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://clinicaltrials.gov; Approval No: NCT03545100)

中文翻译：

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有意识地控制肩胛骨方向对患有肩胛骨运动障碍的口腔癌幸存者的影响：一项随机对照试验

目标：

脊柱副神经功能障碍是口腔癌患者颈部解剖的并发症之一。本研究旨在探讨长期以肩胛骨为重点的练习和有意识地控制肩胛骨方向对肩胛骨运动和生活质量 (QoL) 的影响。

方法：

本研究是一项随机对照试验，采用隐藏分配、评估者盲法和意向治疗分析。36 名口腔癌患者被随机分配到运动对照组（以肩胛骨为中心的运动 + 有意识地控制肩胛骨方向）或常规运动组（仅以肩胛骨为中心的运动）。两组均在颈部清扫术后接受常规理疗3个月。在基线、开始后 1 个月测量肩部疼痛强度、肩外展的主动活动范围 (AROM)、最大随意等长收缩 (MVIC) 下的肩胛肌力量和活动、进行肩胛运动时的肩胛肌肉活动和 QoL。干预，以及干预的结束。

结果：

除了肩部疼痛强度外，两组的所有结果都显示出显着改善。干预 3 个月后，运动控制组的肩外展 AROM 有更显着的改善，差异为 19°（95% CI：10-29，P  < .001），斜方肌上肌力量为 11 N差异 (95% CI: 2-20; P  = .021) 和 QoL 与常规锻炼组相比。在进行肩部水平内收和屈曲时，运动控制组的前锯肌相对值 (%MVIC) 较小，差异为 106%MVIC (95% CI: 7-205, P  = .037 )。

结论：

以肩胛骨为重点的练习对脊髓副神经功能障碍有很好的效果。以肩胛骨为中心的练习与肩胛骨方向的有意识控制相结合，对肩外展、UT 肌肉力量和肌肉激活模式的 AROM 具有比单独以肩胛骨为中心的练习更显着的好处。对于口腔癌和肩胛骨运动障碍患者，应考虑将有意识地控制肩胛骨方向纳入以肩胛骨为重点的锻炼中。

试验注册名称和 URL 以及注册号：ClinicalTrials.gov（URL：https://clinicaltrials.gov；批准号：NCT03545100）