Effectiveness of a guided self-help exercise program tailored to patients treated with total laryngectomy: Results of a multi-center randomized controlled trial

Femke Jansen*, Simone E.J. Eerenstein, Ingrid C. Cnossen, Birgit I. Lissenberg-Witte, Remco de Bree, Patricia Doornaert, György B. Halmos, José A.U. Hardillo, Gerben van Hinte, Jimmie Honings, Cornelia F. van Uden-Kraan, C. René Leemans, Irma M. Verdonck-de Leeuw

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Objective: To investigate the effectiveness of a guided self-help exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL). Materials and methods: This randomized controlled trial included patients treated with TL in the last 5 years. Patients were randomized into the intervention group (self-help exercise program with flexibility, range-of-motion and lymphedema exercises and self-care education program) or control group (self-care education program). Both groups completed measurements before and 3 and 6-months after randomization. The primary outcome was swallowing problems (SWAL-QOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), self-management (patient activation: PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate-high in case a patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention and to investigate whether neck dissection, treatment indication (primary/salvage TL), time since treatment, severity of problems, and preferred format (online/booklet) moderated the effectiveness. Results: Moderate-high adherence to the exercise program was 59%. The intervention group (n = 46) reported less swallowing and communication problems over time compared to the control group (n = 46) (p-value = 0.013 and 0.004). No difference was found on speech, shoulder problems, patient activation and HRQOL. Time since treatment moderated the effectiveness on speech problems (p-value = 0.025): patients within 6 months after surgery benefitted most from the intervention. Being treated with a neck dissection, treatment indication, severity of problems and format did not moderate the effectiveness. Conclusion: The guided self-help exercise program improves swallowing and communication. Trial registration. NTR5255.

Original languageEnglish
Article number104586
Pages (from-to)1-9
Number of pages9
JournalOral Oncology
Early online date8 Feb 2020
Publication statusPublished - Apr 2020


  • Exercise program
  • Head and neck cancer
  • Laryngeal cancer
  • Quality of life
  • Randomized controlled trial
  • Shoulder functioning
  • Speech
  • Swallowing
  • Total laryngectomy


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