THE EFFECTS OF PREVENTION TRISMUS PROGRAM IN PATIENTS WITH HEAD AND NECK CANCER POST-TREATMENT WITH CCRT: a RANDOMIZED CONTROL TRIAL

INTERVENTION: Experimental Behavioral,Experimental Behavioral Intervention group,Control group The intervention group receives usual care plus the prevention of trismus program. The trismus program includes providing Knowledge and practice through booklets, video media, return demonstrations, and recording to prevent trismus. Nurses follow up with patients via telephone or the Line application at weeks 1, 4, 8, and 12 after hospital discharge to monitor progress, provide reminders, encouragement, and motivation, as well as to discuss challenges and barriers with patients and their families, thereby promoting continuous adherence to trismus-prevention practices.,The control group receives usual care only, CONDITION: Head and neck cancer (HNC) post-treatment with Concurrent chemoradiotherapy (CCRT) ; TRISMUS / CCRT / HEAD AND NECK CANCER / INDIVIDUAL ; AND SELF-MANAGEMENT/JAW EXERCISE ADHERENCE ; TRISMUS / CCRT / HEAD AND NECK CANCER / INDIVIDUAL ; AND SELF-MANAGEMENT/JAW EXERCISE ADHERENCE ;, PRIMARY OUTCOME: The effect of the prevention trismus program plus usual care in HNC patients after post treatment with CCRT compared to usual care at 12 weeks at 12 weeks after end of the intervention Incident of trismus, SECONDARY OUTCOME: Maximum interincisal opening, Mandibular function, Health education impact, and, Adherence of prevention of trismus Measure after post-treatment with CCRT compared between the intervention group and control group at baseline, 4 weeks, and 12 weeks TheraBite range of motion scale, The Gothenburg trismus questionnaire 2, The Health Education Impacts Questionnaires (hei Q), and a self-reported practice diary to measure jaw exercise adherence, INCLUSION CRITERIA: 1. Patient HNC has aged over 18 years; the patients who are 60 years and older will be assessed for cognitive impairment using the MINI COG test and score at least 3 points 2. Diagnosis of head and neck cancer patients and staging with stages 3 and 4 using the TNM staging system, 3. Treated with CCRT (all prescribed a dose of 60 to 70 Gy in 30 to 35 fractions to the jaw over 6 to 8 weeks) 4. Baseline MIO less than 35 mm, 5. Eastern Cooperative Oncology Group (ECOG) Performance Status equal to 0 to 2, 6. Ability to read, write, and speak in the Thai language. The family caregivers include 1. Aged over 20 years, the patients who are 60 years and older will be assessed for cognitive impairment using the MINI COG test and score at least 3 points., And 1. The family caregiver lives in the same house for at least 6 months as the significant person involved in daily caregiving, 3. Caring for a patient with a diagnosis of head and neck cancer receiving CCRT from the beginni