinding of therapists, patients, and study staff.

Timing:

More than 6 months post-(chemo)radiotherapy (range 6-36 months).

Time since completion of (chemo)radiotherapy (months):

C: 13.0 (8.1)

Content:

Usual care, i.e., advice about food, drinking, head position, or swallowing maneuvers, such as the supraglottic swallow, effortful swallow, and the Mendelsohn maneuver during meals.

Frequency:

Unclear.

Total duration:

Unclear.

Adherence:

Not applicable.

Blinding:

No blinding of therapists, patients, and study staff.

Battery of measures at baseline (more than 6 months post-(chemo)radiotherapy) and at 2 (8 weeks), and at 12 months after completing the exercise intervention.

Swallowing function:

Dysphagia-specific questionnaire (Patient-reported outcome):

-MDADI

Clinical assessment of swallowing:

-Mouth opening

-Salivary flow

(Measurement method not reported)

HRQOL:

HRQOL questionnaire:

-EORTC QLQ-C30

-EORTC QLQ-H&N35

Aspiration pneumonia:

-Type of assessment unclear

Nutritional status:

BMI:

- Kg/m²

Tube feeding

-Present/absent

11

Dotevall, 2022

Oropharyngeal, hypopharyngeal, and laryngeal carcinoma – (chemo)radiotherapy (upfront)

I/C: 23/24

Male/Female:

I: 16/7
C: 19/5

Mean age (SD):

I: 63.0 (8.2)

C: 62.7 (6.4)

Primary tumor location:

Tonsil:

I: 10/23

C: 10/24

Base of tongue:

I: 9/23

C: 9/24

Hypopharynx:

I: 1/23

C: 2/24

Larynx:

I: 3/23

C: 3/24

Cancer stage grouping:

Stage I:

I: 1/23

C: 2/24

Stage II:

I: 4/23

C: 2/24

Stage III:

I: 0/23

C: 2/24

Stage IV:

I: 18/23

C: 18/24

Upfront IMRT/conventional radiotherapy:

I: 23/23

C: 24/24

Upfront brachytherapy:

I: unclear

C: unclear

Upfront induction chemotherapy:

I: unclear

C: unclear

I+C: 29/47

Upfront concomitant chemotherapy:

I: unclear

C: unclear

I+C: 8/47

Timing:

More than 6 months post-(chemo)radiotherapy (range 6-36 months).

Time since completion of (chemo)radiotherapy (months):

I: 11.2 (5.9)

Content:

Shaker head-lift exercises (isometric & isokinetic) i.c.w. usual care, i.e., advice about food, drinking, head position, or swallowing maneuvers, such as the supraglottic swallow, effortful swallow, and the Mendelsohn maneuver during meals.

Frequency:

Three sessions/day, seven days per week.

Duration: unclear.

Total duration:

Eight weeks.

Adherence:

The patients in the intervention group documented the adherence to the recommended exercise in a diary.

During the 8 weeks of training, the patients met the SLP during five sessions for a control of the training performance with telephone follow-ups in between. Adherence to treatment was between 78% and 93% of the recommended training with on average 2.6–2.9 of the prescribed three training sessions per day.

Blinding:

No blinding of therapists, patients, and study staff. Blinded rating of endoscopic imaging.

Timing:

More than 6 months post-(chemo)radiotherapy (range 6-36 months).

Time since completion of (chemo)radiotherapy (months):

C: 13.0 (8.1)

Content:

Usual care, i.e., advice about food, drinking, head position, or swallowing maneuvers, such as the supraglottic swallow, effortful swallow, and the Mendelsohn maneuver during meals.

Frequency:

Unclear.

Total duration:

Eight weeks.

Adherence:

Not applicable.

Blinding:

No blinding of therapists, patients, and study staff. Blinded rating of endoscopic imaging.

Battery of measures at baseline (more than 6 months post-(chemo)radiotherapy) and 2 months after completing the exercise intervention.

Swallowing function:

Dysphagia-specific questionnaire (Patient-reported outcome):

-EAT-10

Swallow imaging:

-Endoscopic imaging: Murray secretion scale, initiation of the pharyngeal swallow, Penetration Aspiration Scale, Yale Pharyngeal Residue Scale, Swallowing Performance Status Scale (SPSS).

12

Tuomi, 2022

Oropharyngeal, hypopharyngeal, and laryngeal carcinoma – (chemo)radiotherapy (upfront)

I/C: 25/27

Male/Female:

I: 18/7
C: 21/6

Mean age (SD):

I: 63.7 (8.4)

C: 63.7 (6.7)

Primary tumor location:

Tonsil:

I: 11/25

C: 10/27

Base of tongue:

I: 9/25

C: 10/27

Hypopharynx:

I: 3/25

C: 3/27

Larynx:

I: 2/25

C: 4/27

Cancer stage grouping:

Stage I:

I: 2/25

C: 3/27

Stage II:

I: 3/25

C: 2/27

Stage III:

I: 1/25

C: 4/27

Stage IV:

I: 19/25

C: 18/27

Upfront IMRT/conventional radiotherapy:

I: 25/25

C: 27/27

Upfront brachytherapy:

I: 10/25

C: 7/27

Upfront induction chemotherapy:

I: 4/25

C: 5/27

Upfront concomitant chemotherapy:

I: 16/25

C: 17/27

Timing:

More than 6 months post-(chemo)radiotherapy (range 6-36 months).

Time since completion of (chemo)radiotherapy (months):

I: 11.2 (5.9)

C: 13.0 (8.1)

Content:

Shaker head-lift exercises (isometric & isokinetic) i.c.w. usual care, i.e., advice regarding changing the consistencies of solid food or drinks, head positioning such as chin tuck, swallowing maneuvers such as the supraglottic swallow, effortful swallow or the Mendelsohn maneuver, and eating/drinking slowly, in small sips or bites and with sips of water in between bites.

Frequency:

Three sessions/day, seven days per week.

Duration: unclear.

Total duration:

Eight weeks.

Adherence:

The patients in the intervention group documented the adherence to the recommended exercise in a diary.

During the 8 weeks of training, the patients met the SLP during five sessions for a control of the training performance with telephone follow-ups in between. Adherence to treatment was between 80% and 93% of the recommended training with on average 2.6–2.8 of the prescribed three training sessions per day.

Blinding:

No blinding of therapists, patients, and study staff. Blinded rating of videofluoroscopic imaging.

Timing:

More than 6 months post-(chemo)radiotherapy (range 6-36 months).

Time since completion of (chemo)radiotherapy (months):

I: 11.2 (5.9)

C: 13.0 (8.1)

Content:

Usual care, i.e., advice regarding changing the consistencies of solid food or drinks, head positioning such as chin tuck, swallowing maneuvers such as the supraglottic swallow, effortful swallow or the Mendelsohn maneuver, and eating/drinking slowly, in small sips or bites and with sips of water in between bites.

Frequency:

Unclear.

Total duration:

Eight weeks.

Adherence:

Not applicable.

Blinding:

No blinding of therapists, patients, and study staff. Blinded rating of videofluoroscopic imaging.

Battery of measures at baseline (more than 6 months post-(chemo)radiotherapy) and 2 months after completing the exercise intervention.

Swallowing function:

Swallow imaging:

-Videofluoroscopic imaging: Penetration Aspiration Scale, Yale Pharyngeal Residue Scale modified for videofluoroscopy, Swallowing Performance Status Scale (SPSS), kinematic variables (anterior hyoid movement, superior hyoid movement, thyrohyoid approximation, maximum width of the UES opening during swallowing).

HRQOL:

HRQOL questionnaire:

-EORTC QLQ-H&N35 : swallowing & social eating domain

13

Jansen, 2020

Larynx carcinoma – primary or salvage laryngectomy

I/C: 46/46

Male/Female:

I: 36/10
C: 41/5

Mean age (SD):

I: 65 (7)

C: 64 (9)

Primary tumor location:

Larynx:

I: 46/46

C: 46/46

Cancer stage grouping: Unclear

Primary laryngectomy:

I: 22/46

C: 21/46

Salvage laryngectomy:

I: 24/46

C: 25/46

Neck dissection:

I: 31/46

C: 31/46

(Chemo)radiotherapy before or after total laryngectomy:

I: 40/46

C: 38/46

Timing:

Mean time since laryngectomy (months - SD):

I: 24 (18)

<6 months post-laryngectomy:

I: 10/46

6 months – 5 years post-laryngectomy:

I: 36/46

Content:

Seven flexibility exercises for the head, neck and shoulders, eight range of-motion exercises for the tongue, lips, and jaw, and, in case of facial lymphedema, five additional lymphedema exercises plus a self-care education program providing information and self-care advice on stoma care, voice prosthesis care, speech, smelling, nutrition, and mobility.

Frequency:

Three sessions/day, seven days per week.

Duration: unclear.

Total duration:

Twelve weeks.

Adherence:

The patients in the intervention group documented the adherence to the recommended exercises in a diary.

During the 12 weeks of training, the patients were contacted weekly by the SLP via e-mail or telephone.

Adherence to treatment was high in 20 patients (49%), moderate in 4 patients (10%), and low in 17 patients (41%).

Blinding:

No blinding of therapists, patients, and study staff.

Timing:

Mean time since laryngectomy (months - SD):

C: 19 (15)

<6 months post-laryngectomy:

C: 10/46

6 months – 5 years post-laryngectomy:

C: 36/46

Content:

A self-care education program providing information and self-care advice on stoma care, voice prosthesis care, speech, smelling, nutrition, and mobility.

Frequency:

Unclear.

Total duration:

Twelve weeks.

Adherence: -

Blinding:

No blinding of therapists, patients, and study staff.

Measures at baseline (immediately after the intervention), and at three and six months follow-up.

Swallowing function:

Dysphagia-specific questionnaire (Patient-reported outcome):

-SWAL-QOL

HRQOL:

HRQOL questionnaire:

-EORTC QLQ-C30

-EORTC QLQ-H&N35

14

Chen, 2018a

Oral cavity carcinoma – (chemo)radiotherapy (adjuvant)

I/C: 38/38

Male/Female:

I: 36/2
C: 37/1

Mean age (SD):

I: 53.03 (8.67)

C: 51.13 (7.99)

Primary tumor location:

Lip:

I: 0/38

C: 1/38

Buccal mucosa:

I: 9/38

C: 14/38

Oral tongue:

I: 19/38

C: 14/38

Gingivae:

I: 5/38

C: 3/38

Mouth floor:

I: 2/38

C: 2/38

Hard palate:

I: 1/38

C: 0/38

Retromolar:

I: 2/38

C: 4/38

Cancer stage grouping:

Stage I:

I: 3/38

C: 2/38

Stage II:

I: 2/38

C: 5/38

Stage III:

I: 6/38

C: 7/38

Stage IV:

I: 27/38

C: 24/38

Adjuvant (post-surgery) IMRT/ conventional radiotherapy:

I: 8/38

C: 10/38

Adjuvant (post-surgery) chemotherapy:

I: 1/38

C: 1/38

Adjuvant (post-surgery) concomitant chemoradiotherapy:

I: 29/38

C: 27/38

Timing:

More than 3 months post-(chemo)radiotherapy up to six months exercise intervention.

Content:

 Swallowing exercise education and practice, including postural changes (chin tuck, head turn, head tilt, and head back), and swallow maneuvers (supraglottic swallow, super-supraglottic swallow, Mendelsohn maneuver, and effortful swallow) i.c.w. bolus modification.

Frequency:

Three sessions/day, seven days per week.

Duration: 15-20 min. per session.

Total duration:

Six months.

Adherence:

Participants received text messages weekly as reminders, and telephone follow-up was provided biweekly from initiating and participating in this study to 6 months after participating in this study

Blinding:

No blinding of therapists, patients, and study staff.

Timing:

Unclear

Content:

The control group participants were instructed to follow the usual routine-care regimen at the institution.

Frequency:

Unclear.

Total duration:

Unclear.

Adherence:

Unclear.

Blinding:

No blinding of therapists and patients.

Blinding of study staff.

Battery of measures at baseline (more than 3 months post-(chemo)radiotherapy), and 1, 2, 3, and 6 months after completing the exercise intervention.

Swallowing function:

Dysphagia-specific questionnaire (Patient-reported outcome):

-SSQ

-MDADI

Dysphagia-specific questionnaire (Clinician-reported outcome):

-Functional Oral Intake Scale (FOIS)

Swallow imaging:

-Videofluoroscopic imaging: Swallowing Performance Status Scale (SPSS)

Mental health:

Affective symptom questionnaire:

-HADS

15

Tang, 2011

Nasopharyngeal carcinoma – radiotherapy (upfront)

I/C: 22/21

Male/Female:

I: Unclear
C: Unclear

Median age (range):

I: Unclear

C: Unclear

Primary tumor location:

Nasopharynx:

I: 22/22

C: 21/21

Cancer stage grouping:

Unclear

Upfront radiotherapy:

I: 22/22

C: 21/21

Timing:

The postradiotherapy interval was 4.6 ± 1.8 years.

Content:

The exercises and management of dysphagia include pharyngeal or cervical esophageal dilation, dietary modifications, postural strategies, thermotherapy, swallowing maneuvers, such as the super-supraglottic swallow and the Mendelsohn maneuver, and therapeutic exercises that target strength and range of motion for lips, tongue, and larynx.

Frequency:

Three sessions/day, seven days per week.

Duration: unclear.

Total duration:

Unclear.

Adherence:

Study journals/home records on exercise-execution, an appointed guardian, a rehabilitation calendar. If a patient missed more than 15% of all days, the patient was excluded – number of exclusion unclear.

Blinding:

No blinding of therapists, patients, and study staff.

Timing:

The postradiotherapy interval was 4.8 ± 1.6 years.

Content:

No treatment.

Frequency:

Not applicable.

Total duration:

Not applicable.

Adherence:

Not applicable.

Blinding:

No blinding of therapists, patients, and study staff.

Battery of measures at baseline (after radiotherapy – unclear definition) and 3 months after the exercise interventions. Also not specified – unclear.

Swallowing function:

Clinical assessment of swallowing:

-Water swallowing test – 30 ml within 5 seconds.

-Mouth opening

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
median(range)

Follow-up

median(range)

Difference

N

Baseline
median(range)

Follow-up

median(range)

Difference

Change

CR

Wu, 2023

MASA-OC

Baseline (6^th day after surgery)- 15^th day after surgery

Exercise + usual care vs. usual care

62

Median (P25-P75)

92.5 (82.0~99.0)

Median (P25-P75)

101.5 (93.0~109.0)

AD -9

59

Median (P25-P75)

89.0(81.0~96.0)

Median (P25-P75)

99.0 (90.5~103.0)

AD -10

AD 1

No

Baseline- 1 month day after surgery

Exercise + usual care vs. usual care

62

Median (P25-P75)

92.5 (82.0~99.0)

Median (P25-P75)

112.0 (107.0~116.0)

AD -19,5

59

Median (P25-P75)

89.0(81.0~96.0)

Median (P25-P75)

103.0 (94.0~109.0)

AD -14

AD 5.5

No

Zhang, 2022

MASA-OC

Baseline (6^th day after surgery)- 15^th day after surgery before the start of (chemo)radiotherapy

Exercise + usual care vs. usual care

34

Median (P25-P75)

93.00 (78.00 ~ 99.25)

Median (P25-P75)

104.00 (98.25 ~ 109.00)

AD -11

34

Median (P25-P75)

87.00 (77.75 ~ 96.00)

Median (P25-P75)

94.50 (87.75 ~ 104.25)

AD -7.50

AD 3.5

No

Baseline (6^th day after surgery)- 1 month after surgery before the start of (chemo)radiotherapy

Exercise + usual care vs. usual care

34

Median (P25-P75)

93.00 (78.00 ~ 99.25)

Median (P25-P75)

113.00(108.75 ~ 116.00)

AD -20

34

Median (P25-P75)

87.00 (77.75 ~ 96.00)

Median (P25-P75)

102.00 (94.75 ~ 108.25)

AD -15

AD 5

No

Mortensen, 2015

Mouth opening (interdental distance in mm)

Pre-treatment-2 months

Exercise vs. usual care

19

52 (40–60)

47 (29–59)

AD 5

34

46 (17–69)

43 (28–57)

AD 3

AD 2

No

Mouth opening (interdental distance in mm)

Pre-treatment-5 months

Exercise vs. usual care

19

52 (40–60)

48 (39–59)

AD 4

34

46 (17–69)

43 (25–61)

AD 3

AD 1

No

Mouth opening (interdental distance in mm)

Pre-treatment-11 months

Exercise vs. usual care

19

52 (40–60)

50 (31–65)

AD 2

34

46 (17–69)

45 (33–60)

AD 1

AD 1

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
mean (range)/ %

Follow-up

mean (range)/ %

Difference

N

Baseline
mean (range)/ %)

Follow-up

mean (range)/ %

Difference

Change

CR

Mortensen, 2015

Videofluoroscopic imaging:

20

SPSS

Pre-treatment-2months

Exercise vs. usual care

19

1.44 (1–6)

2.36 (1–7)

AD -0.92

20

1.38 (1–4)

2.83 (1–6)

AD -1.45

AD 0.53

No

Pre-treatment-5 months

Exercise vs. usual care

19

1.44 (1–6)

1.85 (1–6)

AD -0.41

20

1.38 (1–4)

2.45 (1–6)

AD -1.07

AD 0.66

No

Pre-treatment-11 months

Exercise vs. usual care

19

1.44 (1–6)

1.92 (1–6)

AD -0.48

20

1.38 (1–4)

2.75 (1–5)

AD -1.38

AD 0.9

No

aspiration (0-2)

Pre-treatment-2months

Exercise vs. usual care

19

5.56 %

5.56%

0.00%

20

4.76 %

4.76%

0%

0%

No

Pre-treatment-5 months

Exercise vs. usual care

19

5.56 %

14.29%

-8.73%

20

4.76 %

16.67%

-12%

3%

No

Pre-treatment-11 months

Exercise vs. usual care

19

5.56 %

7.69%

-2.13%

20

4.76 %

18.18%

-13%

11%

No

penetration

Pre-treatment-2months

Exercise vs. usual care

19

5.56 %

16.67%

-11.11%

20

14.29 %

12.5%

2%

-13%

No

Pre-treatment-5 months

Exercise vs. usual care

19

5.56 %

5.56 %

0.00%

20

14.29 %

14.29 %

0%

0%

No

Pre-treatment-11 months

Exercise vs. usual care

19

5.56 %

28.57 %

-23,01%

20

14.29 %

41.67 %

-27%

4%

No

cough

Pre-treatment-2months

Exercise vs. usual care

19

11.11 %

23.08 %

-11.97%

20

9.52 %

45.45 %

-36%

24%

No

Pre-treatment-5 months

Exercise vs. usual care

19

11.11 %

42.66 %

-31.55%

20

9.52 %

50 %

-40%

9%

No

Pre-treatment-11 months

Exercise vs. usual care

19

11.11 %

11.11 %

0.00%

20

9.52 %

9.52 %

0%

0%

No

residue

Pre-treatment-2months

Exercise vs. usual care

19

44.44 %

28.57 %

15.87%

20

28.57 %

58.33 %

-30%

46%

Yes

Pre-treatment-5 months

Exercise vs. usual care

19

44.44 %

23.08 %

21.36%

20

28.57 %

27.27 %

1%

20%

No

Pre-treatment-11 months

Exercise vs. usual care

19

44.44 %

33.33 %

11.11%

20

28.57 %

50 %

-21%

33%

Yes

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
mean (SD)

Follow-up

mean (SD)

Difference

N

Baseline
mean (SD)

Follow-up

mean (SD)

Difference

Change

CR

Wu, 2023

UW-QoL

v4

Pre-operative-1 month after surgery

Exercise + usual care vs. usual care

62

1094.3 (129.3)

975.8 (139.0)

AD 118.5

59

1061.3 (170.4)

843.4 (149.9)

AD 217.9

AD -99.4

No

Zhang, 2022

UW-QOLv4

1 month after surgery

Exercise + usual care vs. usual care

34

nr

996.39 (75.67)

na

34

nr

809.62 (152.12)

na

MD follow-up 186.77 (129.66 to 243.88)

No

Mortensen, 2015

Global health (median, 25-75)

Pre-treatment-2months

Exercise vs. usual care

19

median (range)

67 (50; 83)

median (range)

50 (33; 67)

AD 17

20

median (range)

75 (58; 83)

median (range)

71 (67; 88)

AD 4

AD 13

No

Pre-treatment-5 months

Exercise vs. usual care

19

median (range)

67 (50; 83)

median (range)

67 (33; 83)

AD 0

20

median (range)

75 (58; 83)

median (range)

83 (83; 83)

AD 8

AD -8

No

Pre-treatment-11 months

Exercise vs. usual care

19

median (range)

67 (50; 83)

median (range)

83 (75; 88)

AD -16

20

median (range)

75 (58; 83)

median (range)

79 (67; 88)

AD -4

AD -12

No

Study

Measure

Timing

Comparison

Intervention group

Control group

Comparison between groups

CR

N

Mean

Range (P25~P75)

N

Mean

Range (P25~P75)

Wu, 2023

Weight loss (%)

6th vs. 15th day after the operation

Exercise vs. usual care

62

−0.15

−1.40–1.83

59

1.99

0.58–4.04

AD -2,14

N0

6^th day vs. 1 month after the operation

Exercise vs. usual care

62

−1.45

−3.25–1.52

59

1.73

−0.47–3.95

AD -3.18

N0

Zhang, 2022

Weight loss (%)

6th vs. 15th day after the operation

Exercise vs. usual care

34

− 0.20

-1.10; 1.09

34

2.45

0.91; 5.43

AD -2.65

N0

6^th day vs. 1 month after the operation

Exercise vs. usual care

34

− 1.54

-3.40; 1.12

34

3.33

-0.54; 4.88

AD -4.87

N0

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD) or /%

Follow-up

Mean (SD)/%

Difference

Mean (SD)/%

N

Baseline
Mean (SD)/%

Follow-up

Mean (SD)/%

Difference

Mean (SD)/%

Change

Mean (95% CI)/%

CR

Fredslund Hajdu, 2021

MDADI-E

End-of-treatment (6 weeks)

Exercise vs. usual care

98

nr

nr

nr

105

nr

nr

nr

Difference in scores; 3.71 (-1.42 to 7.75)

No

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

-2.95 (-7.32 to 1.42)

No

6 month follow-up

Exercise vs. usual care

85

nr

nr

nr

80

nr

nr

nr

Difference in scores;

-0.96 (-5.87 to 3.96)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

-2.25 (-7.07 to 2.58)

No

MDADI-F

End-of-treatment (6 weeks)

Exercise vs. usual care

98

nr

nr

nr

105

nr

nr

nr

Difference in scores;

3.83 (-1.26 to 8.92)

No

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

-7.14 (-12.22 to -2.05)

No

6 month follow-up

Exercise vs. usual care

85

nr

nr

nr

80

nr

nr

nr

Difference in scores;

(-7.05 (-13.04 to -1.07)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

0.22 (-5.54 to 5.98)

No

MDADI-P

End-of-treatment (6 weeks)

Exercise vs. usual care

98

nr

nr

nr

105

nr

nr

nr

Difference in scores;

5.00 (-0.51 to 10.52)

No

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

3.50 (-1.82 to 8.82)

No

6 month follow-up

Exercise vs. usual care

85

nr

nr

nr

80

nr

nr

nr

Difference in scores;

-2.72 (-8.74 to 3.31)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

-5.43 (-11.25 to 0.39)

No

Kumar, 2016

MDADI

Baseline-6 months

Exercise vs. usual care

25

nr

14

na

25

nr

7.76

na

AD follow-up 6.24

No

Van den Berg, 2016

MDADI-E

Baseline-3 months

Exercise vs. usual care

57

79 (12)

76 (12)

nr

57

81(10)

78 (11)

nr

-0.4 (-5.0 to 4.2)

No

Baseline-6 months

Exercise vs. usual care

57

79 (12)

80 (12)

nr

57

81(10)

81 (11)

nr

0.0 (-0.2 to 0.2)

No

MDADI-F

Baseline-3 months

Exercise vs. usual care

57

78 (11)

76 (15)

nr

57

80 (9)

77 (12)

nr

-0.1 (-5.4 to 5.1)

No

Baseline-6 months

Exercise vs. usual care

57

78 (11)

79 (11)

nr

57

80 (9)

79 (10)

nr

0.1 (-0.1 to 0.3)

No

MDADI-P

Baseline-3 months

Exercise vs. usual care

57

76 (19)

65 (17)

nr

57

78 (18)

68 (18)

nr

-0.3 (-6.5 to 5.9)

No

Baseline-6 months

Exercise vs. usual care

57

76 (19)

74 (17)

nr

57

78 (18

77 (17)

nr

0.0 (-0.3 to 0.3)

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)/%

Follow-up

Mean (SD)/%

Difference

Mean (SD)/%

N

Baseline
Mean (SD)/%

Follow-up

Mean (SD)/%

Difference

Mean (SD)/%

Change

Mean (95% CI)/%

CR

Fredslund Hajdu, 2021

FOIS

End-of-treatment (6 weeks)

Exercise vs. usual care

98

nr

nr

nr

105

nr

nr

nr

Difference in scores;

0.00 (-0.34 to 0.33)

No

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

-0.10 (-0.43 to 0.24)

No

6 month follow-up

Exercise vs. usual care

85

nr

nr

nr

80

nr

nr

nr

Difference in scores;

0.16 (-0.20 to 0.53)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

-0.14 (-0.49 to 0.21)

No

Carnaby-Mann, 2012

FOIS

Baseline-6 weeks

Exercise vs. usual care

20

Median (range)

7 (5-7)

Median (range)

5 (2-7)

AD 2

20

Median (range)

7 (5-7)

Median (range)

4 (1-6)

AD 3

AD 1

Yes

Baseline-6 weeks

Exercise vs. sham exercise/compensatory strategies

20

Median (range)

7 (5-7)

Median (range)

5 (2-7)

AD 2

18

Median (range)

7 (5-7)

Median (range)

4 (1-7)

AD 3

AD 1

Yes

Messing, 2017

FOIS 1-5 (more impaired diet level)

Baseline-3 months post CRT

Exercise vs. usual care

30

0%

50%

AD -50%

30

10%

60%

AD -50%

AD 0

No

Baseline-6 months post CRT

Exercise vs. usual care

30

0%

27%

AD -27%

30

10%

33%

AD -22%

AD 5%

No

Baseline-12 months post CRT

Exercise vs. usual care

30

0%

12%

AD -12%

30

10%

4%

AD 6%

AD 18%

No

Van den Berg, 2016

PSS-HN-normalcy of diet

Baseline-3 months

Exercise vs. usual care

57

78 (26)

59 (25)

nr

57

75 (25)

60 (29)

nr

-5.0 (-16.1 to 6.1)

No

Baseline-6 months

Exercise vs. usual care

57

78 (26)

85 (21)

nr

57

75 (25)

79 (24)

nr

5.3 ( -4.2 to 14.9)

No

NFIS-HN-L

Baseline-3 months

Exercise vs. usual care

57

5.5 (0.9)

4.6 (1.3)

nr

57

5.6 (0.6)

4.6 (1.3)

nr

0.0(-0.4 to 0.3)

No

Baseline-6 months

Exercise vs. usual care

57

5.5 (0.9)

5.6 (0.7)

nr

57

5.6 (0.6)

5.3 (0.7)

nr

0.2 (-0.2 to 0.7)

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)/ %

Follow-up

Mean (SD) / %

Difference

Mean (SD) / %

N

Baseline
Mean (SD) / %

Follow-up

Mean (SD) / %

Difference

Mean (SD) / %

Change

Mean (95% CI) / %

CR

Kumar, 2016

ASHA

6 months

Exercise vs. usual care

25

nr

6.44 (nr)

na

25

nr

5.8 (nr)

na

AD follow-up 0.64

No

Messing, 2017

Oro-motor assessment

Baseline-3 months post CRT

Exercise vs. usual care

30

13%

24%

-11%

30

16%

9%

5%

16%

No

Baseline-6 months post CRT

Exercise vs. usual care

30

13%

33%

-20%

30

16%

5%

11%

31%

Yes

Baseline-12 months post CRT

Exercise vs. usual care

30

13%

12%

-1%

30

16%

8%

8%

9%

No

Carnaby-Mann, 2012

MASA

Baseline-6 weeks

Exercise vs. usual care

20

195.1 (5.9)

177.14 (12.5)

17.7 (10.1)

20

195.5 (4.0)

171.5 (14.2)

24.16 (13.4)

-6.46 (-13.81 to 0.89)

No

Baseline-6 weeks

Exercise vs. sham exercise/compensatory strategies

20

195.1 (5.9)

177.14 (12.5)

17.7 (10.1)

18

194.7 (3.5)

173.6 (11.8)

20.8 (12.9)

-3.10 (-10.52 to 4.32)

No

Van den Berg, 2016

Swallowing capacity (ml/s)

Baseline-3 months

Exercise vs. usual care

57

18 (10)

17 (10)

AD 1

57

17 (10)

18 (12)

AD -1

-0.0 (-4.0 to 3.8)

No

Baseline-6 months

Exercise vs. usual care

57

18 (10)

18 (9)

AD 0

57

17 (10)

19 (10)

AD -2

-2.0 (-5.3 to 1.3)

No

Water swallowing (ml)

Baseline-3 months

Exercise vs. usual care

57

42 (23)

44 (22)

AD 2

57

48 (22)

42 (24)

AD 6

-2.5 (-8.8 to 3.8)

No

Baseline-6 months

Exercise vs. usual care

57

42 (23)

48 (21)

AD -6

57

48 (22)

46 (23)

AD 2

5.9 (-1.1 to 12.9)

No

Fredslund Hajdu, 2021

Mouth opening

End-of-treatment (6 weeks)

Exercise vs. usual care

98

nr

nr

nr

105

nr

nr

nr

Difference in scores;

2.38 (0.61 to 4.16)

No

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

0.24 (-1.52 to 1.99)

No

6 month follow-up

Exercise vs. usual care

85

nr

nr

nr

80

nr

nr

nr

Difference in scores;

0.85 (-1.08 to 2.78)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

-0.16 (-1.98 to 1.67)

No

Messing, 2017

Mouth opening (incisal opening in mm)

Baseline-3 months post CRT

Exercise vs. usual care

30

50.7(5.9)

43.2(8.5)

AD 7.5

30

46.4(9.5)

41.9(8.4)

AD 4.5

AD 3

No

Baseline-6 months post CRT

Exercise vs. usual care

30

50.7(5.9)

43.9(8.5)

AD 6.8

30

46.4(9.5)

39.9(7.3)

AD 6.5

AD 0.3

No

Baseline-12 months post CRT

Exercise vs. usual care

30

50.7(5.9)

46.7(7.4)

AD 4

30

46.4(9.5)

43.8(7.0)

AD 2.6

AD 1.4

No

Carnaby-Mann, 2012

Mouth opening (in mm)

Baseline-6 weeks

Exercise vs. usual care

20

41.6 (8.4)

40.05 (8.3)

AD 1.6

20

36.6 (8.05)

32.3 (5.9)

AD 4.3

AD -2.7

No

Baseline-6 weeks

Exercise vs. sham exercise/compensatory strategies

20

41.6 (8.4)

40.05 (8.3)

AD 1.6

18

39.2 (6.4)

34.07 (7.3)

AD 5.1

AD -3.5

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Difference

Mean (SD)

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Difference

Mean (SD)

Change

Mean (95% CI)

CR

Fredslund Hajdu, 2021

Endoscopic imaging:

Penetration – aspiration (PAS)

PAS - liquid

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

0.15 (-0.25 to 0.55)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

0.28 (-0.14 to 0.70)

No

PAS – thickened liquid

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

-0.02 (-0.02 to 0.17)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

0.07 (-0.11 to 0.26)

No

Pharyngeal residue (YPRS)

Vallecula liquid

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

0.61 (0.10 to 1.12)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

0.16 (-0.39 to 0.70)

No

Vallecula thickened

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

0.78 (0.19 to 1.37)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

0.36 (-0.27 to 0.99)

No

Piriformis liquid

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

0.85 (0.19 to 1.51)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

-0.04 (-0.73 to 0.65)

No

Piriformis thickened

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

1.21 (0.41 to 2.01)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

0.52 (-0.32 to 1.37)

No

Hsiang, 2019

Videofluoroscopic imaging:

Penetration – aspiration (PAS)

Overall PAS score

Baseline-3 months

Exercise vs. usual care

20

2.20 (1.72)

2.00 (1.70)

0.20 (0.40)

20

2.05 (1.88)

2.20 (1.91)

-0.15 (0.65)

0.35 (0.02 to 0.68)

No

Oral residue

10 ml thin liquid

Baseline-3 months

Exercise vs. usual care

20

10.00 (7.75)

7.00 (7.14)

3.00 (4.58)

20

12.50 (9.42)

13.00 (10.05)

-0.50 (9.21)

3.50 (-1.01 to 8.01)

Yes

Nectar-like

Baseline-3 months

Exercise vs. usual care

20

13.50 (8.53)

6.50 (5.72)

7.00 (8.43)

20

9.50 (8.05)

13.50 (9.63)

-4.00 (6.63)

11.00 (6.30 to 15.70)

Yes

Honey-like

Baseline-3 months

Exercise vs. usual care

20

15.50 (8.65)

6.00 (4.90)

9.50 (6.69)

20

11.00 (9.43)

14.00 (8.60)

-3.00 (5.67)

12.00 (8.16 to 15.84)

Yes

Pudding-like

Baseline-3 months

Exercise vs. usual care

20

17.00 (9.54)

6.00 (6.63)

11.00 (9.43)

20

13.50 (9.10)

14.00 (9.70)

-0.50 (2.18)

11.50 (7.26 to 15.74)

Yes

Pharyngeal residue

10 ml thin liquid

Baseline-3 months

Exercise vs. usual care

20

10.00 (8.94)

7.00 (7.81)

3.00 (5.57)

20

6.50 (8.53)

7.50 (8.87)

-1.00 (7.68)

4.00 (-0.16 to 8.16)

Yes

Nectar-like

Baseline-3 months

Exercise vs. usual care

20

16.00 (7.35)

11.00 (5.39)

5.00 (5.00)

20

11.00 (10.44)

12.00 (10.30)

-1.00 (6.24)

6.00 (2.50 to 9.50)

Yes

Honey-like

Baseline-3 months

Exercise vs. usual care

20

18.50 (6.54)

12.00 (7.48)

6.50 (6.54)

20

15.00 (10.25)

15.50 (10.23)

-0.50 (3.84)

7.00 (3.68 to 10.32)

Yes

Pudding-like

Baseline-3 months

Exercise vs. usual care

20

20.00 (5.48)

13.50 (7.26)

6.50 (6.54)

20

16.50 (10.62)

17.00 (8.43)

-0.50 (6.69)

7.00 (2.90 to 11.10)

Yes

Study

Measure

Timing of measurement

Comparison

N

Baseline
%

Follow-up

%

Difference

%

N

Baseline
%

Follow-up

%

Difference

%

Change

%

CR

Messing, 2017

Videofluoroscopic imaging:

OPSE total score (seconds, percentage of abnormal)

Baseline- 3 months post CRT

Exercise vs. no exercise/usual care

30

11%

15%

-4%

30%

29%

46%

-17%

13%

No

DOSS (percentage of abnormal)

Baseline- 3 months post CRT

Exercise vs. no exercise/usual care

30

7%

40%

-33%

30%

11%

25%

-14%

19%

No

PAS penetration 2-5

Baseline- 3 months post CRT

Exercise vs. no exercise/usual care

30

10%

21%

-11%

30%

29%

38%

-9%

2%

No

PAS aspiration 6-8

Baseline- 3 months post CRT

Exercise vs. no exercise/usual care

30

7%

0%

7%

30%

7%

9%

-2%

9%

No

Kumar, 2016

Endoscopic imaging:

PAS

3 months

Exercise vs. usual care

25

6%

16%

10%

25%

6%

20%

14%

4%

No

6 months

Exercise vs. usual care

25

6%

8%

2%

25%

6%

16%

10%

8%

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Absolute difference

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Absolute difference

Change

Mean (95% CI)

CR

Fredslund Hadju, 2021

EORTC QLQ-C30 global QoL

End-of-treatment (6 weeks)

Exercise vs. usual care

98

nr

nr

nr

105

nr

nr

nr

Difference in scores;

4.89 (-1.35 to 11.13)

No

2 month follow-up

Exercise vs. usual care

97

nr

nr

nr

97

nr

nr

nr

Difference in scores;

1.92 (-4.31 to 8.16)

No

6 month follow-up

Exercise vs. usual care

85

nr

nr

nr

80

nr

nr

nr

Difference in scores;

0.87 (-6.11 to 7.85)

No

12 month follow-up

Exercise vs. usual care

90

nr

nr

nr

89

nr

nr

nr

Difference in scores;

1.00 (-6.15 to 8.14)

No

Messing, 2017

EORTC QLQ-H&HN35

Baseline-3 months post CRT

Exercise vs. no exercise/usual care

30

15.1(9.0)

23.2(14.0)

-8.1

30

23.1(16.7)

27.1(10.5)

-4

MD -3.90 (-10.16 to 2.36)

No

Baseline-6 months post CRT

Exercise vs. no exercise/usual care

30

15.1(9.0)

17.8(11.3)

-2.7

30

23.1(16.7)

22.6(12.0)

0.5

MD -4.80 (-10.70 to 1.10)

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Difference

Mean (MD) (95%CI)

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Difference

Mean (MD) (95%CI)

Change

Mean (95% CI)

CR

Van den Berg, 2016

NFIS-HN-F*

Baseline-3 months

Exercise vs. usual care

57

5.5 (0.9)

5.2 (0.9)

NR

57

5.6 (0.6)

5.6 (1.1)

Nr

0.0 (-0.4; 0.3)

No

Baseline-6 months

Exercise vs. usual care

57

5.6 (0.6)

5.6 (0.7)

NR

57

5.6 (0.6)

5.3 (0.7)

Nr

0.2 (-0.2; 0.7)

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
N (%)

Follow-up

N (%)

Difference

N

Baseline
N (%)

Follow-up

N (%)

Difference

Change (%)

CR

Van den Berg, 2016

Malnutrition (%)

3 months

Exercise vs. usual care

57

15 (26%)

16 (31%)

1 (-5%)

57

6 (10%)

16 (33%)

10 (-23%)

18%

Yes

6 months

Exercise vs. usual care

57

15 (26%)

10 (24%)

5 (2%)

57

6 (10%)

9 (20%)

3 (10%)

8%

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
N (%)

Follow-up

N (%)

Difference

N

Baseline
N (%)

Follow-up

N (%)

Difference

Change

CR

Messing 2017

PEG in situ (%)

Baseline-3 months post CRT

Exercise vs. no exercise/usual care

30

100%

76%

24%

30

100%

61%

39%

-15%

Yes

Baseline-6 months post CRT

Exercise vs. no exercise/usual care

30

100%

29%

71%

30

100%

18%

82%

-11%

Yes

Baseline-12 months post CRT

Exercise vs. no exercise/usual care

30

100%

14%

86%

30

100%

4%

96%

-10%

Yes

Baseline-24 months post CRT

Exercise vs. no exercise/usual care

30

100%

3%

97%

30

100%

0%

100%

-3%

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Difference

Mean (MD) (95%CI)/ Absolute difference (AD)

N

Baseline
Mean (SD)

Follow-up

Mean (SD)

Difference

Mean (MD) (95%CI)/ Absolute difference (AD)

Change

Mean (95% CI)/ AD

CR

Petersson, 2023

MDADI (total)

Baseline (6–36 months after completion of

(chemo)radiotherapy) - 8 weeks follow-up

Exercise vs. usual care

25

71.4 (17.9)

79.8 (16.3)

7.0 (1.7;

12.5)

27

73.2 (17.7)

77.7 (15.7)

4.5 (1.7; 7.2)

2.6 (− 3.3;

8.3)

No

Baseline-12 months follow-up

Exercise vs. usual care

19

71.4 (17.9)

77.4 (19.1)

3.1 (− 0.8; 7.1)

24

73.2 (17.7)

82.2 (14.9)

7.7 (2.9; 12.6)

− 4.6 (− 11.0; 1.5)

No

Dotevall, 2022

EAT-10

Baseline (6 months post therapy) - 2 months after completing the exercise intervention

Exercise vs. usual care

23

14.2 (10.3)

10.1 (8.1)

MD −4.1 (−6.9; −1.3)

24

14.0 (9.6)

12.5 (9.9)

MD − 1.5 (− 3.4; 0.6)

2.6 (−0.7; 6.0)

No

Jansen, 2020

SWAL-QOL

Baseline (immediately after the intervention) - 3 months after completing the exercise intervention

Exercise vs. usual care

37

29.2 (16.9)

28.4 (16.2)

0.8 (-6.74; 8.34)

44

32.7 (16.3)

31.4 (17.6)

1.30 (-5.79; 8.39)

-0.5

No

Baseline (immediately after the intervention) - 6 months after completing the exercise intervention

Exercise vs. usual care

36

29.2 (16.9)

25.8 (17.1)

3.40 (-4.45; 11.25)

42

32.7 (16.3)

35.0 (17.9)

-2.30 (-9.62; 5.02)

-5.7

No

Chen, 2018a

SSQ

Baseline-1 month

Exercise vs. usual care

38

585.00 (266.42)

543.68 (248.36)

AD 41.32

38

705.26 (246.67)

679.47 (220.66)

AD 25.79

15.53

No

Baseline-2 months

Exercise vs. usual care

38

585.00 (266.42)

587.89 (268.48)

AD -2.89

38

705.26 (246.67)

660.79 (222.95)

AD 44.47

47.36

No

Baseline-3 months

Exercise vs. usual care

38

585.00 (266.42)

629.74 (239.59)

AD -44.74

38

705.26 (246.67)

645.26 (213.02)

AD 60

104.74

No

Baseline-6 months

Exercise vs. usual care

38

585.00 (266.42)

651.84 (272.91)

AD -66.84

38

705.26 (246.67)

629.74 (190.27)

AD 75,52

142.36

No

MDADI (total)

Baseline-1 month

Exercise vs. usual care

38

120.28 (16.16)

80.72 (9.36)

AD 39,56

38

120.83 (13.31)

79.25 (8.09)

AD 41,58

-2.02

No

Baseline-2 months

Exercise vs. usual care

38

120.28 (16.16)

80.16 (9.70)

AD 40,12

38

120.83 (13.31)

81.38 (9.15)

AD 39.45

0.67

No

Baseline-3 months

Exercise vs. usual care

38

120.28 (16.16)

78.16 (9.64)

AD 42,12

38

120.83 (13.31)

81.21 (8.38)

AD 39.62

2.5

No

Baseline-6 months

Exercise vs. usual care

38

120.28 (16.16)

77.36 (10.73)

AD 42,92

38

120.83 (13.31)

81.17 (8.60)

AD 39.66

3.26

No

Intervention group (N=22)

Control group (N=21)

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N0–N1 > 1 excellent

N0–N1 = 1 effective

N0–N1 = 0 ineffective

N0–N1 < 0 deteriorated

N0–N1 > 1 excellent

N0–N1 = 1 effective

N0–N1 = 0 ineffective

N0–N1 < 0 deteriorated

Change

Mean (95% CI)

CR

Tang, 2011

Water swallowing test

3 months

Exercise vs. usual care

0

17

5

0

0

9

8

4

The percentage of patients with excellent and effective result of the rehabilitation group was higher than that of the control group (77% vs. 43%, respectively)

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)/ N (%)

Follow-up

Mean (SD)/

N (%)

Difference

Mean (95%CI) /

%

N

Baseline
Mean (SD) /

N (%)

Follow-up

Mean (SD) /

N (%)

Difference

Mean difference(SD) /

(%)

Change

Mean (95% CI) /

(%)

CR

Petersson, 2023

Mouth opening (trismus; ≤ 35 mm)

Baseline (6–36 months after completion of (chemo)radiotherapy)-12 months follow-up

Exercise vs. usual care

25 (baseline)/19 (follow-up)

3 (12)

4 (21)

9%

27(baseline)/24 (follow-up)

5 (19)

5 (21)

0%

9%

No

Hyposalivation (≤ 0.7 ml/min)

Baseline (6–36 months after completion of (chemo)radiotherapy)-12 months follow-up

Exercise vs. usual care

25 (baseline)/19 (follow-up)

11 (44)

2 (11)

33%

27(baseline)/24 (follow-up)

7 (26)

4 (17)

11%

22%

No

Tang, 2011

Mouth opening (IID), in cm

Baseline-3 months

Exercise vs. usual care

22

1.89 (0.69)

1.7 (0.68)

0.19 (0.5)

21

1.8 (0.56)

1.1 (0.36)

0.69 (0.56)

-0.50 (-0.82, -0.18)

No

Intervention group

Control group

Comparison between groups

Study

Measure

Timing of measurement

Comparison

N

Baseline
Mean (SD)