. 2022 Nov 19;10(1):100169. doi: 10.1016/j.apjon.2022.100169

Table 1.

Study and patient characteristics (n = 21).

First author, year, language	Study design	Sample size (I/C)	Participant characteristics	Swallow training regimen
Starmer H, 2022, English	Quasi-experimental study	44/47	Cancer type: HNC (oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx)	During radiation
			Age (years): 59.3 ± 9.9/61.0 ± 9.6
			Gender: male (85.7%/87.2%)
			Treatment: radiation
			Timepoint: planning radiation
			Dysphagia stage: NR
Constantinescu G, 2021, English	Quasi-experimental study	20	Cancer type: HNC (oral, oropharyngeal, or other cancers)	After radiation A target of 72 swallows per day split between 3 different exercise types: 3 regular swallows, 3 effortful swallows, and 3 Mendelsohn maneuver swallows
			Age (years): 61 ± 8
			Gender: male (75%)
			Treatment: surgery ± (chemo)radiation
			Time point: 3 months post-HNC treatment
			Dysphagia stage: may benefit from the Mendelsohn maneuver swallow(depend on SLP)
Hajdú SF, 2019, English	Quasi-experimental study	45	Cancer type: HNC (oral cavity, larynx, oropharynx, hypopharynx, or unknown primary tumor) Age (years): 62 (41–78) Gender: male (78%) Treatment: (chemo)radiotherapy Timepoint: planning radiation Dysphagia stage: NR	During radiation
				Three times daily
				14 exercises (tongue stretching and strengthening, jaw mobility and mouth opening, Mendelsohn maneuver, Shaker exercise, Masako maneuver, Effortful swallow, and Valsalva)
Starmer HM, 2018, English	Quasi-experimental study	36	Cancer type: HNC (oropharyngeal tumors 83%)	During radiation 3 sets of 10 reps of each exercise twice daily Specific exercises included effortful swallow, Masako, Mendelsohn, effortful pitch glides, and jaw stretches
			Age (years): 61 ± 8
			Gender: male (80%)
			Treatment: Chemoradiation (75%) Surgery + radiation (17%) Radiation (8%)
			Timepoint: planning radiation
			Dysphagia stage: NR
Cnossen IC, 2017, English	Quasi-experimental study	50	Cancer type: HNC (oral cavity, oropharynx, hypopharynx, or larynx)	After radiation At least once a day for 15 min and preferably 3 times a day Swallowing with strength: effortful swallow, taking sips of water regularly
			Age (years): 66 (40–77)
			Gender: male (78%)
			Treatment: (chemo)radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: RTOG scores: 2-4
Wall LR, 2017, English	Randomized controlled study	20/25/26	Cancer type: HNC (100%)	During radiation Usual swallowing rehabilitation based on a literature review
			Age (years): 58 ± 8
			Gender: male (89%)
			Treatment: (chemo)radiotherapy
			Time point: planning radiation
			Dysphagia stage: FOIS: 7/≤ 6
Shinn EH, 2013, English	Cohort	109	Cancer type: oropharyngeal cancer (100%)	Preradiotherapy/mid-radiotherapy/postradiotherapy Speech pathology-led swallowing exercises
			Age (years): 57 ± 9
			Gender: male (87%)
			Treatment: (chemo)radiotherapy
			Time point: planning radiation
			Dysphagia stage: NR
Govender R, 2020, English	Randomized controlled study	16/16	Cancer type: HNC (oral cavity, nasopharynx, Oropharynx, hypopharynx, larynx)	After radiation Usual posttreatment swallowing rehabilitation
			Age (years): 58.56 ± 12.41/55.19 ± 9.45
			Gender: male (95%)
			Treatment: radiotherapy ± surgery (2%) ± chemotherapy
			Time point: planning radiation (radiotherapy group)
			Dysphagia stage: NR
Govender R, 2017, English	Qualitative	13	Cancer type: HNC (oral cavity, nasopharynx, oropharynx, hypopharynx/larynx)	After radiation Depend on swallowing exercise consulting with a SLT
			Age (years): 56.5 ± 6.5
			Gender: male (69%)
			Treatment: radiotherapy ± surgery ± chemotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: PSS: < 50: 4 PSS: ≥ 50: 9
Kraaijenga SA, 2017, English	Quasi-experimental study	18	Cancer type: HNC (parotic gland, parotic gland, hypopharynx, oral cavity, neck metastasis, oropharynx,larynx)	After radiation Perform the SEA exercises 3 times daily for at least 6 weeks and for a maximum of 8 weeks Progressive muscle overload, including chin tuck, jaw opening, and effortful swallow exercises
			Age (years): 65 (42–74)
			Gender: male (76%)
			Treatment: (chemo)radiotherapy
			Time point: The dysphagia had to be persistent for at least 1 year
			Dysphagia stage: PAS ≤ 4
Baudelet M, 2020, English	Randomized controlled study (protocol)	50/50/50	Cancer type: HNC (100%)	Before and during radiation 5 times/wk (30–40 min) Tongue strengthening exercises and chin tuck against resistance combined with an effortful swallow
			Treatment: (chemo)radiotherapy
			Time point: 4 weeks before (chemo)radiotherapy
Wen K, 2021, Chinese	Cross-sectional study	124	Cancer type: NPC (100%)	After radiation Mouth opening exercise
			Age (years): ＜ 60:78 ≥ 60:46
			Gender: male (66%)
			Treatment: radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
Zhang YF, 2020, Chinese	Cross-sectional study	88	Cancer type: NPC (100%)	After radiation (1) Mouth opening exercise lasting 5 s, more than 60 times a day; (2) Tapping teeth, 100 times/time, 3 times/d; (3) Drum gills, chewing gum, blowing balloons, and other exercises; (4) Neck exercise 3–5 min/time, 5 times/d
			Age (years): 35–60
			Gender: male (49%)
			Treatment: radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
Xu X, 2018, Chinese	Quasi-experimental study	118/121	Cancer type: NPC (100%)	After radiation Mouth opening exercise
			Age (years): 25–65
			Gender: male (76.03%)
			Treatment: radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
He PY, 2015, Chinese	Randomized controlled study	143/144	Cancer type: NPC (100%)	After radiation (1) Mouth opening exercise, 10–15 min/time, 3 times/d; (2) Tapping teeth, 100 times/time, 3 times/d; (3) Tongue exercise, 10 times/d, each interval of 10 min; (4) Drum cheeks, chewing, whistling, deep breathing exercise, 10–15 min/time, 3 times/d; (5) Temporomandibular joint massaging, 10–15 min/time, 3 times/d
			Age(years): 47 ± 11
			Gender: male (76.1%)
			Treatment: radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
Yu JF, 2021, Chinese	Randomized controlled study	40/40	Cancer type: NPC (100%)	After radiation Mouth opening exercise
			Age (years): 40 ± 6
			Gender: male (68.8%)
			Treatment: radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
Fan SQ, 2021, Chinese	Cross-sectional study	150	Cancer type: NPC (100%)	During radiation and after radiation Mouth opening exercise
			Age (years): 40 ± 6
			Gender: male (68.8%)
			Treatment: radiotherapy
			Time point: undergoing radiotherapy for more than 4 weeks
			Dysphagia stage: NR
Wang XM, 2017, Chinese	Quasi-experimental study	84	Cancer type: NPC (100%)	During radiation Mouth opening exercise
			Age (years): 17–72
			Gender: male (70.2%)
			Treatment: radiotherapy
			Time point: planning radiotherapy
			Dysphagia stage: NR
Lu XN, 2017, Chinese	Randomized controlled study	60/60	Cancer type: NPC (100%)	After radiation Mouth opening exercise, drum gill, shrink gill exercise, tongue exercise, knock teeth exercise, temporomandibular joint exercise, neck muscle exercise
			Age (years): 24–69
			Gender: male (78%)
			Treatment: radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
Chen PJ, 2016, Chinese	Cross-sectional study	124	Cancer type: NPC (100%)	After radiation Mouth opening exercise
			Age (years): < 60:78 ≥ 60:46
			Gender: male (66.1%)
			Treatment: (chemo)radiotherapy
			Time point: terminate radiotherapy
			Dysphagia stage: NR
You GM, 2005, Chinese	Cross-sectional study	50	Cancer type: NPC (100%)	Preradiotherapy/midradiotherapy/postradiotherapy Mouth opening exercise: mouth opening to the maximum and then slowly closed, repeated 10 rounds, 3 times a day; bite cork 10–15 min, 1 times a day
			Age (years): ＜ 60:78 ≥ 60:46
			Gender: male (68%)
			Treatment: radiotherapy
			Time point: planning radiotherapy
			Dysphagia stage: NR

FOIS, Functional Oral Intake Scale; HNC, head and neck cancer; I/C, intervention/control; IOPI, Iowa Oral Performance Instrument; NPC, nasopharyngeal carcinoma cancer; NR, not report; PAS, penetration-aspiration scale; PSS, Performance Status Scale; RTOG, Radiation Therapy Oncology Group; SEA, Swallow Exercise Aid; SLPs, speech and language pathologist; SLTs, speech and language therapists.