الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Introduction:
Dysphagia considered being the most prominent symptom resulting from disease process of head and neck cancer and its treatment. Damage of swallowing function is causing malnutrition, dehydration, aspiration and pneumonia. It occurs due to incompetent closure of the epiglottis during swallowing, weakness of oral muscle (Vogel, Rommel & Oettin, 2017).
Swallowing exercises for head and neck cancer patients; is very effective to diminish swallowing problems, promote strength, mobility and endurance of base of tongue, pharyngeal constrictors and suprahyoid strap muscles. Recent data refer to these exercises as a promising method in preventing swallowing problems and it is a standard preventive program (Peng, et al., 2015).
Aim of the study:
The present study aimed to assess:
Effect of Swallowing Exercises Program on Patients with Head and Neck Cancer through the followings:
Asses the patients’ knowledge regarding head and neck cancer.
Assess swallowing problems among patients with head and neck cancer.
Design, implement and evaluate the effect of swallowing exercises program on patients with head and neck cancer.
Research hypothesis:
The current study hypothesized that; the implementation of the swallowing exercises program will lead to significant positive improvement in knowledge related head and neck and swallowing exercises, and will improve swallowing problems among patients with head and neck cancer.
Research Design:
Quasi- experimental design will be used to achieve the aim of the current study. A quasi-experimental design aim to establish a cause and effect relationship between a dependent variable and independent variable (Kao et al., 2016).
Setting:
The study will be conducted at the oncology outpatient clinics affiliated to Fayoum University hospital.
Subject:
A purposive sample composed of 30 patient from both gender male and female with head and neck cancer who was admitted to previous setting from was selected within the following inclusion criteria; adult patients from both gender with a new head and neck primary cancer, Patients are aware of the clinical decision and accept to participate in this study.
The exclusion criteria include; Patients have cognitive impairment, patients enrolled in other studies or trials
Sample size:
Study subjects include of patient with head and neck cancer were number was (n=40) at Fayoum University Hospital at 2016 based on smaple size equation 30 patient will be participating in the study.
So, the sample size was calculated by adjusting the power of the test to 80% and the confidence interval to 95% with margin of error accepted adjusted to 5% using the following equation:
Type I error ()= 0.05%
Type II ()= 0.20%
With power of test 0.80%
n= (N ×p (1-p))/([[N-1×(d^2÷z^2 )]+p(1-p)])
N ×p (1-p) = (40*(0.5*(1.0.5)))/
N-1 = (40-1)*
d2/z2 = 0.0025/3.8416+
p(1-p) = 0.5*(1-0.5)
n = 30
N= Community size
z= Class standard corresponding to the level of significance equal to 0.95 and 1.96
d= The error rate is equal to 0.05
p= Ratio provides a neutral property= 0.50
(Kao et al., 2016)
Tools for data collection:
Three tools were used in the current study.
Tool (1): Patients’ interviewing questionnaire (Appendix I):
This tool was developed and filled by the researcher in a simple Arabic language. It was composed of three parts
Part 1: Patients’ demographic characteristics:
It was used to assess patients’ demographic characteristics regarding (age, gender, educational level, marital status, working, place of residence, and living status). It composed of seven end closed question.
Part II: Patients’ Medical data:
It was used to collect the medical data for patients with head and neck cancer. It was included 18 closed ended questions divided into seven questions regarding patient’s general medical data (weight, height and body mass index (kg/M2), smoking, smoking quitters and passive smoking). Three MCQ regarding present medical history as (chief complain, therapeutic management, symptoms), four questions regarding past medical history as (chronic illness, swallowing problems), Past surgical history two MCQ (previous significant injuries and surgeries) and family history two MCQ as (family get sick and degree of kinship).
Part III: Patients’ knowledge regarding head and neck cancer swallowing exercises:
This part used to assess patients’ knowledge regarding head and neck cancer and swallowing exercises. Based on reviewing recent literature (Conway et al., 2015), (Su et al., 2015), (Liang et al., 2015), (Kamal, 2014). It consisted of 18 statements and divided to two parts:
A- Part I: It included ten statements to assess patient’s knowledge regarding head and neck cancer include (definition, The prevalence of the disease, factors, signs& symptoms, diagnosis, method of treatment, side effect of treatment, dealing with side effect, precautions and suitable nutrition).
B- Part II: It included eight statements to assess patient’s knowledge regarding swallowing exercises include (difficulty swallowing, severity of difficulty swallowing, dealing with difficulty of swallowing, regarding swallowing exercises, importance and goals, types, how to practice and practicing swallowing exercises before).
Tool (2): Sydney Swallowing scale (Appendix II):
It was used to assess symptomatic severity of swallowing difficulty as reported by patients. It was adapted from (Wallace, Middleton & Cook, 2000). This tool consisted of (17) statements translated and retranslation to help the patients choose a mark on the place which he/she best described. High score was referring to worse condition.
Tool (3): Observational check list for swallowing exercises assessment tool (Appendix III):
This tool was used to assess the ability of head and neck cancer patients to practice swallowing exercises pre and post swallowing exercises program implementation. Adapted from (Lewins 2014). This tool consisted of 15 statements including the following items.
Improve the ability to swallow (4 questions).
Muscle and tongue exercises (7 questions).
Closing wind pipe exercises (4 questions).
Results:
The results of this study have shown the following:
Regarding patients’ demographic characteristics, half of the studied patients 50.0 % were age between 41to 60 yrs. with the mean age 38.76±5.09. While 60.0% were males, 63.3%were educated, 70.0% were married, 76.7% not working, 66.7% of them were living in urban areas, and 96.7% were living with family.
Concerning patients’ medical data, 46.7% were of the patients were underweight. Regarding smoking, it was found that, 66.7of them were smokers. According to present diagnosis it was found 43.3% of patients’ diagnosed with tumor in (larynx). The most common treatment was chemotherapy 60.0%. As well as 100% of the study sample were suffering from difficult in swallowing.
Regarding total level of patients’ knowledge (10. 0%) of the studied patients had satisfactory level of knowledge regarding HNC and swallowing exercises pre swallowing exercises program implementation, but (86.7%) of the studied patients had satisfactory level of knowledge regarding HNC and swallowing exercises post swallowing exercises program implementation respectively.
Concerning patients’ degree of practice swallowing exercises, 40.0 % of studied patients were unable to practice swallowing exercises pre swallowing exercises program implementation, but 86. 7 % were able to practice post swallowing exercises program implementation.
Concerning patients’ degree of swallowing difficulty, the highest percentage of the study subjects patient suffer from sever difficulty before swallowing exercises program implementation (50.0%), moderate difficulty (36.7%) and mild difficulty (13.3%). Post swallowing exercises program implementation; Swallowing exercises improve swallowing by decrease degree of swallowing severity as convert to sever (6.7%), moderate (26.7%) and mild (66.7%).
Also there is a positive correlation between the total level of knowledge of the patients and the total performance of swallowing exercises at (r=0.284). There is a positive correlation between total patients’ level of knowledge and the total swallowing scale of Sydney at (r=0.401). There is a positive correlation between total practice of swallowing exercise and total Sydney swallowing scale at (r=0.375).
Conclusion:
Based on findings of the current study, it could be concluded that: there is statistical significant improvement among the studied patients’ level of knowledge related to head and neck cancer and swallowing exercises post swallowing exercises program implementation. Meanwhile, there is statistical significant improvement among the studied patients in all items of swallowing Sydney scale (related to swallowing problems).