a Department of Occupational Therapy & Physiotherapy , University Hospital of Copenhagen, Rigshospitalet , Copenhagen , Denmark.
b Faculty of Health & Medical Sciences , University of Copenhagen, Copenhagen , Denmark.
Acta Oncol. 2019 May;58(5):658-664. doi: 10.1080/0284186X.2018.1563715. Epub 2019 Jan 30.
In recent years, preventive swallowing exercises have been investigated as a means to limit dysphagia in head and neck cancer patients. However, adherence to exercise regimes has been poorly documented limiting the conclusions drawn on the effects of the interventions. We investigated adherence to a preventive swallowing exercise program and identified possible associations between adherence and four selected baseline factors: HPV status, partner status, concomitant chemotherapy and tumor site and between adherence to swallowing exercises and attendance to supervised training sessions. Forming part of an ongoing RCT (clinicaltrials.gov NCT02385929) adherence to intervention was based on participant provided training-logs. The exercise program consisted of 3 weekly supervised sessions of 30 min each and a home-based exercise program to be performed three times daily. Adherence was calculated as percentage of prescribed exercises completed and dichotomously as high (≥80%∼median) and low (<80%∼median) adherence. Associations between adherence and clinical/demographic factors (HPV, partner status, chemotherapy, tumor site or attendance level) were explored by logistic regression analyses. Full adherence data were available from 45 (76%) participants. The total cohort median adherence to exercises was 78%. No association was found between any of the tested factors and adherence. The study found a high adherence to preventive swallowing exercises in HNC patients undergoing (chemo)radiotherapy, both in home-based exercises and in supervised sessions, when compared to other studies, although median adherence to home-based exercises was below the defined 80% threshold. We acknowledge, that adherence in an RCT may be higher than in the everyday clinical situation due to surveillance bias. However, we find it reassuring that HNC patients comply with a preventive swallowing program, which requires some time investment from the patients.
近年来，预防性吞咽练习已被研究作为限制头颈部癌症患者吞咽困难的一种方法。然而，由于运动方案的坚持情况记录不佳，限制了对干预效果的结论。我们调查了对预防性吞咽练习方案的坚持情况，并确定了坚持情况与四个选定的基线因素（HPV 状态、伴侣状况、同时进行的化疗和肿瘤部位）之间的可能关联，以及与吞咽练习的坚持情况和参加监督训练课程之间的可能关联。作为正在进行的 RCT（clinicaltrials.gov NCT02385929）的一部分，干预措施的依从性基于参与者提供的培训记录。该运动方案包括每周三次、每次 30 分钟的三次监督训练课程，以及在家中进行的每日三次的运动方案。坚持情况按规定完成的练习百分比计算，并分为高（≥80%中位数）和低（<80%中位数）两种。通过逻辑回归分析探索了依从性与临床/人口统计学因素（HPV、伴侣状况、化疗、肿瘤部位或出勤率）之间的关系。共有 45 名（76%）参与者提供了完整的依从性数据。整个队列的练习依从性中位数为 78%。未发现任何测试因素与依从性之间存在关联。该研究发现，与其他研究相比，接受（放）化疗的头颈部癌症患者对预防性吞咽练习的依从性很高，无论是在家中进行的练习还是在监督训练课程中，尽管在家中进行的练习的依从性中位数低于规定的 80%阈值。我们承认，由于监测偏差，RCT 中的依从性可能高于日常临床情况。然而，我们感到欣慰的是，头颈部癌症患者会遵守需要他们投入一些时间的预防性吞咽计划。
