Early Feasibility of an Activity-Based Intervention for Improving Ingestive Functions in Older Adults with Oropharyngeal Dysphagia

Tina Hansen, Louise Bolvig Laursen, Maria Swennergren Hansen, Tina Hansen, Louise Bolvig Laursen, Maria Swennergren Hansen

Abstract

There is growing awareness about the use of combined strength- and skill-based swallowing training for improving swallowing physiology in the event of dysphagia. Such an approach involves focusing on coordination and timing as well as swallowing strengthening in the context of increased exercise complexity in eating and drinking activities. This study aimed to determine the early feasibility of a newly developed 12-week intervention, named the ACT-ING program (ACTivity-based strength and skill training of swallowing to improve INGestion), in older adults with dysphagia and generalized sarcopenia. In a multiple-case-study design, seven participants above 65 years of age (five women and two men) with slight to severe dysphagia and indications of sarcopenia underwent the intervention during hospitalization and in the community after discharge. The ACT-ING program met most of the feasibility marks in terms of demand (73.3% of those invited accepted participation), safety (100%), no reports of adverse events, tolerance (85.7%), usability (100%), and acceptability (100%). Three putative mediators of change (experienced autonomy support, in-therapy engagement, and perceived improvement in swallowing capacity) appeared to have been best accomplished in participants with slight to moderate dysphagia. The ACT-ING program showed preliminary evidence of early feasibility, warranting further early-phase dose articulation and proof-of-concept trials.

Keywords: acceptability; deglutition disorders; early-phase intervention; feasibility; intervention development; sarcopenia; skill-based training; strength training.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow diagram for study participants.
Figure 2
Figure 2
Percentage distribution of internal exercise loads across all sets. Perceived exertion assessed with a rating of perceived exertion (RPE) scale from 0 (extremely easy) to 10 (extremely hard) [45]. The color codes are: green—extremely hard (9–10); blue—hard (7–8); yellow—somewhat hard (5–6); grey—somewhat easy (3–4); orange—easy (1–2). Extremely easy (0) was not reported.

References

    1. Rajati F., Ahmadi N., Naghibzadeh Z.A., Kazeminia M. The global prevalence of oropharyngeal dysphagia in different populations: A systematic review and meta-analysis. J. Transl. Med. 2022;20:175. doi: 10.1186/s12967-022-03380-0.
    1. de Sire A., Ferrillo M., Lippi L., Agostini F., de Sire R., Ferrara P.E., Raguso G., Riso S., Roccuzzo A., Ronconi G., et al. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients. 2022;14:982. doi: 10.3390/nu14050982.
    1. Dibello V., Zupo R., Sardone R., Lozupone M., Castellana F., Dibello A., Daniele A., De Pergola G., Bortone I., Lampignano L., et al. Oral frailty and its determinants in older age: A systematic review. Lancet Healthy Longev. 2021;2:e507–e520. doi: 10.1016/S2666-7568(21)00143-4.
    1. Wakabayashi H., Kishima M., Itoda M., Fujishima I., Kunieda K., Ohno T., Shigematsu T., Oshima F., Mori T., Ogawa N., et al. Diagnosis and Treatment of Sarcopenic Dysphagia: A Scoping Review. Dysphagia. 2021;36:523–531. doi: 10.1007/s00455-021-10266-8.
    1. Nagano A., Ueshima J., Tsutsumichi K., Inoue T., Shimizu A., Mori N., Maeda K. Effect of tongue strength on clinical outcomes of patients: A systematic review. Arch. Gerontol. Geriatr. 2022;102:104749. doi: 10.1016/j.archger.2022.104749.
    1. Mizuno S., Wakabayashi H., Wada F. Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability. Curr. Opin. Clin. Nutr. Metab. Care. 2022;25:29–36. doi: 10.1097/MCO.0000000000000787.
    1. Baumann C.W., Clark B.C., Phillips B.E., Szewczyk N.J., Consitt L.A. Regenerative Rehabilitation in Sarcopenia, Dynapenia, and Frailty. In: Greising S.M., Call J.A., editors. Regenerative Rehabilitation. From Basic Science to the Clinic. 1st ed. Springer; Cham, Switzerland: 2022. pp. 121–176.
    1. Kagaya H., Inamoto Y. Possible Rehabilitation Procedures to Treat Sarcopenic Dysphagia. Nutrients. 2022;14:778. doi: 10.3390/nu14040778.
    1. Jannah S.N., Syahrul S., Kadar K. The Effectiveness of Tongue Strengthening Exercise in Increasing Tongue Strength Among Older People with Dysphagia: A Systematic Review. Health Sci. Rev. 2022;4:100047. doi: 10.1016/j.hsr.2022.100047.
    1. Krekeler B.N., Rowe L.M., Connor N.P. Dose in Exercise-Based Dysphagia Therapies: A Scoping Review. Dysphagia. 2021;36:1–32. doi: 10.1007/s00455-020-10104-3.
    1. Huckabee M.L., Flynn R., Mills M. Expanding Rehabilitation Options for Dysphagia: Skill-Based Swallowing Training. Dysphagia. 2022 doi: 10.1007/s00455-022-10516-3. Online ahead of print.
    1. Zimmerman E., Carnaby G., Lazarus C.L., Malandraki G.A. Motor learning, neuroplasticity, and strength and skill training: Moving from compensation to retraining in behavioral management of dysphagia. Am. J. Speech. Lang. Pathol. 2020;29:1065–1077. doi: 10.1044/2019_AJSLP-19-00088.
    1. Carnaby G.D., LaGorio L., Silliman S., Crary M. Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial. J. Oral Rehabil. 2020;47:501–510. doi: 10.1111/joor.12928.
    1. Carnaby-Mann G.D., Crary M.A. Adjunctive neuromuscular electrical stimulation for treatment-refractory dysphagia. Ann. Otol. Rhinol. Laryngol. 2008;117:279–287. doi: 10.1177/000348940811700407.
    1. Hansen T., Thomassen J.D., Jensen L.E., Irgens M.R., Kjaersgaard A. Development of an Intervention for Improving Ingestion in Elders with Oropharyngeal Dysphagia. Phys. Occup. Ther. Geriatr. 2021;39:70–95. doi: 10.1080/02703181.2020.1800159.
    1. Hoffmann T.C., Glasziou P.P., Boutron I., Milne R., Perera R., Moher D., Altman D.G., Barbour V., Macdonald H., Johnston M., et al. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ (Clin. Res. Ed.) 2014;348:g1687. doi: 10.1136/bmj.g1687.
    1. Mathiowetz B. Task oriented approach to stroke rehabilitation. In: Gillen G., editor. Stroke Rehabilitation: A Function-Based Approach. 4th ed. Elsevier Inc.; St. Louis, MD, USA: 2016. pp. 59–78.
    1. Hosseini S.A., Ghamari N., Hayatizadeh Z. Review of task-oriented interventions in occupational therapy. J. Rehab. Med. 2017;6:239–248.
    1. Forsgren E., Åke S., Saldert C. Person-centred care in speech-language therapy research and practice for adults: A scoping review. Int. J. Lang. Commun. Disord. 2022;57:381–402. doi: 10.1111/1460-6984.12690.
    1. Ryan R.M., Deci E.L. Self-Determination Theory: Basic Psychological Needs in Motivation Development and Wellness. 1st ed. Guilford Press; New York, NY, USA: 2017.
    1. Blamey A.A.M., MacMillan F., Fitzsimons C.F., Shaw R., Mutrie N. Using programme theory to strengthen research protocol and intervention design within an RCT of a walking intervention. Evaluation. 2013;19:5–23. doi: 10.1177/1356389012470681.
    1. Skivington K., Matthews L., Simpson S.A., Craig P., Baird J., Blazeby J.M., Boyd K.A., Craig N., French D.P., McIntosh E., et al. A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. BMJ. 2021;374:n2061. doi: 10.1136/bmj.n2061.
    1. Czajkowski S.M., Hunter C.M. From ideas to interventions: A review and comparison of frameworks used in early phase behavioral translation research. Health Psychol. 2021;40:829–844. doi: 10.1037/hea0001095.
    1. Gonot-Schoupinsky F.N., Garip G. A flexible framework for planning and evaluating early-stage health interventions: FRAME-IT. Eval. Program Plann. 2019;77:101685. doi: 10.1016/j.evalprogplan.2019.101685.
    1. Yin R.K. Case Study Research and Applications: Design and Methods. 6th ed. SAGE Publications, Inc.; Los Angeles, CA, USA: 2018.
    1. Creswell J. Designing and Conducting Mixed Methods Research. 3rd ed. SAGE Publications, Inc.; Thousand Oaks, CA, USA: 2017.
    1. Schmidt M., Schmidt S.A.J., Adelborg K., Sundbøll J., Laugesen K., Ehrenstein V., Sørensen H.T. The Danish health care system and epidemiological research: From health care contacts to database records. Clin. Epidemiol. 2019;11:563–591. doi: 10.2147/CLEP.S179083.
    1. Umay E., Eyigor S., Karahan A.Y., Gezer I.A., Kurkcu A., Keskin D., Karaca G., Unlu Z., Tıkız C., Vural M., et al. The GUSS test as a good indicator to evaluate dysphagia in healthy older people: A multicenter reliability and validity study. Eur. Geriatr. Med. 2019;10:879–887. doi: 10.1007/s41999-019-00249-2.
    1. Crary M.A., Mann G.D., Groher M.E. Initial Psychometric Assessment of a Functional Oral intake Scale for Dysphagia in Stroke Patients. Arch. Phys. Med. Rehabil. 2005;86:1516–1520. doi: 10.1016/j.apmr.2004.11.049.
    1. Bahia M.M., Lowell S.Y. A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults with Normal and Disordered Swallowing. Am. J. Speech. Lang. Pathol. 2020;29:1655–1673. doi: 10.1044/2020_AJSLP-19-00132.
    1. The International Dysphagia Diet Standardisation Initiative (IDDSI) Complete IDDSI Framework: Detailed Definitions, Version 2.0. Published 2019. [(accessed on 7 August 2019)]. Available online: .
    1. Hall W.H., Ramachandran R., Narayan S., Jani A.B., Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer. 2004;4:94. doi: 10.1186/1471-2407-4-94.
    1. Bahat G., Erdoğan T., İlhan B. SARC-F and other screening tests for sarcopenia. Curr. Opin. Clin. Nutr. Metab. Care. 2022;25:37–42. doi: 10.1097/MCO.0000000000000801.
    1. Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. doi: 10.1093/ageing/afy169.
    1. Lee S.H., Gong H.S. Measurement and Interpretation of Handgrip Strength for Research on Sarcopenia and Osteoporosis. J. Bone Metab. 2020;27:85–96. doi: 10.11005/jbm.2020.27.2.85.
    1. Franciotti R., Di Maria E., D’Attilio M., Aprile G., Cosentino F.G., Perrotti V. Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-Analysis. Biomedicines. 2022;10:2319. doi: 10.3390/biomedicines10092319.
    1. IOPI Medical. [(accessed on 12 January 2022)]. Available online:
    1. Kaiser M.J., Bauer J.M., Ramsch C., Uter W., Guigoz Y., Cederholm T., Thomas D.R., Anthony P., Charlton K.E., Maggio M., et al. Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J. Nutr. Health Aging. 2009;13:782–788. doi: 10.1007/s12603-009-0214-7.
    1. Hansen T., Melgaard Kristiansen D. Revisiting the psychometric properties of a revised Danish version of the McGill ingestive skills assessment. Cogent Med. 2017;4:1–14. doi: 10.1080/2331205X.2017.1281558.
    1. Beets M.W., von Klinggraeff L., Weaver R.G., Armstrong B., Burkart S. Small studies, big decisions: The role of pilot/feasibility studies in incremental science and premature scale-up of behavioral interventions. Pilot Feasibil. Stud. 2021;7:173. doi: 10.1186/s40814-021-00909-w.
    1. Crary M.A., Carnaby G.D. Adoption into clinical practice of two therapies to manage swallowing disorders: Exercise-based swallowing rehabilitation and electrical stimulation. Curr. Opin. Otolaryngol. Head Neck Surg. 2014;22:172–180. doi: 10.1097/MOO.0000000000000055.
    1. Center for Self-Determination Theory Intrinsic Motivation Inventory (IMI) [(accessed on 5 January 2020)]. Available online:
    1. Sekhon M., Cartwright M., Francis J.J. Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Serv. Res. 2017;17:88. doi: 10.1186/s12913-017-2031-8.
    1. Vlachopoulos S.P., Michailidou S. Development and initial validation of a measure of autonomy, competence, and relatedness in exercise: The Basic Psychological Needs in Exercise Scale. Meas. Phys. Educ. Exerc. Sci. 2006;10:179–201. doi: 10.1207/s15327841mpee1003_4.
    1. Lagally K.M., Robertson R.J. Construct validity of the OMNI resistance exercise scale. J. Strength Cond. Res. 2006;20:252–256. doi: 10.1519/R-17224.1.
    1. Ose S.O. Using Excel and Word to structure qualitative data. J. Appl. Soc. Sci. 2016;10:147–162. doi: 10.1177/1936724416664948.
    1. Forsat N.D., Palmowski A., Palmowski Y., Boers M., Buttgereit F. Recruitment and Retention of Older People in Clinical Research: A Systematic Literature Review. J. Am. Geriatr. Soc. 2020;68:2955–2963. doi: 10.1111/jgs.16875.
    1. Ganz J.B., Ayres K.M. Methodological standards in single-case experimental design: Raising the bar. Res. Dev. Disabil. 2018;79:3–9. doi: 10.1016/j.ridd.2018.03.003.
    1. Collado-Mateo D., Lavín-Pérez A.M., Peñacoba C., Del Coso J., Leyton-Román M., Luque-Casado A., Gasque P., Fernández-Del-Olmo M.Á., Amado-Alonso D. Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review. Int. J. Environ. Res. Public Health. 2021;18:2023. doi: 10.3390/ijerph18042023.
    1. Ward E.C., Raatz M., Marshall J., Wishart L.R., Burns C.L. Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia. 2022;37:1386–1399. doi: 10.1007/s00455-022-10444-2.
    1. Dalton E.J., Churilov L., Lannin N.A., Corbett D., Campbell B.C.V., Hayward K.S. Multidimensional Phase I Dose Ranging Trials for Stroke Recovery Interventions: Key Challenges and How to Address Them. Neurorehabil. Neural Repair. 2021;35:663–679. doi: 10.1177/15459683211019362.
    1. Smith R., Bryant L., Hemsley B. The true cost of dysphagia on quality of life: The views of adults with swallowing disability. Int. J. Lang. Commun. Disord. 2023;58:451–466. doi: 10.1111/1460-6984.12804.
    1. Bick S., Buxton H., Chase R.P., Ross I., Adriano Z., Capone D., Knee J., Brown J., Nalá R., Cumming O., et al. Using path analysis to test theory of change: A quantitative process evaluation of the MapSan trial. BMC Public Health. 2021;21:1411. doi: 10.1186/s12889-021-11364-w.
    1. Abu-Ghanem S., Graf A., Govind J. Diagnosis of Sarcopenic Dysphagia in the Elderly: Critical Review and Future Perspectives. Dysphagia. 2022;37:1093–1102. doi: 10.1007/s00455-021-10371-8.
    1. Rossi V., Pourtois G. Transient state-dependent fluctuations in anxiety measured using STAI, POMS, PANAS or VAS: A comparative review. Anxiety Stress. Coping. 2012;25:603–645. doi: 10.1080/10615806.2011.582948.
    1. Baamer R.M., Iqbal A., Lobo D.N., Knaggs R.D., Levy N.A., Toh L.S. Utility of unidimensional and functional pain assessment tools in adult postoperative patients: A systematic review. Br. J. Anaesth. 2022;128:874–888. doi: 10.1016/j.bja.2021.11.032.
    1. Facco E., Zanette G., Favero L., Bacci C., Sivolella S., Cavallin F., Manani G. Toward the validation of visual analogue scale for anxiety. Anesth. Prog. 2011;58:8–13. doi: 10.2344/0003-3006-58.1.8.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する