Method for integrating and analyzing head and neck tumor postoperative neck and shoulder function exercise through health behavior change

Abstract

The invention relates to the technical field of medical rehabilitation, discloses a head and neck tumor postoperative neck and shoulder function exercise method based on health behavior change integration analysis, and aims to provide a scientific and systematic shoulder and neck function exercise scheme for a head and neck tumor and cervical lymph node cleaning postoperative patient. According to the method, an exercise scheme is constructed through an evidence-based and expert conference method, effect evaluation is carried out by adopting a class experiment research method, and various exercise modes such as active exercise, passive exercise and progressive resistance training are included. According to the health behavior change integrated analysis head and neck tumor postoperative neck and shoulder function exercise method, postoperative pain of a patient can be relieved in the early stage, shoulder and neck dysfunction is improved, the neck scar contracture degree is relieved, the daily life activity of the patient is improved, clinical applicability and scientificity are achieved, and the method is worthy of further application and popularization.

Description

Technical Field

[0001] The present invention relates to the field of medical rehabilitation technology, and in particular to a method for training neck and shoulder functions after head and neck tumor surgery by integrating analysis of health behavior changes. Background Art

[0002] The incidence of head and neck cancer ranks seventh in the world, and the mortality rate ranks eighth among cancer-related causes of death. Cervical lymph node metastasis is a common metastasis of head and neck cancer. Therefore, carcinoma in situ resection + cervical lymph node dissection is one of the commonly used surgical procedures in head and neck tumor surgery. Due to the large scope of surgery, damage to the accessory nerve, cervical plexus, muscle blood vessels and fascia tissue during the operation causes patients to suffer from pain, neck and shoulder dysfunction, swelling and numbness of the surgical incision for a long period of time after the operation, and they are unable to resume their normal work and life before the operation, which reduces the quality of life of patients. Integrated analysis of health behavior change: Behavioral change is a dynamic and repetitive process. ① Desire and motivation are prerequisites for behavior change; ② Self-reflection is conducive to progress; ③ Social influence will shake a person's interest and willingness. Changes in health behavior can be achieved by cultivating knowledge and beliefs, improving self-regulation skills and abilities, and strengthening social promotion. The short-term results of these interventions are personal participation in self-management behavior, and the long-term results are long-term effects on health status.

[0003] A large number of studies at home and abroad have shown that postoperative neck and shoulder functional exercise is beneficial to the recovery of neck and shoulder function, relieves shoulder and neck discomfort symptoms, reduces postoperative complications and scar formation, reduces hospitalization time and treatment costs, and improves self-management efficacy and quality of life. In previous studies, researchers have explored the development of different neck and shoulder exercise methods and analyzed their application effects, such as active training, passive training, progressive resistance training, muscle energy technology, etc. Although different exercise methods have changed the patient's behavior, they cannot keep the patient for a long time; some researchers have also explored the effect of psychological theories such as self-efficacy on patient functional exercise. Although it can improve the patient's confidence, it ignores the social and physical aspects of the patient. Past studies often only focus on the patient's one side, but the patient is a whole. In order to truly change the patient's health behavior and make it have a long-term effect, it should start from multiple aspects such as bio-psychology-society. The integrated analysis based on health behavior change has a significant effect on the functional exercise of patients with total knee replacement, hemiplegia due to ischemic stroke, pulmonary rehabilitation due to COPD, and cardiac rehabilitation due to coronary heart disease. However, no research has been found to integrate health behavior change for the analysis of neck and shoulder functional exercise in patients with head and neck tumors. Summary of the invention

[0004] In order to solve the above technical problems, the present invention provides a method for training neck and shoulder functions after head and neck tumor surgery by integrating analysis of healthy behavior changes.

[0005] The method for training neck and shoulder function after head and neck tumor surgery by integrating analysis of health behavior change provided by the present invention comprises the following steps:

[0006] Constructing an exercise program: Constructing a shoulder and neck function exercise program for patients after neck lymph node dissection for head and neck tumors through evidence-based and expert conference methods;

[0007] Effect evaluation: A quasi-experimental research method was used to select patients with head and neck tumor surgery within a certain period of time as the research subjects. Some patients were selected as the control group to receive routine postoperative nursing measures, and the other patients were selected as the experimental group to receive the shoulder and neck exercise program on the basis of routine nursing. The shoulder and neck dysfunction and the degree of neck scar contracture were evaluated by tools such as the Constant-Murley Shoulder Function Evaluation Scale (CMS);

[0008] Exercise implementation: includes active exercise, passive exercise and progressive resistance training. Active exercise starts from a small range at the distal end of the affected limb on the surgical side, gradually moves to the surgical incision site, and gradually increases in intensity. Passive exercise is mainly carried out under the guidance of a rehabilitation trainer. Progressive resistance training refers to the process of continuously increasing the resistance load during training, stimulating the muscles to continuously adapt to the increased intensity and thus increase strength.

[0009] Preferably, the process of constructing the exercise program includes systematically searching domestic and foreign databases and guideline websites, reading relevant clinical guidelines, systematic reviews and other literature, performing literature screening, quality evaluation, and evidence extraction according to the steps of evidence-based nursing, and constructing a preliminary plan after discussion, collation and summarization by the project team members, and inviting experts to modify and improve it.

[0010] Preferably, the effect evaluation step evaluates the degree of shoulder and neck dysfunction and neck scar contracture, and in addition to using the Constant-Murley Shoulder Function Evaluation Scale (CMS) as a research tool, it also includes a general situation questionnaire, a shoulder and neck active range of motion (AROM) measurement form, the Vancouver Scar Scale and other tools.

[0011] Preferably, in the effect evaluation step, the inclusion criteria for selecting research subjects are:

[0012] ① Patients with head and neck cancer diagnosed in accordance with the diagnostic criteria of the "CSCO Guidelines for the Diagnosis and Treatment of Head and Neck Cancers 2022";

[0013] ②18 years old ≤ ≤ 65 years old;

[0014] ③ The patient is planned to undergo carcinoma in situ resection + neck lymph node dissection;

[0015] ④ Those whose condition is stable, whose consciousness is clear and whose communication is barrier-free;

[0016] ⑤ Voluntarily participate in this study and sign the informed consent form;

[0017] Exclusion criteria were:

[0018] ① Those with a history of neck and shoulder trauma or neck and shoulder functional activity disorders;

[0019] ② History of bone and joint system diseases, such as rheumatoid arthritis, osteoarthritis, etc.;

[0020] ③ Patients with severe heart, brain, lung diseases and cognitive dysfunction;

[0021] ④ Patients with combined neuromuscular disease or diabetes affecting limb function;

[0022] ⑤ Patients with tumor recurrence or terminal cancer, whose expected survival rate is less than 1 year.

[0023] Preferably, the training method further includes quality control, specifically including:

[0024] ① Intervention design stage: read a lot of literature, consult otolaryngology and head and neck surgery experts to design a reasonable and effective neck and shoulder function exercise program, comment on the scientificity, practicality and feasibility of this study design, and put forward opinions and suggestions on the shortcomings of the design to improve the design;

[0025] ②Intervention implementation stage: strictly follow the intervention plan to implement the intervention, conduct unified training for instructors to ensure uniform action quality; strictly select research subjects according to the inclusion and exclusion criteria;

[0026] ③ Data collection and data processing stage: Use a unified measuring instrument to measure the range of motion of the patient's neck and shoulder joints; guide the patient to fill out the questionnaire, collect the data on the spot, ensure the accuracy and completeness of the data, and pay attention to protecting the patient's privacy; all data are double-checked and entered into the software;

[0027] ④ Ethical approval: Apply for approval from the hospital ethics committee. For example, this study applied for approval from the Ethics Committee of the Second Hospital of Jilin University.

[0028] Preferably, in the effect evaluation, a non-contemporaneous control experiment is conducted using a quasi-experimental research method, and the following operations are performed on the control group:

[0029] Admission assessment: Perform a routine assessment of the patient's general condition when the patient is admitted to the hospital;

[0030] Routine nursing: Provide one-on-one guidance to patients according to the routine nursing pathway of the department, explain disease-related knowledge, preoperative and postoperative precautions, etc.; distribute the "Neck and Shoulder Function Exercise Guidance Manual" and "Neck and Shoulder Function Exercise Monitoring Diary" and exercise guidance videos to patients, mainly through verbal education, and accept patient consultations; inform patients to remove stitches and change dressings regularly when discharged, and emphasize the time for follow-up visits;

[0031] Follow-up: Add the patient to WeChat and establish a WeChat group. After the patient is discharged from the hospital, follow up with the patient on WeChat and when he / she comes to the hospital for follow-up visits to understand the recovery of his / her neck and shoulder function;

[0032] The following operations were performed on the experimental group:

[0033] ① Individualized assessment: focus on assessing the patient's disease risk factors and disease cognition, guide the patient to express his or her views on functional exercise and some obstacles that may affect functional exercise, arouse the patient's awareness of functional exercise, and stimulate the patient's enthusiasm for functional exercise;

[0034] ② Explain the anatomy of the cervical and shoulder joints, the surgical process of cervical lymph node dissection, and postoperative complications to patients, help them analyze the adverse effects of cervical and shoulder dysfunction caused by the disease on their daily lives, distribute the "Neck and Shoulder Functional Exercise Guidance Manual" and exercise guidance videos, explain the relevant content of functional exercises to patients and guide specific movements, and provide personalized education for them based on the results of the patient assessment;

[0035] ③ Work with patients to set training goals, understand patients' daily functional exercise status based on the "Neck and Shoulder Functional Exercise Monitoring Diary", and also facilitate patients to conduct self-monitoring and self-reflection, timely discover patients' discomfort symptoms and psychological changes, and provide necessary guidance and adjustments based on the diary;

[0036] ④ Strengthen social support, including:

[0037] Caregiver support: When educating patients, invite caregivers to participate in disease knowledge learning, supervise patients’ exercise and health diary records, and guide them to give understanding and support to patients;

[0038] Peer support: organize experience exchanges among patients and set up WeChat group chats to facilitate communication among patients;

[0039] Information support: The hospital distributes the "Neck and Shoulder Functional Exercise Guidance Manual" and provides one-on-one guidance on functional exercises. Outside the hospital, we follow up with patients through WeChat and telephone calls to solve their questions, and push disease-related knowledge through WeChat groups from time to time.

[0040] Compared with the related art, the method for training neck and shoulder function after head and neck tumor surgery by integrating analysis of health behavior change provided by the present invention has the following beneficial effects:

[0041] 1. Construct a scientific and systematic exercise program: This invention aims to provide a scientific and systematic shoulder and neck function exercise program for patients after neck lymph node dissection for head and neck tumors, so as to help patients restore their shoulder and neck functions.

[0042] 2. Reduce postoperative pain: By implementing this exercise program, the patient's postoperative pain can be reduced early.

[0043] 3. Improve shoulder and neck dysfunction: This program can improve patients' shoulder and neck dysfunction, especially neck flexion and left flexion, shoulder extension, flexion and abduction activities.

[0044] 4. Reduce the degree of neck scar contracture: This exercise program can effectively reduce the degree of neck scar contracture, which is of great significance for improving the quality of life of patients.

[0045] 5. Improved daily living activities: By improving shoulder and neck function, this program can also improve the patient's overall daily living activities.

[0046] 6. Clinical applicability and scientificity: This exercise program has certain clinical applicability and scientificity, and is worthy of further promotion and application.

[0047] 7. Evidence-based nursing practice: The program is constructed based on evidence-based and expert conference methods to ensure its scientificity and effectiveness.

[0048] 8. Promote patient recovery: Through the initial application of quasi-experimental research methods in clinical practice and the evaluation of the application effect, a new method is provided for the recovery of patients after cervical lymph node dissection for head and neck tumors.

[0049] In summary, the purpose of the process method of the invention is to help patients after head and neck tumor surgery to restore shoulder and neck function, relieve pain, improve quality of life, and promote their overall recovery through scientific and systematic exercise. BRIEF DESCRIPTION OF THE DRAWINGS

[0050] Figure 1 A flowchart of a method for integrating and analyzing neck and shoulder function training after head and neck tumor surgery based on health behavior change provided by the present invention. DETAILED DESCRIPTION

[0051] The present invention will be further described below in conjunction with the accompanying drawings and implementation modes.

[0052] The health behavior change integrated analysis and neck and shoulder function training method after head and neck tumor surgery proposed by the present invention adopts the following technical route:

[0053] Systematic literature search and quality assessment: Relevant literature was retrieved through domestic and international databases, and quality assessment and evidence extraction were performed.

[0054] Expert meeting: Invite experts in the field to discuss and modify the preliminary plan to form a more complete plan.

[0055] Quasi-experimental research: Evaluate the actual effect of the program by setting up a control group and an experimental group.

[0056] Statistical analysis: Use statistical methods to analyze the collected data to evaluate the effectiveness of the program and draw research conclusions.

[0057] Integrated analysis of health behavior changes: Neck and shoulder function training methods after head and neck tumor surgery include:

[0058] The implementation scheme of the method for integrated analysis of health behavior change and neck and shoulder function training after head and neck tumor surgery provided by the present invention is as follows:

[0059] 1. Use non-concurrent control experiments in quasi-experimental studies.

[0060] Patients who were scheduled to undergo carcinoma in situ resection + cervical lymph node dissection in the Department of Otolaryngology and Head and Neck Surgery of a tertiary hospital in Changchun within a certain period of time were included as research subjects. Convenient sampling method was used to select patients admitted to the hospital within a certain period of time as the control group, and in order to avoid contamination, patients admitted to the hospital within a certain period of time were selected as the experimental group. The control group received routine postoperative nursing measures, and the observation group received the shoulder and neck exercise program constructed in this study on the basis of routine nursing.

[0061] (1) Inclusion criteria:

[0062] ① Patients with head and neck cancer diagnosed in accordance with the diagnostic criteria of the "CSCO Guidelines for the Diagnosis and Treatment of Head and Neck Cancers 2022"

[0063] ②18 years old ≤ ≤ 65 years old

[0064] ③ Treatment with carcinoma in situ resection + neck lymph node dissection

[0065] ④ Those whose condition is stable, whose consciousness is clear and who can communicate well

[0066] ⑤ Volunteer to participate in this study and sign the informed consent

[0067] (2) Exclusion criteria:

[0068] ① Those with a history of neck and shoulder trauma or neck and shoulder functional impairment

[0069] ② History of bone and joint diseases, such as rheumatoid arthritis, osteoarthritis, etc.

[0070] ③ Patients with severe heart, brain, lung diseases and cognitive impairment

[0071] ④ Patients with combined neuromuscular disease or diabetes affecting limb function

[0072] ⑤ Patients with tumor recurrence or terminal cancer, with an expected survival rate of less than 1 year

[0073] 2. Sample size estimation:

[0074] This study uses the sample content calculation formula for comparing the means of two independent samples to calculate the sample size required for this study. The calculation formula is: n1 = n2 = 2 × [(Zα + Zβ) × (σ / δ)]2, taking the significance level α = 0.05, β = 0.10, and looking up the table to find that Zα = 1.96, Zβ = 1.282. This study consulted the literature and found that σ = 12.44, δ = 9.4. The required sample size for each group was calculated to be 37 cases. Adding a 20% dropout rate, 45 cases per group, and the final total sample size was 90 cases.

[0075] 3. Research Tools:

[0076] ① General Questionnaire

[0077] ②Constant-Murley Shoulder Function Scale (CMS)

[0078] ③ Shoulder and neck active range of motion (AROM) measurement table

[0079] ④ Vancouver Scar Scale (VSS)

[0080] 4. Statistical methods:

[0081] SPSS25.0 was used for data collation and analysis. The measurement data that met the normal distribution and variance homogeneity were described by (mean ± standard deviation), and the measurement data that did not meet the normal distribution and variance homogeneity were expressed by median and interquartile range; the count data were described by frequency and percentage (%). Two independent sample t-tests or rank sum tests were used to compare measurement data; chi-square tests were used to compare count data. Repeated measures analysis of variance was used to compare and analyze the shoulder joint function, neck and shoulder joint range of motion, self-management efficacy and quality of life at different time points. All statistical tests in this study were statistically significant with P < 0.05.

[0082] 5.Quality Control:

[0083] ①Intervention design stage: Read a large amount of literature, consult otolaryngology and head and neck surgery experts to design a reasonable and effective neck and shoulder functional exercise program, comment on the scientificity, practicality and feasibility of this study design, and put forward opinions and suggestions on the shortcomings in the design to improve the design.

[0084] ②Intervention implementation stage: Strictly follow the intervention plan to implement the intervention, provide unified training for instructors to ensure uniform action quality; select research subjects strictly according to the inclusion and exclusion criteria.

[0085] ③ Data collection and data processing stage: Use a unified measuring instrument to measure the range of motion of the patient's neck and shoulder joints; guide the patient to fill out the questionnaire, collect the data on the spot, ensure the accuracy and completeness of the data, and pay attention to protecting the patient's privacy. All data are double-checked and entered into the software.

[0086] ④ Ethical approval: This study intends to apply for approval from the Ethics Committee of the Second Hospital of Jilin University.

[0087] 6. Research plan:

[0088] A patent research team was established. The first inventor was responsible for research coordination and judging the scientificity and feasibility of the plan. Members were responsible for assisting researchers in formulating reasonable plans, assisting in plan construction and clinical research, formulating rehabilitation plans for patients, and providing guidance on neck and shoulder functional exercises to researchers participating in clinical empirical research. They were responsible for the implementation of the plan, including individualized assessment of patients, guidance on functional exercises, disease knowledge education, data collection, clinical empirical research, and data statistical analysis.

[0089] 7. Preliminary preparation:

[0090] We read a lot of relevant literature on HNC neck and shoulder functional exercises at home and abroad, referred to the HNC neck and shoulder functional exercise guidelines issued by the American Society of Oncology Nursing, the American Society of Clinical Oncology, the French Otolaryngology Head and Neck Surgery, etc., combined with the actual clinical situation, and finally determined the exercise plan after review and modification by the chief physician of Otolaryngology Head and Neck Surgery, formulated the "Neck and Shoulder Functional Exercise Manual" and "Neck and Shoulder Functional Exercise Monitoring Diary", and recorded exercise guidance videos.

[0091] 8. Control group:

[0092] Admission assessment: A routine assessment of the patient's general condition is performed when the patient is admitted to the hospital.

[0093] Routine nursing: Provide one-on-one guidance to patients according to the routine nursing pathway of the department, explain disease-related knowledge, preoperative and postoperative precautions, etc.; distribute the "Neck and Shoulder Functional Exercise Guidance Manual" and "Neck and Shoulder Functional Exercise Monitoring Diary" and exercise guidance videos to patients. The education method is mainly oral education, and patients are consulted; inform patients to remove stitches and change dressings regularly when discharged from the hospital, and emphasize the time for follow-up visits.

[0094] Follow-up: Add the patient to WeChat and establish a WeChat group. After the patient is discharged from the hospital, follow up with the patient on WeChat and when he / she comes to the hospital for follow-up visits to understand the recovery of his / her neck and shoulder function.

[0095] 9. Experimental group:

[0096] ① Individualized assessment: focus on assessing the patient's disease risk factors and disease cognition, guide the patient to express his or her views on functional exercise and some obstacles that may affect functional exercise, arouse the patient's awareness of functional exercise, and stimulate the patient's enthusiasm for functional exercise.

[0097] ② Explain to patients the anatomy of the cervical and shoulder joints, the surgical process of cervical lymph node dissection, and postoperative complications, etc., help patients analyze the adverse effects of cervical and shoulder dysfunction caused by the disease on their daily lives, distribute the "Neck and Shoulder Functional Exercise Guidance Manual" and exercise guidance videos, explain to patients the relevant content of functional exercises and guide specific movements, and provide personalized education based on the results of patient assessment.

[0098] ③ Set training goals together with the patient, and understand the patient's daily functional exercise status based on the "Neck and Shoulder Functional Exercise Monitoring Diary". It is also beneficial for the patient to conduct self-monitoring and reflection, promptly discover the patient's discomfort symptoms and psychological changes, and provide necessary guidance and adjustments based on the diary.

[0099] ④ Strengthen social support. Caregiver support: When educating patients, invite caregivers to participate in disease knowledge learning, supervise patients' exercise and health diary records, and guide them to give patients understanding and support; peer support: organize patient experience exchanges and establish WeChat group chats to facilitate patient communication; information support: distribute the "Neck and Shoulder Functional Exercise Guidance Manual" in the hospital, provide one-on-one guidance on functional exercises, solve patients' questions through WeChat and telephone follow-up outside the hospital, and push disease-related knowledge through WeChat groups from time to time.

[0100] 10. Research process:

[0101] All subjects received nursing intervention and follow-up for 2 months. Baseline survey was conducted before surgery, including general demographic data, active range of motion of the neck and shoulder joints, self-management efficacy, and quality of life. Follow-up survey was conducted when the patients came to the hospital for follow-up after surgery, including the assessment of the shoulder and neck dysfunction and the degree of neck scar contracture of the subjects 1 day before surgery, 1 week after surgery, 1 month after surgery, and 3 months after surgery.

[0102] 11. Effect evaluation:

[0103] The Constant-Murley shoulder function evaluation scale (CMS), shoulder and neck active range of motion (AROM) measurement table, Vancouver scar scale (VSS) and other tools were used to evaluate the shoulder and neck dysfunction and neck scar contracture degree of the subjects 1 day before surgery, 1 week after surgery, 1 month after surgery, and 3 months after surgery. 2 The data were analyzed by statistical methods such as test and repeated measures analysis of variance, and P < 0.05 was considered statistically significant.

[0104] Compared with the related art, the method for training neck and shoulder function after head and neck tumor surgery by integrating analysis of health behavior change provided by the present invention has the following beneficial effects:

[0105] 1. Application of evidence-based and expert meeting methods

[0106] This study is based on the principles of evidence-based medicine. Through systematic searches of domestic and foreign databases and guideline websites, such as the American Society of Oncology Nursing, PubMed, and China National Knowledge Infrastructure, relevant clinical guidelines, systematic reviews, and other literature were read, and literature screening, quality evaluation, and evidence extraction were performed according to the steps of evidence-based nursing. This method ensures the scientificity and practicality of the program.

[0107] 2. Comprehensive application of multi-dimensional assessment tools

[0108] The study used a variety of assessment tools, including the Constant-Murley Shoulder Function Scale (CMS), the Active Range of Motion (AROM) of the Shoulder and Neck, and the Vancouver Scar Scale (VSS), to comprehensively assess the shoulder and neck function of patients. This multi-dimensional assessment method can provide a more comprehensive understanding of the patient's rehabilitation process.

[0109] 3. Construction of personalized exercise program

[0110] The preliminary plan was discussed and modified through the expert meeting, and a personalized neck and shoulder function training plan that is easy to implement clinically was formed. This personalized plan can better adapt to the specific conditions of different patients and improve the rehabilitation effect.

[0111] 4. Early intervention and pain management

[0112] Studies have shown that this program can relieve patients' postoperative pain early and improve shoulder and neck dysfunction, especially neck flexion and left flexion, shoulder extension, flexion and abduction activities. This shows the importance of early intervention in pain management and functional recovery.

[0113] These innovations not only improve the scientificity and effectiveness of perioperative neck and shoulder functional training programs for patients with head and neck tumors, but also provide a theoretical and practical basis for clinical transformation, and are worthy of further promotion and application.

[0114] The above descriptions are merely embodiments of the present invention and are not intended to limit the patent scope of the present invention. Any equivalent structure or equivalent process transformation made using the contents of the present invention specification and drawings, or directly or indirectly applied in other related technical fields, are also included in the patent protection scope of the present invention.

Claims

1. A method for training neck and shoulder function after head and neck tumor surgery by integrating analysis of health behavior change, characterized in that: The following steps are involved: Constructing an exercise program: Constructing a shoulder and neck function exercise program for patients after neck lymph node dissection for head and neck tumors through evidence-based and expert conference methods; Effect evaluation: A quasi-experimental research method was used to select patients with head and neck tumor surgery within a certain period of time as the research subjects. Some patients were selected as the control group to receive routine postoperative nursing measures, and the other patients were selected as the experimental group to receive the shoulder and neck exercise program on the basis of routine nursing. The Constant-Murley shoulder joint function evaluation scale tool was used to evaluate the degree of shoulder and neck dysfunction and neck scar contracture. Exercise implementation: includes active exercise, passive exercise and progressive resistance training. Active exercise starts from a small range at the distal end of the affected limb on the surgical side, gradually moves to the surgical incision site, and the intensity gradually increases; passive exercise is performed under the guidance of a rehabilitation trainer; progressive resistance training refers to the process of continuously increasing the resistance load during training, stimulating the muscles to continuously adapt to the increased intensity and thus improve strength.

2. The method for training neck and shoulder function after head and neck tumor surgery based on integrated analysis of health behavior change as claimed in claim 1, characterized in that: The process of constructing the exercise program includes systematically searching domestic and international databases and guideline websites, reading relevant clinical guidelines and systematic review literature, and conducting literature screening, quality evaluation, and evidence extraction according to the steps of evidence-based nursing. The project team members discuss, organize and summarize the preliminary plan, and invite experts to modify and improve it.

3. The method for training neck and shoulder function after head and neck tumor surgery based on integrated analysis of health behavior change as claimed in claim 1, characterized in that: The effect evaluation step evaluates the degree of shoulder and neck dysfunction and neck scar contracture. In addition to using the Constant-Murley Shoulder Function Evaluation Scale as a research tool, it also includes a general condition questionnaire, a shoulder and neck active joint range of motion measurement form, and the Vancouver Scar Scale.

4. The method for training neck and shoulder function after head and neck tumor surgery by integrated analysis of health behavior change as claimed in claim 1, characterized in that: In the effect evaluation step, the inclusion criteria for selecting research subjects are: ① Patients with head and neck cancer diagnosed in accordance with the diagnostic criteria of the "CSCO Guidelines for the Diagnosis and Treatment of Head and Neck Cancers 2022"; ②18 years old ≤ ≤ 65 years old; ③ The patient is planned to undergo carcinoma in situ resection + neck lymph node dissection; ④ Those whose condition is stable, whose consciousness is clear and whose communication is barrier-free; ⑤ Voluntarily participate in this study and sign the informed consent form; Exclusion criteria were: ① Those with a history of neck and shoulder trauma or neck and shoulder functional activity disorders; ② History of bone and joint system diseases, such as rheumatoid arthritis, osteoarthritis, etc.; ③ Patients with severe heart, brain, lung diseases and cognitive dysfunction; ④ Patients with combined neuromuscular disease or diabetes affecting limb function; ⑤ Patients with tumor recurrence or terminal cancer, whose expected survival rate is less than 1 year.

5. The method for training neck and shoulder function after head and neck tumor surgery based on integrated analysis of health behavior change as claimed in claim 1, characterized in that: Quality control is also required in the exercise method, including: ① Intervention design stage: read a lot of literature, consult otolaryngology and head and neck surgery experts to design a reasonable and effective neck and shoulder function exercise program, comment on the scientificity, practicality and feasibility of this study design, and put forward opinions and suggestions on the shortcomings of the design to improve the design; ②Intervention implementation stage: strictly follow the intervention plan to implement the intervention, conduct unified training for instructors to ensure uniform action quality; strictly select research subjects according to the inclusion and exclusion criteria; ③ Data collection and data processing stage: Use a unified measuring instrument to measure the range of motion of the patient's neck and shoulder joints; guide the patient to fill out the questionnaire, collect the data on the spot, ensure the accuracy and completeness of the data, and pay attention to protecting the patient's privacy; all data are double-checked and entered into the software; ④ Ethical approval: Apply for approval from the hospital ethics committee.

6. The method for training neck and shoulder function after head and neck tumor surgery based on integrated analysis of health behavior change as claimed in claim 1, characterized in that: In the effect evaluation, a quasi-experimental research method was used to conduct a non-contemporaneous control experiment, and the following operations were performed on the control group: Admission assessment: Perform a routine assessment of the patient's general condition when the patient is admitted to the hospital; Routine nursing: Provide one-on-one guidance to patients according to the routine nursing pathway of the department, explain disease-related knowledge, and precautions before and after surgery; distribute the "Neck and Shoulder Function Exercise Guidance Manual" and "Neck and Shoulder Function Exercise Monitoring Diary" and exercise guidance videos to patients. The education method is mainly verbal education, and patients are consulted; inform patients to remove stitches and change dressings regularly when discharged, and emphasize the time for follow-up visits; Follow-up: Add the patient to WeChat and establish a WeChat group. After the patient is discharged from the hospital, follow up with the patient on WeChat and when he / she comes to the hospital for follow-up visits to understand the recovery of his / her neck and shoulder function; The following operations were performed on the experimental group: ① Individualized assessment: focus on assessing the patient's disease risk factors and disease cognition, guide the patient to express his or her views on functional exercise and some obstacles that may affect functional exercise, arouse the patient's awareness of functional exercise, and stimulate the patient's enthusiasm for functional exercise; ② Explain the anatomy of the cervical and shoulder joints, the surgical process of cervical lymph node dissection, and postoperative complications to patients, help them analyze the adverse effects of cervical and shoulder dysfunction caused by the disease on their daily lives, distribute the "Neck and Shoulder Functional Exercise Guidance Manual" and exercise guidance videos, explain the relevant content of functional exercises to patients and guide specific movements, and provide personalized education for them based on the results of the patient assessment; ③ Work with patients to set training goals, understand patients' daily functional exercise status based on the "Neck and Shoulder Functional Exercise Monitoring Diary", and also facilitate patients to conduct self-monitoring and self-reflection, timely discover patients' discomfort symptoms and psychological changes, and provide necessary guidance and adjustments based on the diary; ④ Strengthen social support, including: Caregiver support: When educating patients, invite caregivers to participate in disease knowledge learning, supervise patients’ exercise and health diary records, and guide them to give understanding and support to patients; Peer support: organize experience exchanges among patients and set up WeChat group chats to facilitate communication among patients; Information support: The hospital distributes the "Neck and Shoulder Functional Exercise Guidance Manual" and provides one-on-one guidance on functional exercises. Outside the hospital, we follow up with patients through WeChat and telephone calls to solve their questions, and push disease-related knowledge through WeChat groups from time to time.

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