Progressive Muscle Relaxation for Pain and Quality of Life in Thyroid Cancer

This is a single-center, parallel-group, randomized controlled trial to be conducted at PINUM Cancer Hospital, Faisalabad, Pakistan. A total of 32 patients with histologically confirmed thyroid cancer (Stage I-III) undergoing chemotherapy (1-3 sessions) will be enrolled. Inclusion criteria: age 30-50 years, moderate pain (NPRS 3-7), baseline FACT-G score ≥80%, history of lobectomy or thyroidectomy. Exclusion criteria: comorbidities (cardiomyopathy, respiratory disorders, severe mental illness), recent fractures or surgeries, inability to follow instructions, current practice of relaxation therapies. Participants will be randomly allocated 1:1 using an online random number generator into two groups. Experimental group (n=16): Progressive Muscle Relaxation Technique (PMRT) once daily for 4-5 consecutive days, each session 20-40 minutes, targeting head/neck, shoulders, arms/hands, lower back/hips, calves/thighs, and feet/toes. Each movement involves deep inhalation, tensing for 10-20 seconds, then exhalation with relaxation. Control group (n=16): gentle range-of-motion and stretching exercises of same frequency and duration. Outcomes: pain (NPRS, 0-10) and quality of life (FACT-G, 4 subscales) measured at baseline and post-intervention. Normality of data assessed by using Shapiro-Wilk test. Between-group comparisons is performed by using Mann-Whitney U test, and within-group pre-post comparisons using Wilcoxon signed-rank test. No adverse events are anticipated. After study completion, results will be submitted separately in the Results Module.

• Progressive Muscle Relaxation Technique (Behavioral): Participants were guided through sequential tensing and relaxing of six muscle groups: head/neck, shoulders/upper back, arms/hands, lower back/hips, calves/thighs, and feet/toes. For each group, they inhaled deeply and tensed muscles for 10-20 seconds, then exhaled slowly while relaxing completely. Each session lasted 20-40 minutes, once daily for 4-5 consecutive days. Sessions were conducted by a trained physiotherapist in a quiet hospital room.
• Range of Motion and Stretching Exercises (Other): Participants performed gentle range-of-motion (ROM) and stretching exercises for the same muscle groups (head/neck, shoulders, arms, lower back, legs, feet), without the tensing-relaxation component of PMR. Each session lasted 20-40 minutes, once daily for 4-5 consecutive days, supervised by the same physiotherapist.

Primary outcomes

• Change in Pain Intensity [Baseline (day 1) and post-intervention (day 4-5)]: Pain intensity measured using the Numeric Pain Rating Scale (NPRS), an 11-point scale from 0 (no pain) to 10 (worst possible pain). Higher scores indicate worse pain.
• Change in Quality of Life [Baseline (day 1) and post-intervention (day 4-5)]: Quality of life measured using the Functional Assessment of Cancer Therapy - General (FACT-G), a 27-item questionnaire covering physical, social/family, emotional, and functional well-being. Higher scores indicate better quality of life.

Sex: All, ages: 30 Years to 50 Years

Inclusion Criteria:

* Histologically confirmed thyroid cancer (Stage I-III)
* Age 30-50 years
* Moderate pain (NPRS score 3-7)
* Baseline FACT-G score ≥80%
* Undergoing chemotherapy (1-3 sessions completed)
* History of lobectomy or thyroidectomy
* Provided written informed consent

Exclusion Criteria:

* Comorbidities (cardiomyopathy, respiratory disorders, severe mental illness)
* Recent fractures or surgeries
* Unable to comprehend or follow instructions
* Currently practicing PMR or any other relaxation therapy