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

Spinelli, Bryan A., PT, MS, OCS, CLT-LANA1; Galantino, Mary Lou, PT, MS, PhD, MSCE2; Eden, Melissa M., PT, DPT, OCS3; Flores, Ann Marie, PT, PhD, CLT4


Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in neck function and activities of daily living due to neurological and soft tissue changes and side effects of cancer treatment. Physical therapists must use valid and reliable outcome measures to quantify functional outcomes related to treatment of the neck.

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 neck dysfunction.

Methods: We conducted a systematic literature review of neck outcome measures that are clinically feasible and relevant to the HNC patient population using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) model. Recommendations are based on the quality of psychometric properties, clinical feasibility, and previous use in HNC-related research. Ten outcome measures were selected and 3 are highly recommended for use in the HNC population.

Conclusions: There were strengths and weaknesses related to each of the recommended outcome measures. The Neck Disability Index, Northwick Park Neck Pain Questionnaire, and Neck Pain and Disability Scale demonstrate strong psychometric properties across multiple patient populations, but have been minimally used in the HNC population. Further research should address the efficacy and appropriateness of these measures for use in patient populations presenting with cancer-treatment related neck dysfunction for HNC.

Systematic Review Registration Number: PROSPERO CRD42013004898

1Good Shepherd Penn Partners, Penn Therapy and Fitness, Philadelphia, PA

2Professor of Physical Therapy, School of Health Sciences, The Richard Stockton College of New Jersey, Galloway, NJ

3Instructor of Physical Therapy, Mayo Clinic, Phoenix, AZ

4Assistant Professor & Director, Center for Cancer Survivorship Studies, Dept. Of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA

Address correspondence to: Bryan A. Spinelli, PT, MS, OCS, CLT-LANA, Good Shepherd Penn Partners, Penn Therapy and Fitness, 3737 Market St, Suite 200, Philadelphia, PA 19104 (

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