30 Participants Needed

Early Physical Therapy for Lockjaw

(PRECISE Trial)

LM
MM
Overseen ByMargaret McNeely, PhD
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: University of Alberta
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to assist people with head and neck cancer who might develop trismus, a condition that makes it difficult to open the mouth wide. The focus is on early physical therapy, including exercises and a special jaw-stretching device, to improve jaw movement during cancer treatment. The researchers aim to determine if these early treatments make a difference and whether participants find them helpful. The trial seeks participants who have a specific type of cancer, are receiving radiation therapy, live in Alberta, and speak English. As an unphased trial, it offers a unique opportunity to contribute to innovative approaches that could enhance quality of life during cancer treatment.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this early physical therapy intervention is safe for individuals with head and neck cancer?

Research has shown that starting physical therapy early, including using devices to assist jaw movement, is generally safe for treating trismus (difficulty opening the mouth) in head and neck cancer patients. One study found that a device like the Therabite, which helps stretch the jaw, was both effective and safe for improving jaw movement. Another study involving jaw stretching exercises reported that 114 out of 120 participants completed the program safely. No major safety issues emerged in these studies, suggesting that this method is well-tolerated. These findings provide strong evidence for the safety of early physical therapy in managing trismus.12345

Why are researchers excited about this trial?

Researchers are excited about early physical therapy for trismus because it offers a proactive approach to managing lockjaw. Unlike traditional treatments that often focus on addressing symptoms after they worsen, this method involves weekly monitoring and early intervention. By incorporating physical therapy, home exercises, and a jaw stretching device as soon as a 5% or greater reduction in mouth opening is detected, it aims to prevent significant impairment before it happens. This early intervention strategy could lead to better long-term outcomes and improve quality of life for patients with trismus.

What evidence suggests that early physical therapy is effective for trismus?

Research shows that exercise therapy can help people with trismus, a condition that restricts mouth opening. This trial will focus on early physical therapy intervention for trismus. One study found that a jaw-stretching device called the Dynasplint Trismus System helped people with head and neck cancer open their mouths wider. Another study showed that physiotherapy reduced pain and improved muscle function after treatment. Although one source found no benefit from using jaw-mobilizing devices alone, combining hands-on therapy and exercises appears promising. Overall, starting physical therapy early may improve jaw movement and reduce discomfort.13678

Who Is on the Research Team?

MM

Margaret McNeely, PhD

Principal Investigator

University of Alberta

Are You a Good Fit for This Trial?

This trial is for individuals with head and neck cancer who are about to undergo radiation therapy. They should be new patients at the HNC clinic and willing to participate in a study that could involve additional physical therapy.

Inclusion Criteria

I am scheduled for cancer treatment that includes radiation.
Ability to read and understand English
Residency in Alberta
See 1 more

Exclusion Criteria

Inability to provide informed consent
I had surgery on my jaw joint not related to head or neck cancer.
My cancer has returned or spread to other parts of my body.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Radiation Therapy

Participants undergo weekly monitoring of mouth opening and jaw function during radiation therapy. Early intervention is provided if there is a 5% or greater reduction in mouth opening.

6 weeks
Weekly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessments of trismus, neck disability, and quality of life.

3 months

What Are the Treatments Tested in This Trial?

Interventions

  • Early Physical Therapy for Trismus
Trial Overview The trial is testing whether early physical therapy can help prevent or reduce trismus (lockjaw) compared to usual care, which involves exercises and referral for physical therapy only after trismus is detected.
How Is the Trial Designed?
1Treatment groups
Experimental Treatment
Group I: Prospective Surveillance for Trismus and Early Physical Therapy InterventionExperimental Treatment1 Intervention

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials
957
Recruited
437,000+

Alberta Health services

Collaborator

Trials
168
Recruited
658,000+

Published Research Related to This Trial

The Dynasplint Trismus System (DTS) effectively increased the maximal incisal opening (MIO) in patients with trismus due to head and neck cancer, with a mean improvement of 32% from 19.3 mm to 25.5 mm over the treatment period.
The most significant improvement occurred in the first 6 weeks, with an initial rate of gain of 0.36 mm/day, indicating that early intervention with DTS is crucial for maximizing benefits.
Dynasplint for the management of trismus after treatment of upper aerodigestive tract cancer: a retrospective study.Barañano, CF., Rosenthal, EL., Morgan, BA., et al.[2019]
The scoping review of nine studies found that while jaw-mobilizing devices may help manage trismus in head and neck cancer survivors, they did not show effectiveness in preventing trismus.
There is a need for more research led by physical therapists to explore the potential benefits of manual therapy for trismus, as current studies indicate poor adherence and completion rates among survivors.
A Scoping Review of Physiotherapeutic Interventions for Trismus in Head and Neck Cancer: Where Is the Manual Therapy?Nedeljak, J., Armijo-Olivo, S., Hernandez, IA., et al.[2023]
Radiotherapy affecting the temporomandibular joint and pterygoid muscles can lead to a significant reduction in mouth opening (average decrease of 18%), highlighting a common risk factor for trismus in head and neck cancer patients.
Interventions such as exercises with a therabite device and tongue blades have been shown to significantly improve mouth opening, with effect sizes of 2.6 and 1.5 respectively, indicating their potential efficacy in treating trismus.
Trismus in head and neck oncology: a systematic review.Dijkstra, PU., Kalk, WW., Roodenburg, JL.[2018]

Citations

Where Is the Manual Therapy? - PMC - PubMed CentralConclusions: No benefit was found for the use of jaw-mobilizing devices for the prevention of trismus. Given the potential of manual therapy to enhance ...
Early Physical Therapy for Lockjaw (PRECISE Trial)The Dynasplint Trismus System (DTS) effectively increased the maximal incisal opening (MIO) in patients with trismus due to head and neck cancer, with a mean ...
Exercise therapy for trismus in head and neck cancerThe results of this retrospective study indicate that mouth opening increases significantly after exercise therapy in patients with trismus. The increase in ...
Effectiveness of Physiotherapy in the Treatment of ...After 3 months of treatment of the TMJs and cervical spine, pain decreased in both groups (p = 0001). Muscle testing at the cervical spine and ...
Effectiveness of Physiotherapy Rehabilitation on Hysterical ...The purpose of the present study was to evaluate the effect of a structured 2-week intervention using a combination of structured exercise and electrotherapy ...
Early Use of a Mechanical Stretching Device to Improve ...Conclusions. The Therabite mechanical stretching device is effective and safe for the management of trismus in a select group of head and neck cancer patients ...
Jaw Motion Rehabilitation SystemsA significant improvement in MIO was observed post-exercise (3.5 mm, 15.3 %, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1 %, p = 0.0029). A ...
Restorabite™: Phase II trial of jaw stretching exercises ...Safety, adherence, changes in mouth opening, and patient-reported outcomes are presented. 114/120 participants with trismus completed the ...
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