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have to be preceded by careful evaluation of current abilities and maximal functional capacity. For some patients rehabilitation will have to take place in the clinic. This will most often be the case when exercise ability is low, when there are specific impairments in physical functioning in terms of activities of daily living, when there are one or more relative contraindications (such as insufficient nutritional status or comorbidity), or when compliance with an unsupervised intervention is estimated to be too low.\u000DTraining during treatment seems to be possible, at least in part, in home-based form, which is in line with patients\u0027 preferences. Further research on this topic would, however, be desirable.\u000D5.5.4 Lymphedema\u000DLymphedema after neck dissection has received little attention in the literature. One study with 81 patients found a prevalence of 9% external, 39% internal, and 50% combined lymphedema (Deng, Ridner et al. 2012). Clinical experience shows that lymphedema in the face will often go away spontaneously. Persistent oedema does however occur. In a recent cross-sectional comparison between sentinel node biopsy (SNB) and selective neck dissection (SND) it was found that persistent lymphedema occurred predominantly in the SND group; 17% (mild only) versus 36% (mild to moderate) respectively. The mean follow-up time after surgery in this study was 26.8 \u00B1 17.3 months (Schiefke, Akdemir et al. 2009).\u000DThe risk of lymphedema appears to be bigger in patients with a pharyngeal tumour, and after radiotherapy as an addition to surgery (Deng, Ridner et al. 2012).\u000DLymphedema in the head and neck area is associated with swallowing impairments, xerostomia, worse nutritional status and voice quality, lower quality of life and impairments in neck rotation (Deng, Ridner et al. 2013).\u000D5.5.4.1 Detection and evaluation of Lymphedema\u000DIt is difficult to quantify lymphedema in the head and neck area in a reliable and valid way. The recently developed Lymphedema Symptom Intensity & Distress Survey-Head & Neck (LSIDS-H&N) has not been sufficiently validated yet (Deng, Ridner et al. 2012). The validity and reliability of measurements performed by care professionals, too, are insufficiently evidence-based to offer concrete recommendations for clinical practice (Deng, Ridner et al. 2015).\u000D5.5.4.2 Physical therapy treatment for lymphedema\u000DAlthough the therapeutic value of complex decongestive therapy (CDT), which consists of manual lymph drainage, compression and exercise therapy, has been well established for extremity lymphedema (RJ 2003), little research has been done on the efficacy of this therapy for head and neck cancer-related lymphedema, and no randomised studies have yet been published.\u000DOn the basis of non-systematic clinical observations, it seems that adhesions / inflexible scars contribute to the occurrence and/or persistence of lymphedema. Such adhesions appear to respond well to the use of CureTape\u00AE.\u000DOne very small pilot study (n=11) into the effect of early applied oedema therapy for lymphedema that persisted for more than ten days after surgery showed a significant decrease of the swelling after six weeks of manual lymph drainage (Piso, Eckardt et al. 2001). Patients furthermore reported a significant decrease in swallowing and speech problems. The results of this study should however be interpreted with caution, due to its small population size, lack of a control group and non-blinding of the outcome measures.\u000D128\u000D