Rehabilitation and Physiotherapy for Functional Sequelae in Adults with Head and Neck Cancer: A Systematic Review and Meta-Analysis

Vollständiger Abstract

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Background and Objectives: Functional sequelae following head and neck cancer (HNC) treatment frequently impair swallowing, mouth opening, speech, cervical and shoulder mobility, and overall quality of life. Although rehabilitation is increasingly recognized as an essential component of multidisciplinary care, evidence has largely focused on isolated functional impairments rather than providing a comprehensive evaluation across rehabilitation domains. To systematically evaluate the effectiveness of rehabilitation and physiotherapy interventions for preventing and treating functional sequelae in adults with head and neck cancer. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Cochrane Library, and PEDro were searched from inception to June 2026. Studies involving adult patients with head and neck cancer receiving conservative rehabilitation interventions were included. Random-effects meta-analyses were performed for clinically homogeneous intervention contrasts within the mouth-opening and trismus domains. Distinct comparisons involving intervention timing, additional therapeutic components, or delivery strategies were analysed separately. Results: Twenty-seven publications representing 21 independent randomized trials were included. Quantitative synthesis was restricted to clinically homogeneous intervention contrasts. Compared with usual care, preventive jaw rehabilitation favoured greater mouth opening across three independent trials (mean difference = 2.85 mm; conventional 95% CI: 0.38–5.32), although the modified Hartung–Knapp sensitivity interval included no effect (95% CI: −2.58–8.27). The pooled estimate for trismus across three independent trials also favoured rehabilitation, although both conventional and small-sample-adjusted confidence intervals included no effect (RR = 0.87; conventional 95% CI: 0.53–1.42; modified Hartung–Knapp 95% CI: 0.25–2.98). Postoperative swallowing rehabilitation after oral-cancer surgery and free-flap reconstruction favoured rehabilitation in both sequential cohorts (adjusted difference in change = 10.06 points; 95% CI: 7.68–12.44; GEE group-by-time β = 7.29 points; 95% CI: 4.11–10.47). Additional timing, support, enhancement, and delivery comparisons were analysed separately. Conclusions: Targeted rehabilitation interventions produced favourable estimates for mandibular mobility and postoperative swallowing function in adults with head and neck cancer. Preventive jaw rehabilitation favoured greater mouth opening, although the result was inconclusive after small-sample adjustment; the trismus estimate also favoured rehabilitation but remained imprecise.