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Physiotherapy for Radiation-induced Trismus

Primary Purpose

Trismus, Radiation-induced Fibrosis

Status
Completed
Phase
Not Applicable
Locations
Brazil
Study Type
Interventional
Intervention
Therabite
Hyperboloid
Sponsored by
Federal University of Health Science of Porto Alegre
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Trismus focused on measuring head and neck neoplasms, radiotherapy, physical therapy, trismus

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • signature of the Informed Consent Form;
  • both male and female individuals, aged 18 or over;
  • patients with a diagnosis of anatomopathological mouth and/or pharyngeal cancer;
  • patients who have undergone radiotherapy only, or radiotherapy combined with surgery and/or chemotherapy;
  • patients who have one or more muscles of mastication in the radiation field, and;
  • patients who have scored more than 60% in the Karnofsky Performance Status.

Exclusion Criteria:

  • those with facial paralysis, trigeminal neuralgia and/or herpes zoster;
  • patients undergoing brachytherapy;
  • patients undergoing physiotherapy intervention.

Sites / Locations

  • Hospital Santa Rita - Santa Casa de Porto Alegre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

No Intervention

Arm Label

Device Hyperboloid

Device Therabite

Control

Arm Description

5 min of bilateral mastication alternated with the device hyperboloid The exercises should begin one day before the onset of Radiotherapy (RT) and kept until the end of RT. Repeated 4x a day (after breakfast, lunch, dinner and before going to bed).

10 repetitions holding the device Therabite for 30 seconds 5 min of bilateral mastication alternated with the device hyperboloid The exercises should begin one day before the onset of Radiotherapy and kept until the end of RT. Repeated 4x a day (after breakfast, lunch, dinner and before going to bed).

The control group (GEC) will not receive any of the protocols tested in the study, but together with the other groups, will receive the regular treatment offered by the institution, which is made up of guidance and advice given by the hospital´s nursing team about the radiotherapy treatment. Currently, patients do not receive any information as far as trismus is concerned.

Outcomes

Primary Outcome Measures

mouth opening in millimeters (mm)
Mouth opening will be assessed before (baseline) and after total radiotherapy treatment (post radiotherapy) in order to establish if there have been any changes resulting from radiotherapy. The measure of mouth opening will be conducted with a pachymeter placed at the incisal edge of the superior and inferior incisor teeth. The maximal vertical distance, in millimeters, between the superior and inferior incisor teeth will be considered the total mouth opening of the patient.

Secondary Outcome Measures

Quality of life
Quality of life will be assessed by applying the UW-QOL Questionnaire, version 4, which is validated for the Brazilian population
Performance status
Perfomance status will be assessed by applying Karnofsky Perfirmance Status
Mucositis
Mucositis will be graduated through World and Health Organization scale

Full Information

First Posted
July 12, 2013
Last Updated
January 3, 2019
Sponsor
Federal University of Health Science of Porto Alegre
Collaborators
Irmandade Santa Casa de Misericórdia de Porto Alegre
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1. Study Identification

Unique Protocol Identification Number
NCT02094690
Brief Title
Physiotherapy for Radiation-induced Trismus
Official Title
Prophylactic Physiotherapy Development Of Radiation-Induced Trismus In Patients With Head And Neck Cancer: Randomized Controlled Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
January 2019
Overall Recruitment Status
Completed
Study Start Date
June 2013 (undefined)
Primary Completion Date
May 2014 (Actual)
Study Completion Date
June 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Federal University of Health Science of Porto Alegre
Collaborators
Irmandade Santa Casa de Misericórdia de Porto Alegre

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to assess the effect of two protocols of physiotherapeutic exercises in the maintenance and/or increase of the mandibular range of movement in patients suffering from head and neck cancer (HNC) who are undergoing radiotherapy.
Detailed Description
Because of contradictory data in the literature with regards to the efficiency of physiotherapeutic techniques to prevent and treat radiation-induced trismus, we believe there is a need to better investigate the efficiency and the quality of life resulting from the different prophylactic physiotherapeutic techniques for radiation-induced trismus in patients with HNC. After the conclusion of this research, we hope to suggest a suitable physiotherapeutic protocol to prevent this complication thereby allowing for an improvement in patients' quality of life. Data collection: All patients who begin Radiotherapy the Hospital will attend a group meeting with the nursing staff in order to receive information about their treatment. In the groups, we will identify patients who meet the study inclusion criteria and explain the Informed Consent Form. After we explain to patients their rights in accordance with resolution 196/96 of the National Health Council and they agree to take part by signing the consent form, we will begin gathering data. The gathering of data will be done always by the same researcher, who will assess the patient twice; the first assessment will take place before the onset of radiotherapy treatment, preferably on the day that the patient undergoes simulation (baseline), the second assessment will take place immediately after the last session of radiotherapy (post radiotherapy), third assessment will take a place six months after radiotherapy and the late follow-up one year after the radiotherapy treatment. Each patient will have a different total duration of radiotherapy regarding the dosage of radiation and type of tumor. It is expected that the total duration of radiation will vary between 45 to 60 days. Prior to that, all patients will be interviewed on a one-to-one basis in the premises of the Radiotherapy Service to provide their medical history. Other information such as tumor site, neoplastic histological type, staging,radiation field, dosage for each radiotherapy session, bilateral or unilateral presentation and aim of treatment (palliative or curative) will be taken from the patient's hospital records. The physical examination will take place in accordance with the guidelines and specifications of the Research Diagnostic Criteria for Temporomandibular Disorders - RDC/TMD, which evaluates variables such as the range of motion of the temporomandibular joint (TMJ), joint sounds and level of pain when pressed by the fingers and to the mastication muscles. RDC/TMD is widely used in the scientific and clinical practice for assessment of temporomandibular dysfunction, as it has been officially translated into 18 languages, including Portuguese. After recording the patient´s medical history and carrying out a physical examination, the patient will receive the University of Washington Quality of Life Questionnaire, version 4. After undergoing assessment, patients will be given instructions about the physiotherapy exercises to be performed with the aid of an assistant physiotherapist. Patients will be randomly placed into 3 Groups. The control group will not receive any of the protocols tested in the study, but together with the other groups, will receive the regular treatment offered by the institution, which is made up of guidance and advice given by the hospital´s nursing team about the radiotherapy treatment. In order to assess patients' compliance with the protocol, they will be given a training calendar at baseline in order to record their compliance or not with the regime. Completed calendars will be collected at post radiotherapy. Sample Size: The sample size has been determined with the aid of the software PEPI (Programs for Epidemiologists) version 4.0 and based in the works of Tang et al. (2011) and Buchbinder et al. (1993). In order to achieve a significance of 5%, a power of 90% and an effect size of one standard deviation amongst the groups, we have obtained a total of at least 23 patients in each of the 3 groups, with a grand total of 69 patients. Randomization: The randomization will be done by the software PEPI (Programs for Epidemiologists), subcategory RANDOM, which will draw the random numbers in each group. The allocation will be kept secret by the existence of a randomization list which will be kept in an isolated venue. The sequence of numbers to be used in the randomization will be kept confidential and will only be disclosed at the exact moment when intervention begins. Statistical Analysis: The quantitative variables will be described by standard deviation and mean while the qualitative variables will be described by absolute and relative frequency. The Kolmogorov-Smirnov Test will be used to verify data normality. In order to compare intra and inter groups, the two-way Variable Analysis (ANOVA) for repeated measures with Bonferroni post-hoc test will be applied. In order to compare the means amongst the groups at the baseline, the one-way Analysis of Variance (ANOVA) with Tukey´s post-hoc will be used. If asymmetry is detected, we will apply the Kruskal-Wallis test supplemented by Mann-Whitney test. In order to compare distribution, the Pearson chi-square test supplemented by the adjusted residuals will be applied. In order to compare the domains of Quality of Life, the Analysis of Variance (ANOVA) with Bonferroni post-hoc will be used for repeated measurements. In order to assess the correlation between continuous variables, the Pearson linear correlation test will be used. If asymmetry is detected, the Spearman correlation will be applied. The significance level adopted will be that of 5% (p<0,05) and the analyses will be done using the software SPSS (Statistical Package for the Social Sciences) version 17.0.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Trismus, Radiation-induced Fibrosis
Keywords
head and neck neoplasms, radiotherapy, physical therapy, trismus

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Factorial Assignment
Masking
InvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
90 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Device Hyperboloid
Arm Type
Active Comparator
Arm Description
5 min of bilateral mastication alternated with the device hyperboloid The exercises should begin one day before the onset of Radiotherapy (RT) and kept until the end of RT. Repeated 4x a day (after breakfast, lunch, dinner and before going to bed).
Arm Title
Device Therabite
Arm Type
Active Comparator
Arm Description
10 repetitions holding the device Therabite for 30 seconds 5 min of bilateral mastication alternated with the device hyperboloid The exercises should begin one day before the onset of Radiotherapy and kept until the end of RT. Repeated 4x a day (after breakfast, lunch, dinner and before going to bed).
Arm Title
Control
Arm Type
No Intervention
Arm Description
The control group (GEC) will not receive any of the protocols tested in the study, but together with the other groups, will receive the regular treatment offered by the institution, which is made up of guidance and advice given by the hospital´s nursing team about the radiotherapy treatment. Currently, patients do not receive any information as far as trismus is concerned.
Intervention Type
Device
Intervention Name(s)
Therabite
Intervention Description
10 repetitions holding Therabite for 30 seconds. The exercises should begin one day before the onset of Radiotherapy and kept until the end of RT. Repeated 4x a day (after breakfast, lunch, dinner and before going to bed).
Intervention Type
Device
Intervention Name(s)
Hyperboloid
Intervention Description
5 min of bilateral mastication alternated with hyperboloid. The exercises should begin one day before the onset of Radiotherapy and kept until the end of RT. Repeated 4x a day (after breakfast, lunch, dinner and before going to bed).
Primary Outcome Measure Information:
Title
mouth opening in millimeters (mm)
Description
Mouth opening will be assessed before (baseline) and after total radiotherapy treatment (post radiotherapy) in order to establish if there have been any changes resulting from radiotherapy. The measure of mouth opening will be conducted with a pachymeter placed at the incisal edge of the superior and inferior incisor teeth. The maximal vertical distance, in millimeters, between the superior and inferior incisor teeth will be considered the total mouth opening of the patient.
Time Frame
baseline (before radiotherapy), post radiotherapy (after the end of radiotherapy), 6 months follow-up and one year follow-up It is expected that the total duration of radiation will vary between a 45 to 60 days.
Secondary Outcome Measure Information:
Title
Quality of life
Description
Quality of life will be assessed by applying the UW-QOL Questionnaire, version 4, which is validated for the Brazilian population
Time Frame
baseline (before radiotherapy), post radiotherapy (after the end of radiotherapy), 6 months follow-up and one year follow-up It is expected that the total duration of radiation will vary between a 45 to 60 days.
Title
Performance status
Description
Perfomance status will be assessed by applying Karnofsky Perfirmance Status
Time Frame
baseline (before radiotherapy), post radiotherapy (after the end of radiotherapy), 6 months follow-up and one year follow-up It is expected that the total duration of radiation will vary between a 45 to 60 days.
Title
Mucositis
Description
Mucositis will be graduated through World and Health Organization scale
Time Frame
baseline (before radiotherapy), post radiotherapy (after the end of radiotherapy), 6 months follow-up and one year follow-up It is expected that the total duration of radiation will vary between a 45 to 60 days.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: signature of the Informed Consent Form; both male and female individuals, aged 18 or over; patients with a diagnosis of anatomopathological mouth and/or pharyngeal cancer; patients who have undergone radiotherapy only, or radiotherapy combined with surgery and/or chemotherapy; patients who have one or more muscles of mastication in the radiation field, and; patients who have scored more than 60% in the Karnofsky Performance Status. Exclusion Criteria: those with facial paralysis, trigeminal neuralgia and/or herpes zoster; patients undergoing brachytherapy; patients undergoing physiotherapy intervention.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geraldo P. Jotz, Ph.D
Organizational Affiliation
Federal University of Rio Grande do Sul - UFRGS
Official's Role
Study Director
Facility Information:
Facility Name
Hospital Santa Rita - Santa Casa de Porto Alegre
City
Porto Alegre
State/Province
Rio Grande Do Sul
ZIP/Postal Code
90.020-090
Country
Brazil

12. IPD Sharing Statement

Links:
URL
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478082/pdf/nihms-695420.pdf
Description
RDC/TMD is widely used in the scientific and clinical practice for assessment of temporomandibular dysfunction

Learn more about this trial

Physiotherapy for Radiation-induced Trismus

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