Getting Recovery Right After Neck Dissection for head and neck cancer (GRRAND)
Rehabilitation after neck dissection for head and neck cancer
1. Control Group (Best Practice NHS Post-Discharge Care) Treatment Given: Routine NHS care including ward-based physiotherapy (respiratory care, positioning, walking, activities of daily living, neck and shoulder exercises) supplemented by a leaflet. Total Duration of Treatment: Initial physiotherapy within the first 24 hours postoperatively, with no further physiotherapy unless deemed necessary by the ward physiotherapist or surgical team. Follow-Up: Participants will be advised to continue exercises provided pre-hospital discharge and remain physically active. Follow-up assessments at baseline, six weeks, six months, and 12 months post-randomisation. Randomisation Process: Participants will be randomised after verifying eligibility post-surgery. The specific method of randomisation (e.g., online tool, sealed envelope) is not detailed in the provided information. 2. Experimental Group (GRRAND Programme) Treatment Given: Routine NHS care as described for the control group, plus a personalised physiotherapy intervention (up to six, one hour sessions) provided by a GRRAND-trained physiotherapist. The intervention includes range of motion exercises, progressive resistance exercises, education and advice on positioning, oral health, pain management, exercise adherence, return to work and normal activities, scar management, and education on fatigue, anxiety, and sleep hygiene. Total Duration of Treatment: Up to six sessions of physiotherapy, each lasting 60 minutes. Follow-Up: Similar follow-up assessments as the control group at baseline, six weeks, six months, and 12 months post-randomisation. Randomisation Process: Same as the control group, with randomisation occurring after verifying eligibility post-surgery.
1. People aged 18 years or over 2. Diagnosis of HNC with requirement for a neck dissection as part of their treatment with curative intent. Including those undergoing completion neck dissection following positive sentinel node biopsy or open neck node biopsy. 3. Able to attend out-patient physiotherapy appointments. 4. Provide informed consent.
1. People for whom intensive post-discharge physiotherapy is expected (e.g., scapula/scapula tip and/or latissimus dorsi free flaps or components thereof). This constitutes 3-5% of the neck dissection population and clinical equipoise regarding the role of physiotherapy is less evident. 2. People with a pre-existing, long-term disease affecting the shoulder, e.g., hemiplegia. 3. People who had prior neck dissection surgery on the affected side. People who had a previous neck dissection on the affected side (except sentinel lymph node biopsy requiring completion neck dissection) 4. People undergoing Lymph Node Biopsy or Sentinel Lymph Node Biopsy only. 5. Previous entry in the present trial. 6. Unable to adhere to trial processes.