Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium.
Department of ENT, University Hospital Ghent, 9000 Ghent, Belgium.
Dysphagia. 2024 Apr;39(2):267-281. doi: 10.1007/s00455-023-10609-7. Epub 2023 Aug 8.
Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75- group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75-. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018-retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
预防性吞咽练习（PSE）对头颈部癌症（HNC）（放化疗）期间的吞咽功能和肌肉力量有积极影响。然而，PSE 的依从率中等偏低，削弱了这些效果。PRESTO 已经表明，服务提供模式（SDM），即提供练习的方式，会影响依从性。本研究旨在调查 SDM 对放化疗期间和之后吞咽功能和肌肉力量的影响。此外，还研究了总依从率（OA），即不考虑 SDM 的情况下的依从率的影响。
共有 148 名接受 CRT 治疗的 HNC 患者被随机分配到三种 SDM 中的一种（纸质支持、应用程序支持或治疗师支持的 PSE），并进行了为期 4 周的 PSE 计划。OA 根据完成的练习百分比计算。患者分为 OA 水平：OA75+和 OA75-组分别完成了练习的≥75%和<75%。基于癌症患者吞咽能力评估量表（MASA-C）比较了放化疗期间和放化疗结束后 3 个月的吞咽功能，以及 SDM 和 OA 水平之间的舌和颏舌骨肌肉力量。使用线性混合效应模型进行事后两两比较和 Bonferroni-Holm 校正。三种 SDM 之间没有发现显著差异。发现了显著的时间效应：MASA-C 评分在放化疗期间下降，肌肉力量显著增加。在放化疗结束时，OA75+的吞咽功能明显优于 OA75-。OA75+组的肌肉力量增加显著更高。SDM 对吞咽功能和肌肉力量没有影响；然而，OA 水平显示出显著的影响。进行高重复的运动练习对于从 PSE 中获益至关重要。
试验注册 ISRCTN，ISRCTN98243550。2018 年 12 月 21 日注册-回溯性注册，https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search。
