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Recommendations for Patient-reported Outcome Measures for Head and Neck Cancer-related Shoulder Dysfunction: A Systematic Review

Eden, Melissa M., PT, DPT, OCS1; Flores, Ann Marie, PT, PhD, CLT2; Galantino, Mary Lou, PT, MS, PhD, MSCE3; Spinelli, Bryan A., PT, MS, OCS, CLT-LANA4

Rehabilitation Oncology: 2014 - Volume 32 - Issue 3 - p 6–19

Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in shoulder function and ability to participate in daily activities due to spinal accessory nerve (SAN) damage. Physical therapists must use valid and reliable outcome measures to quantify functional outcomes related to treatment of the shoulder.

Purpose: As part of the activities of the Oncology Section Head and Neck EDGE Task Force, we report evidence-based recommendations for patient-reported outcome measures for patients with HNC-related shoulder dysfunction.

Methods: We conducted a systematic literature review of shoulder outcome measures that are clinically feasible and relevant to the HNC patient population using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical feasibility, and previous use in HNC-related research. Sixteen outcome measures were reviewed and five are recommended [Disabilities of the Arm, Shoulder and Hand (DASH), Neck Dissection Impairment Index (NDII), Shoulder Pain and Disability Index (SPADI), University of Washington Quality of Life (UW-QOL) shoulder subscale, and QuickDASH] for use in the HNC population.

Conclusions: There were strengths and weaknesses related to each of the recommended outcome measures. The DASH, QuickDASH and the SPADI demonstrate strong psychometric properties across multiple patient populations, but have been minimally used in the HNC population. The NDII and UW-QOL were specifically developed for the HNC population but have not been fully tested. Further research should address the efficacy and appropriateness of these measures for use in patient populations presenting with shoulder dysfunction in the setting of HNC.

Systematic Review Registration Number: PROSPERO CRD42013004898

1Instructor of Physical Therapy, Mayo Clinic, Phoenix, AZ

2Assistant Professor & Director, Center for Cancer Survivorship Studies, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA

3Professor of Physical Therapy, School of Health Sciences, The Richard Stockton College of New Jersey, Galloway, NJ

4Good Shepherd Penn Partners, Penn Therapy and Fitness, Philadelphia, PA

Address correspondence to: Melissa M. Eden, PT, DPT, OCS, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (

©2014 (C) Academy of Oncologic Physical Therapy, APTA
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