{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:09:54Z","timestamp":1792663794446,"version":"4.5.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018911","name":"University Hospital Foundation","doi-asserted-by":"crossref","award":["RES0021130"],"award-info":[{"award-number":["RES0021130"]}],"id":[{"id":"10.13039\/501100018911","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Shoulder dysfunction is common after neck dissection for head and neck cancer (HNC). Brief electrical stimulation (BES) is a novel technique that has been shown to enhance neuronal regeneration after nerve injury by modulating the brain-derived neurotrophic growth factor (BDNF) pathways. The objective of this study was to evaluate the effect of BES on postoperative shoulder function following oncologic neck dissection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult participants with a new diagnosis of HNC undergoing Level IIb +\/\u2212 V neck dissection were recruited. Those in the treatment group received intraoperative BES applied to the spinal accessory nerve (SAN) after completion of neck dissection for 60\u00a0min of continuous 20\u00a0Hz stimulation at 3-5\u00a0V of 0.1\u00a0msec balanced biphasic pulses, while those in the control group received no stimulation (NS). The primary outcome measured was the Constant-Murley Shoulder (CMS) Score, comparing changes from baseline to 12\u00a0months post-neck dissection. Secondary outcomes included the change in the Neck Dissection Impairment Index (\u0394NDII) score and the change in compound muscle action potential amplitude (\u0394CMAP) over the same period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty-four patients were randomized to the treatment or control group with a 1:1 allocation scheme. No differences in demographics, tumor characteristics, or neck dissection types were found between groups. Significantly lower \u0394CMS scores were observed in the BES group at 12\u00a0months, indicating better preservation of shoulder function ( p\u2009=\u20090.007). Only four in the BES group compared to 17 patients in the NS groups saw decreases greater than the minimally important clinical difference (MICD) of the CMS ( p\u2009=\u20090.023). However, NDII scores ( p\u2009=\u20090.089) and CMAP amplitudes ( p\u2009=\u20090.067) between the groups did not reach statistical significance at 12\u00a0months. BES participants with Level IIb\u2009+\u2009V neck dissections had significantly better \u0394CMS and \u0394CMAP scores at 12\u00a0months ( p\u2009=\u20090.048 and p\u2009=\u20090.025, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Application of BES to the SAN may help reduce impaired shoulder function in patients undergoing oncologic neck dissection, and may be considered a viable adjunct to functional rehabilitation therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Clinicaltrials.gov (NCT02268344, October 17, 2014).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40463-017-0244-9","type":"journal-article","created":{"date-parts":[[2018,1,23]],"date-time":"2018-01-23T08:20:27Z","timestamp":1516695627000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":69,"title":["Intraoperative Brief Electrical Stimulation of the Spinal Accessory Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: A double-blinded, randomized controlled trial"],"prefix":"10.1177","volume":"47","author":[{"given":"Brittany","family":"Barber","sequence":"first","affiliation":[{"name":"Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadi","family":"Seikaly","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Ming Chan","sequence":"additional","affiliation":[{"name":"Department of Physical Rehabilitation Medicine, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhys","family":"Beaudry","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Texas, Arlington, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Rychlik","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaret","family":"Olson","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Curran","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Dziegielewski","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Biron","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Harris","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"McNeely","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"O'Connell","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,1,1]]},"reference":[{"key":"bibr1-s40463-017-0244-9","doi-asserted-by":"publisher","DOI":"10.1097\/CCO.0b013e328344f53a"},{"issue":"1","key":"bibr2-s40463-017-0244-9","first-page":"S65","volume":"41","author":"Biron VL","year":"2012","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"bibr3-s40463-017-0244-9","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2013.0113"},{"key":"bibr4-s40463-017-0244-9","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2009.11.027"},{"key":"bibr5-s40463-017-0244-9","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21112"},{"key":"bibr6-s40463-017-0244-9","doi-asserted-by":"publisher","DOI":"10.1006\/ijom.2003.0507"},{"key":"bibr7-s40463-017-0244-9","doi-asserted-by":"publisher","DOI":"10.1002\/hed.10067"},{"key":"bibr8-s40463-017-0244-9","author":"NSW","year":"2005","journal-title":"CI. 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