Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.
Am J Speech Lang Pathol. 2021 Nov 4;30(6):2465-2475. doi: 10.1044/2021_AJSLP-21-00026. Epub 2021 Aug 31.
Purpose A large knowledge gap related to dysphagia treatment adherence was identified by a recent systematic review: Few existing studies report on adherence, and current adherence tracking relies heavily on patient self-report. This study aimed to report weekly adherence and dysphagia-specific quality of life following home-based swallowing therapy in head and neck cancer (HNC). Method This was a quasi-experimental pretest-posttest design. Patients who were at least 3 months post-HNC treatment were enrolled in swallowing therapy using a mobile health (mHealth) swallowing system equipped with surface electromyography (sEMG) biofeedback. Participants completed a home dysphagia exercise program across 6 weeks, with a target of 72 swallows per day split between three different exercise types. Adherence was calculated as percent trials completed of trials prescribed. The M. D. Anderson Dysphagia Inventory (MDADI) was administered before and after therapy. Results Twenty participants (75% male), with an average age of 61.9 years ( = 8.5), completed the study. The majority had surgery ± adjuvant (chemo)radiation therapy for oral (10%), oropharyngeal (80%), or other (10%) cancers. Using an intention-to-treat analysis, adherence to the exercise regimen remained high from 84% in Week 1 to 72% in Week 6. Radiation therapy, time since cancer treatment, medical difficulties, and technical difficulties were all found to be predictive of poorer adherence at Week 6. A statistically significant improvement was found for composite, emotional, and physical MDADI subscales. Conclusions When using an mHealth system with sEMG biofeedback, adherence rates to home-based swallowing exercise remained at or above 72% over a 6-week treatment period. Dysphagia-specific quality of life improved following this 6-week treatment program.
最近的一项系统评价发现，吞咽障碍治疗依从性方面存在很大的知识空白：现有的研究很少报告依从性，目前的依从性跟踪主要依赖于患者的自我报告。本研究旨在报告头颈部癌症（HNC）患者接受家庭吞咽治疗后每周的依从性和吞咽特异性生活质量。
这是一项准实验性的前后测试设计。至少在 HNC 治疗后 3 个月的患者被纳入使用配备表面肌电图（sEMG）生物反馈的移动健康（mHealth）吞咽系统的吞咽治疗。参与者在 6 周内完成家庭吞咽练习计划，每天目标为 72 次吞咽，分为三种不同的练习类型。依从性计算为规定的试验完成百分比。在治疗前后使用 MD 安德森吞咽障碍量表（MDADI）进行评估。
20 名参与者（75%为男性），平均年龄为 61.9 岁（ = 8.5），完成了研究。大多数患者因口腔（10%）、口咽（80%）或其他部位（10%）癌症接受了手术加辅助（放）化疗。采用意向治疗分析，从第 1 周的 84%到第 6 周的 72%，对锻炼方案的依从性仍然很高。在第 6 周时，放射治疗、癌症治疗后的时间、医疗困难和技术困难均被发现与较差的依从性相关。在 MDADI 综合、情绪和生理分量表上均发现了统计学上的显著改善。
使用配备 sEMG 生物反馈的 mHealth 系统时，家庭吞咽锻炼的依从率在 6 周的治疗期间保持在 72%或以上。经过 6 周的治疗计划，吞咽特异性生活质量得到改善。
