The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial

Abstract

Background: Following surgery for benign nodular goiter, patients may experience neck and shoulder pain, neck pressure and tightness, choking sensation, altered voice function, and dysphagia leading to decreased short-term quality of life (QoL). This single-blinded randomized controlled trial investigated the effect of post-thyroidectomy rehabilitative neck stretching and movement exercises on these variables including QoL.

Methods: Patients undergoing thyroid lobectomy or total thyroidectomy were randomized to perform neck stretching and movement exercises three times daily in four weeks following surgery (intervention group) or conventional follow-up without exercises (control group). Outcome measures were scores in the following questionnaires: Disease-specific Thyroid-Related Patient-Reported Outcome (ThyPRO-39) involving symptoms of "sense of fullness in the neck," "pressure in the throat," and "discomfort swallowing" combined in the multi-item Goiter Symptom Scale, the Voice Handicap-Index-10 (VHI-10), neck and shoulder pain measurement by a numeric rating scale (NRS), and General measure of health (EQ-5D-5L). All scores were assessed prior to surgery and one, two, four weeks, and three months after surgery. Data were analyzed using a linear mixed model.

Results: Eighty-nine patients were included and randomized to the control (n = 45) or the intervention group (n = 44). At three months after surgery, both the control and the intervention group experienced large to moderate improvements in the Goiter symptom and Hyperthyroid symptom scale of the ThyPRO questionnaire (p < 0.004). No significant between-group differences were found in any of the other applied scales.

Conclusions: This study confirms that patients experience profound improvements in QoL after surgery for benign nodular goiter. However, early post-thyroidectomy neck stretching and movement exercises did not result in further QoL improvement, reduction in pain or less impacted subjective voice function for patients primarily undergoing thyroid lobectomy. Trial Registration Number NCT04645056 ( https://clinicaltrials.gov ).

Conflict of interest statement

The authors declare that they have no conflict of interests.

© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.

Figures

Fig. 1

Illustration of neck stretching and movement exercises for the intervention group. Patients performed five repetitions to each side and a 10 s hold in the stretching exercises

Fig. 2

CONSORT flowchart of the enrollment, randomization, follow-up, and analysis phase

Fig. 3

Radar plots of mean ThyPRO scores comparing baseline, two weeks, and three months data in the control group (n = 44) and the intervention group (n = 45). Large scores indicate more severely affected quality of life. a Baseline vs. two weeks and three months in the control group (p < 0.004)

Fig. 4

Generic quality of life measured by the instrument EQ-5D-5L. The figure shows the EQ-5D-5L VAS percentage distribution in the control (n = 45) and the intervention group (n = 44), at baseline (top) and at three months (bottom). Low scores indicate a reduced generic quality of life. None of the differences between groups were statistically significant at any point in time (level of significance p)

Fig. 5

Proportion of responses divided in “no problems” or “any problems” for EQ-5D-5L dimensions at baseline, one week, two weeks, four weeks, and three months for the control group (CTL) (n = 45) and the intervention group (INT) (n = 44). No differences between the groups were statistically significant at any time during the follow-up (level of significance p < 0.05)