The “Cristo Re” hospital experience on telerehabilitation for treatment post thyroidectomy neck pain

BACKGROUND: Thyroidectomies are one of the most frequently performed endocrine surgical procedures and are mostly consequent to thyroid cancers with about 80% of patients develop neck pain and stiffness. For better management in a public health setting, Cristo Re Hospital in Rome has designed specific physiotherapy based on selective stretching and strengthening of neck muscles combined with breathing. METHODS: The study enrolled 26 patients with a mean age of 51.2 years: 20 were treated with total thyroidectomy and 6 with thyroid lobectomy. Follow-up was performed at 1 day, 1 week and 1 month after surgery. We used for assessment: Visual Analog Scale (VAS), Neck Pain and Disability Scale-I (NPDS-I), Short Form-12 (SF12), Disability of the Arm, Shoulder and Hand (DASH), Neck Disability Index Questionnaire (NDI). The patients performed 10 therapeutic sessions: the first in the hospital on the first post-surgery day, the others in telerehabilitation 3 times a week (40 min. each) for 3 weeks. A nonparametric Friedmann test was analyzed the differences between the scale averages at T0/T1 and T2. Using case-control analysis the effects of treatment duration (<vs>90 min.) were assessed with the U-Mann-Whitney test. RESULTS: A statistically significant improvement was shown in the Physical Component Summary- SF12 at 1 week and 1 month after treatment (+3 pts at T1, +13.2 at T2 p < 0.001), while no significant changes in the Mental Component Summary. The averages of NPDS-I, NDI and DASH also decreased at T1 and T2 demonstrating the effectiveness of the protocol (-37.7 median points,-18.3 mp,-34.5 mp,-35 mp, respectively p < 0.001). No significant change in VAS scale at T1 and T2 and in patients treated for more or less than 90 minutes. CONCLUSIONS: This protocol is useful for reducing neck pain and improving quality of life and can be recommended as a therapy after thyroidectomy with a strong reduction in cost and morbidity, being able to treat patients even in telerehabilitation. KEY MESSAGES: • Therapy after thyroidectomy that, by being able to treat patients even in telerehabilitation, reduces hospitalization rates, costs, and morbidity due to neck pain, with increased quality of life. • New low-cost methodology for neck physiotherapy after thyroidectomy, also performed in telerehabilitation, which improves quality of life and ability of movement while greatly reducing pain.