Post-thyroidectomy rehabilitation exercise improves swallowing QoL but increases early pain in single-center RCT

BACKGROUND: Approximately 80% of post-thyroidectomy patients suffer from swallowing disorders even in the absence of definite laryngeal nerve injury. This study aimed to evaluate the efficacy of a standardized postoperative neck and orofacial rehabilitation exercise in enhancing quality of life (QoL), particular swallowing-related QoL, among post-thyroidectomy patients without definite laryngeal nerve injury during surgery. METHODS: This was a single-center, open-label randomized controlled trial. The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2500097960). Participants were randomized 1:1 to rehabilitation exercise group (RE group) and control group. The RE group performed a standardized postoperative neck and orofacial rehabilitation exercise, which included neck extension, swallowing, and voice training, while the control group received only general advice to move their necks freely. The rehabilitation exercise program duration is 3 months. The QoL of participants was evaluated at 1 week, 1 month, 3 months, and 6 months postoperatively. The primary outcome was swallowing-related QoL evaluated by the MD Anderson Dysphagia Inventory (MDADI) at 1 month after surgery. Secondary outcomes included swallowing-related QoL at other follow-up time points, the thyroid cancer-specific QoL, scar assessment, and safety endpoints defined by postoperative drainage, pain scores, and adverse events. RESULTS: A total of 374 patients were recruited, and 356 participants were included in final analysis, including 176 in RE group and 180 in control group. The swallowing-related QoL in the RE group was significantly better than that in the control group at 1 month (MDADI total score 97.4 [80.3, 100] vs. 88.9 [75.8, 99.7], = 0.004) and 6 months (MDADI total score 100 [96.8, 100] vs. 98.9 [85.5, 100], = 0.020) postoperatively. The RE group reported higher pain levels at 1 week after surgery ( = 0.013) but no significant differences at subsequent time points. No statistically significant differences between groups were observed in other outcomes. No severe adverse event occurred during rehabilitation exercise. CONCLUSIONS: The standardized postoperative neck and orofacial rehabilitation exercise was an effective and safe approach for accelerating the recovery of the swallowing-related QoL in post-thyroidectomy patients without definite laryngeal nerve injury during surgery.