Table 4

Evidence quotes for Themes 2–5

Theme 2: Behavioural adherence to GRRAND
26“…I was told to just push my fingers until there was resistance… not to go over the top, and they have definitely helped.” (Participant 107 Intervention)
27“I’m doing all this on my own and for the exercises I found that just a bit overwhelming.” (Participant 102 Usual care)
28“I’d tell the missus and the kids, and my boy, he’s a professional footballer, so that side of it is very much a part of his life, so he had been nagging…come on dad, we’re going out for a walk even if we go halfway, or something like that, so that was all very positive.” (Participant 109 Intervention)
29“Plenty of space and plenty of time, yeah. There was nothing at home to stop me from doing everything or anything. No, nothing.” (Participant 107 Intervention)
30“they’ve never said, ‘I can’t do them.’… we tend to have patients who live in nice expensive bungalows. ((City)) is a very different demographic.” (Physiotherapist Norwich 1)
31“…patients have said to me that they like having that check-in with the physios …They're doing their exercises, they're noticing no improvements…they think ‘what’s the point?’ They touch base with us and it gives them that…(Motivation)… to carry on.” (Physiotherapist Oxford 2)
32“One gentleman wanted to go back to driving and he couldn’t see his blind spot, so we really put the focus on the range of movement exercises and stretching to enable him to do that… So, it’s really working towards their goals I suppose.” (Physiotherapist Oxford 2)
33“…it’s important to keep doing it. The nurse last week said we call it, the afterlife treatment because it never seems to go away and you can go six months with no problems and then suddenly you start stiffening up, so it’s important to keep doing them, probably for the rest of my life.” (Participant 109 Intervention)
Theme 3: Patients’ and physiotherapists’ perceptions of clinical outcomes
34“How’s it been helping? (laughs) It’s helped me because if I didn’t do it, it would be worse!” (Participant 115 Intervention)
35“Yeah, because my neck, I can move quite freely now and I can lift my arms quite a long way up now, I can almost get it vertically now, I couldn’t do that to begin with, but I can do it now. It’s not easy, but I can do it.” (Participant 111 Usual care)
36“I don’t believe it’s helped with the swallowing. In fact, I think my swallowing did get better and now it’s starting to get worse” (Participant 107 Intervention)
37… has the physio exercises helped with the swallowing? (Interviewer) No that’s still about the same.” (Participant 108 Usual care)
38“I don’t do anything with a swallow, because I don’t want to cross over with them…they do them with SALT, so we don’t do those.” (Physiotherapist Norwich 1)
39“Yeah, I think they have helped, definitely…. but I do think I’ve still got a long way to go.” (Participant 107 Intervention)
40“But there does come a point when you start flipping towards, it’s not gonna get better.” (Physiotherapist Norwich 1)
41“At the moment, nothing’s really helping for me to do anything more, I don’t believe.” (Participant 107 Intervention)
Theme 4: Stand-alone themes
42“What I didn’t appreciate at the time was how much effect the dissection would have on me…I prefer…to know more about - certainly side effects were…” (Participant 114 Usual care)
43“…before I had the operation, it could have been a good thing to have some physio beforehand…getting you something to focus on…and things, just maybe have something, so that when you’re feeling low or something, it could give you something to aim at, focus on.” (Participant 107 Intervention)
44“So, I think it could be helpful to meet people beforehand but also we’d be giving them really vague information, like, well you might not have any symptoms at all or you might have this.” (Physiotherapist Oxford 1)
45“…in terms of conditioning, we could have a two, three week window of, ‘Here’s some exercises to get you fitter, to get your neck, your shoulder fitter, which is gonna help after your surgery and cause less restrictive range of movement.’” (Physiotherapist Birmingham 1)
46I don’t think there is much to be achieved from doing it online, personally. I really don’t.” (Participant 107 Intervention)
47“And now that we can actually get face to face appointments, still life gets in the way and it’s difficult isn’t it?” (Carer for Participant 115 Intervention)
48We did video because we needed to and alternating is okay. I didn’t do any first assessments over video, they were all face to face which is where a lot of the really helpful stuff happens.” (Physiotherapist Oxford 1)
49“I had joined heads2gether” (Participant 102 Usual care)
Theme 5: Feasibility
50“I said: well yeah, if anything it will help even me or others, yeah I’m quite prepared to go ahead with it.” (Participant 108 Usual Care)
51“It was something I was really keen to be part of … I was very keen to keep involved and to deliver the intervention … the unmet need in this population is so profound.” (Physiotherapist Oxford 1)
52“So, it’s taking time out of the day to look at when their appointment is, sometimes it’s not there yet, you have to check back another day. It’s all these little things that you're having to…, if this were to be a full-blown trial I think there’d need to be admin support definitely.” (Physiotherapist Oxford 2)
53“… I was actually quite disappointed. I think it was at that stage I realised how things would affect me in the long-term. I think it was around then I was told that I didn’t qualify.” (Participant 102 Usual Care)
54“…we living in {County Name} we wouldn’t be selected because the trials would be done in Oxford.” (Participant 108 Usual care)
55“I was there when she told him that he’d been put into the usual care group and he was absolutely gutted…So, I spent quite a lot of that session reassuring him actually, ‘usual care is not a bad thing and you're still going to be getting physio.” (Physiotherapist Oxford 2)
56“Well, some of them I thought they were a waste of time … you know, your moods… and you were getting fed up of answering them as the page went on and on.” (Participant 108 Usual care)
57“Over the year his dysfunction worsened and worsened and worsened…” (Physiotherapist Oxford 1)
  • GRRAND, Getting Recovery Right After Neck Dissection; SALT, Speech and Language Therapist.