JMIR Publications

ABSTRACT

Background:

Multimodal treatment-induced dysphagia has serious negative effects in survivors of head and neck cancer, e.g., aspiration and pneumonia. Researchers have found that face-to-face swallowing interventions are effective for survivors. Given advances in communication technologies, several studies have applied telecommunication-based interventions that incorporate swallowing training, education, monitoring, feedback, self-management, and communication. It is especially urgent to implement home-based remote rehabilitation given the COVID-19 pandemic. However, the optimal strategy and effectiveness of remote interventions are unclear.

Objective:

This systematic review aimed to examine the evidence for using remote rehabilitation to reduce physiological and functional impairments in swallowing and improve the adherence to treatment of head and neck cancer survivors and to explore facilitators and barriers.

Methods:

We performed a systematic search to identify relevant articles published in the PubMed, MEDLINE, CINAHL, Embase, and Cochrane Library databases before November 2022. Two investigators independently extracted the data and assessed the methodological quality of the included studies using the Quality Assessment Tool of the Joanna Briggs Institute.

Results:

Thirteen studies that examined the effects of remote rehabilitation of survivors and intervention strategies related to sociodemographic, clinical, educational, technical, and behavioural factors were included. The results showed that home-based remote rehabilitation (1) improved the safety of swallowing and oral feeding, nutritional status, swallowing-related quality of life, and reduced negative emotions; (2) improved the adherence to remote swallowing rehabilitation; (3) was rated by participants as highly satisfactory and supportive; and (4) was cost effective. In addition, this review investigated supporting factors related to the effectiveness, adherence and quality of life of remote rehabilitation; these included (5) striking a balance among swallowing training strategy, intensity, frequency, duration and individual motor ability; treating side effects of radiotherapy; providing access to medical, motivational and educational information; providing feedback on training; providing communication and support from speech pathologists, families, and other survivors; and addressing technical problems.

Conclusions:

Home-based remote rehabilitation for dysphagia caused by head and neck cancer appeared to improve the safety of swallowing and oral feeding, swallowing function and quality of life, and reduce negative emotions; a more significant effect on swallowing rehabilitation may be observed during long-term follow-up. In addition, due to the variation in sociodemographic and clinical characteristics, individual swallowing physiology and functional impairment, and behavioural factors, we propose that individualized telemedicine interventions should be developed for optimal rehabilitation, more effective precise interventions and maximal adherence with family training plans.