Surgery ยท Medical Literature
Effects of evidence-based rehabilitation nursing combined with early neck and shoulder exercises on cervical mobility in patients undergoing transoral endoscopic thyroidectomy via the vestibular approach.
Abstract
This paper was designed to reveal the effects of evidence-based rehabilitation nursing (EBRN) combined with early neck and shoulder exercises on cervical mobility in patients with thyroid cancer (TC) undergoing transoral endoscopic thyroidectomy via the vestibular approach (TOETVA). One hundred and twenty TOETVA patients were randomized into control (routine nursing) and study (EBRN plus early neck/shoulder exercises) groups (n = 60 each). Outcomes included related surgical indicators, adverse events, neck pain and mobility (NPDS), illness perception (BIPQ), quality of life (QLICP-HN), and nursing satisfaction (NSNS). No significant differences were observed between the two groups with respect to the 24-h postoperative drainage volume, drainage tube retention time, postoperative hospital stay, or the incidence of postoperative adverse events (all P > 0.05). At postoperative day 7, the study group had lower NPDS scores across all dimensions and greater cervical mobility in six directions than the control group (P < 0.05). At 1 month postoperatively, the study group had lower BIPQ scores and higher QLICP-HN and NSNS scores than the control group (all P < 0.05). EBRN plus early neck and shoulder exercises may effectively improve cervical mobility, alleviate postoperative pain and disability, and enhance disease perception, quality of life, and nursing satisfaction in TC patients undergoing TOETVA.
Clinical relevance
In patients with thyroid cancer undergoing transoral endoscopic thyroidectomy via the vestibular approach (TOETVA), does evidence-based rehabilitation nursing (EBRN) combined with early neck and shoulder exercises improve cervical mobility, neck pain, illness perception, quality of life, and nursing satisfaction compared with routine nursing care? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (two-arm, parallel-group)","setting":"Not reported (single or multi-center status not specified in abstract; presumably China based on author names and institutional context)","sampleSize":"n = 120 (intervention: n = 60; control: n = 60)","population":"Adult patients with thyroid cancer undergoing TOETVA; specific age range, sex distribution, tumor stage, and comorbidity data not reported in abstract","intervention":"Evidence-based rehabilitation nursing (EBRN) combined with early neck and shoulder exercises initiated postoperatively","comparator":"Routine postoperative nursing care","primaryOutcome":"Cervical mobility (range of motion in six directions) and neck pain/disability (NPDS score) at postoperative day 7; additional outcomes included illness perception (BIPQ), quality of life (QLICP-HN), and nursing satisfaction (NSNS) at one month postoperatively","followUp":"One month postoperatively (minimum reported timepoint for patient-reported outcomes); day 7 for cervical mobility and pain","fundingSource":"Not reported"}
Key findings
No statistically significant between-group differences were observed for 24-hour postoperative drainage volume, drainage tube retention time, postoperative hospital stay, or the incidence of postoperative adverse events (all P > 0.05), indicating comparable perioperative safety profiles. At postoperative day 7, the EBRN-plus-exercise group demonstrated statistically significantly lower NPDS scores across all subscale dimensions and greater cervical range of motion in all six directions (flexion, extension, left/right lateral bending, left/right axial rotation) compared with the routine nursing group (P < 0.05 for each). At one month postoperatively, the study group had statistically significantly lower BIPQ scores (indicating more favorable illness perception), higher QLICP-HN scores (better head-and-neck cancer-specific quality of life), and higher NSNS scores (greater nursing satisfaction) than the control group (P values for individual comparisons not reported in the abstract beyond directional statements). Specific absolute effect sizes, mean differences, confidence intervals, and NNT/NNH values were not reported in the abstract and cannot be calculated from available data.
Practice implications
This trial suggests that a structured, evidence-based rehabilitation nursing protocol combined with early neck and shoulder exercises, initiated in the postoperative period following TOETVA, is associated with meaningful short-term improvements in cervical range of motion, neck pain and disability, illness perception, and quality of life without increasing perioperative complications. The findings are directly applicable to patients with thyroid cancer (predominantly differentiated thyroid cancer, though histologic subtype is not specified) who are surgical candidates for TOETVA. Patients undergoing conventional open thyroidectomy or remote-access endoscopic approaches were not studied, and generalizability to those groups is not established. The absence of reported absolute effect sizes, confidence intervals, and specific p-values for patient-reported outcomes limits precise assessment of the magnitude of clinical benefit. Because only an abstract is available, full assessment of randomization methods, allocation concealment, blinding of outcome assessors, exercise protocol details, baseline balance between groups, and handling of missing data is not possible. The question of whether these gains persist beyond one month remains unanswered. Results are clinically plausible given the known risk of cervical stiffness following TOETVA due to the submental tunnel dissection and patient positioning, and the findings align directionally with prior rehabilitation literature in this population. Practice change at this time would be premature without full-text review and independent replication. __LIMITATIONS__ Only the abstract is available; full assessment of methods (allocation concealment, blinding, randomization sequence generation, intention-to-treat analysis) is not possible.,Relatively small sample size (n = 60 per arm) limits statistical power for subgroup analyses and detection of rarer adverse events.,Follow-up limited to one month; durability of cervical mobility gains and quality-of-life improvements beyond this period is unknown.,Blinding of patients and nursing staff to the intervention is inherently difficult in rehabilitation nursing trials, introducing performance and detection bias.,Specific p-values, mean differences, standard deviations, and confidence intervals for patient-reported outcome measures (BIPQ, QLICP-HN, NSNS) are not reported in the abstract, precluding quantitative clinical significance appraisal.,The exercise protocol content, intensity, frequency, and adherence monitoring are not described, limiting reproducibility.,Institutional setting and geographic context not specified, potentially limiting generalizability to different healthcare systems and patient populations.,Selection of TOETVA-specific patients with thyroid cancer may not represent the full spectrum of patients undergoing thyroid surgery, including those with benign disease or undergoing open procedures.,Funding source is not reported, and potential conflicts of interest cannot be assessed.,Composite or multi-dimensional instruments (NPDS, BIPQ, QLICP-HN, NSNS) may vary in psychometric performance across cultures and clinical settings. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this 120-patient RCT, evidence-based rehabilitation nursing combined with early postoperative neck and shoulder exercises significantly improved cervical range of motion, neck pain scores, illness perception, and quality of life at 7 days and 1 month following TOETVA, without increasing perioperative adverse events. The findings are clinically plausible and directionally consistent with the rehabilitation literature, but the absence of reported effect sizes, confidence intervals, and full-text methodological detail warrants caution before adopting this protocol as standard practice. Independent replication in larger, geographically diverse populations with longer follow-up is needed to confirm benefit and define the optimal exercise protocol.