The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment) and by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 3 studies with a total of 104 subjects to compare exercise therapy with any other intervention in patients with shoulder dysfunction due to treatment of head and neck cancer.
Two studies applied progressive resistance training (PRT) combined with range of motion exercises and stretching; the comparison group received standard care. Pooled data demonstrated that PRT can reduce shoulder pain (mean difference -6.26; 95% CI -12.20 to -0.31) and shoulder disability (MD -8.48; 95% CI -15.07 to -1.88), measured using the Shoulder Pain and Disability Index (SPADI) (range 0 to 100).
Secondary outcomes were also improved: active range of motion for external rotation (MD 14.51 degrees; 95% CI 7.87 to 21.14), passive range of motion for abduction (MD 7.65 degrees; 95% CI 0.64 to 14.66), forward flexion (MD 6.20 degrees; 95% CI 0.69 to 11.71), external rotation (MD 7.17 degrees; 95% CI 2.20 to 12.14) and horizontal abduction (MD 7.34 degrees; 95% CI 2.86 to 11.83).
The studies did not demonstrate a statistically significant difference in quality of life. Only two non-serious adverse events were described in the PRT group compared with none in the standard care group.
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