# Perceptions and Experiences of Physiotherapists Treating Trismus in Head and Neck Cancer Patients: Findings from a Spanish Web-Based Survey

## TL;DR

This study explores how Spanish physiotherapists treat trismus in head and neck cancer patients, highlighting challenges and the need for better tools.

## Contribution

The study provides new insights into physiotherapists' clinical practices and barriers in managing trismus, emphasizing device limitations and patient-specific challenges.

## Key findings

- Physiotherapists commonly use manual therapy and therapeutic exercise but selectively use medical devices.
- Barriers include lack of functional tools, dental limitations, and patient adherence issues.
- Current devices often fail to mimic functional mastication, affecting recovery outcomes.

## Abstract

Background: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC), often arising after surgery or radiotherapy. Despite the key role physiotherapists play in rehabilitation, little is known about their perspectives and clinical approaches. This study aimed to explore physiotherapists’ experiences, perceptions, and treatment strategies in the management of treatment-induced trismus in HNC. Methods: A qualitative, cross-sectional study was conducted via a web-based self-administered questionnaire, developed in accordance with the CHERRIES guidelines. The survey combined closed- and open-ended questions across five thematic areas: sociodemographic, clinical experience, treatment practices, barriers, and medical devices. An inclusion algorithm ensured participation of physiotherapists with expertise in trismus. Quantitative data were analyzed descriptively; open responses underwent inductive thematic analysis. Results: Of 72 invited physiotherapists, 31 responded and 18 met inclusion criteria. Participants reported integrating manual therapy (100%) and therapeutic exercise (100%) into treatment, with more selective use of medical devices (77%). Barriers to implementation included lack of functional tools, dental status limitations, patient adherence issues, and socioeconomic constraints. Many highlighted that current devices often fail to mimic functional mastication, potentially overloading central incisors and limiting functional carryover. Conclusions: This qualitative study reveals limited device use, perceived design shortcomings, and the influence of dental status on functional recovery. Findings highlight the need for device innovation, interdisciplinary coordination, and protocols tailored to patient-specific barriers. Future research should explore combined approaches and include patient perspectives.