Summary of findings 2. Therapeutic swallowing exercises compared with sham intervention for dysphagia in head and neck cancer patients.

Therapeutic swallowing exercises compared with sham intervention for dysphagia in head and neck cancer patients
Patient or population: adults with advanced head and neck cancer Settings: acute/hospital departments and clinics Intervention: therapeutic swallowing exercises (Pharyngocise) Comparison: sham exercises
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Sham exercises	Pharyngocise
Adverse events: Dysphagia‐related complications Occurrence of dysphagia‐related complications: pneumonia, dehydration, mucositis and oral yeast infection	N/A	N/A	No data	27 (Pharyngocise group: 14; sham group 13) (1 study) Carnaby‐Mann 2012	⊕⊝⊝⊝ very low1,2	There was no comparison of outcomes between the interventions in the study.
Adverse event: Weight loss (> 10%) Change in nutritional status reflected by a patient's weight at 6 weeks after treatment	N/A	N/A	Change at 6 weeks RR 0.62 (95% CI 0.22 to 1.71)	27 (Pharyngocise group: 14; sham group 13) (1 study) Carnaby‐Mann 2012	⊕⊝⊝⊝ very low1,2	At 6 weeks post‐treatment the risk of weight loss (> 10%) is lower in the Pharyngocise group compared to the sham group. The sham group has less likelihood of weight loss than the Pharyngocise group. However, the estimate has a wide confidence interval, so it is not statistically significant. The risk of weight loss > 10% (of baseline body weight) is around 40% lower in the Pharyngocise group compared to the sham group.
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; N/A: not applicable; RR: risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹Few participants.

²Risk of performance bias is high (Carnaby‐Mann 2012).