Effects of Conscious Control of Scapular Orientation in Oral Cancer Survivors With Scapular Dyskinesis: A Randomized Controlled Trial

Yueh-Hsia Chen, Cheng-Ya Huang, Wei-An Liang, Chi-Rung Lin, Yuan-Hung Chao, Yueh-Hsia Chen, Cheng-Ya Huang, Wei-An Liang, Chi-Rung Lin, Yuan-Hung Chao

Abstract

Objectives: Spinal accessory nerve dysfunction is one of the complications of neck dissection in patients with oral cancer. This study aimed to explore the effects of long-term scapular-focused exercises and conscious control of scapular orientation on scapular movement and quality of life (QoL).

Methods: This study was a randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Thirty-six patients with oral cancer were randomly allocated to the motor-control group (scapular-focused exercise + conscious control of scapular orientation) or the regular-exercise group (scapular-focused exercises only). Both groups received conventional physical therapy after neck dissection for 3 months. Shoulder pain intensity, active range of motion (AROM) of shoulder abduction, scapular muscle strength and activity under maximal voluntary isometric contraction (MVIC), scapular muscle activity when performing scapular movements, and QoL were measured at baseline, 1 month after the start of the intervention, and the end of the intervention.

Results: Both groups showed significant improvement in all outcomes except shoulder pain intensity. After the 3-month intervention, the motor-control group had more significant improvement in AROM of shoulder abduction with a 19° difference (95% CI: 10-29, P < .001), muscle strength of upper trapezius with an 11 N difference (95% CI: 2-20; P = .021), and QoL than the regular-exercise group. When performing shoulder horizontal adduction and flexion, the relative value (%MVIC) of serratus anterior was smaller in the motor-control group with a 106%MVIC difference (95% CI: 7-205, P = .037).

Conclusions: Scapular-focused exercises have promising effects on spinal accessory nerve dysfunction. Combining scapular-focused exercises with conscious control of scapular orientation has more remarkable benefits on AROM of shoulder abduction, UT muscle strength, and muscle activation pattern than the scapular-focused exercises alone. Conscious control of scapular orientation should be considered to integrate into scapular-focused exercises in patients with oral cancer and scapular dyskinesis.Trial registry name and URL, and registration number: ClinicalTrials.gov (URL: https://ichgcp.net/clinical-trials-registry/NCT03545100" title="See in ClinicalTrials.gov">NCT03545100).

Keywords: accessory nerve; conscious control of scapular orientation; neck dissection; oral cancer; scapular dyskinesis.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Design and flow of participants through the trial.
Figure 2.
Figure 2.
Effects of intervention on the AROM of shoulder abduction for the motor-control and regular-exercise groups.
Figure 3.
Figure 3.
Effects of intervention on muscle strength of the (A) Upper trapezius. (B) Middle trapezius. (C) Lower trapezius. (D) Serratus anterior under MVIC conditions in the motor-control and regular-exercise groups.
Figure 4.
Figure 4.
Effects of intervention on EMG activity of the (A) Upper trapezius. (B) Middle trapezius. (C) Lower trapezius. (D) Serratus anterior under MVIC conditions in the motor-control and regular-exercise groups.
Figure 5.
Figure 5.
Effects of intervention on the EORTC QLQ-C30. (A) Global health score. (B) Physical functioning score. (C) Role functioning score. (D) Emotional functioning score. (E) Cognitive functioning score. (F) Social functioning score in the motor-control and regular-exercise groups.

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