Effects of oral neuromuscular training on swallowing dysfunction among older people in intermediate care-a cluster randomised, controlled trial

Abstract

Objectives: this prospective, cluster randomised, controlled trial investigated the effect of oral neuromuscular training among older people in intermediate care with impaired swallowing.

Methods: older people (≥65 years) with swallowing dysfunction were cluster randomised according to care units for 5 weeks of neuromuscular training of the orofacial and pharyngeal muscles or usual care. The primary endpoint was the change in swallowing rate (assessed with a timed water swallow test) from baseline to the end-of-treatment and 6 months post-treatment. The secondary endpoints were changes in signs of aspiration during the water swallow test, and swallowing-related quality of life (QOL). An intention-to-treat principle was followed, and mixed-effects models were used for data analysis with the clustered study design as a random factor.

Results: in total, 385 participants from 36 intermediate care units were screened, and 116 participants were randomly assigned to oral neuromuscular training (intervention; n = 49) or usual care (controls; n = 67). At the end of treatment, the geometric mean of the swallowing rate in the intervention group had significantly improved 60% more than that of controls (P = 0.007). At 6 months post-treatment, the swallowing rate of the intervention group remained significantly better (P = 0.031). Signs of aspiration also significantly reduced in the intervention group compared with controls (P = 0.01). No significant between-group differences were found for swallowing-related QOL.

Conclusions: oral neuromuscular training is a new promising swallowing rehabilitation method among older people in intermediate care with impaired swallowing.

Trial registration: ClinicalTrials.gov: NCT02825927.

Keywords: dysphagia; nursing homes; quality of life; rehabilitation; swallowing disorders.

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.

Figures

Figure 1

(a) Oral neuromuscular training of orofacial and pharyngeal muscles (left). The training is performed as follows: (1) the device is placed in the mouth, predentally, behind closed lips; (2) the participant pulls the handle of the device straight forward, as if to pull it out of the mouth, for approximately 5 to maximum 10 s. The manoeuvre is performed three times, with a 3 s rest between each manoeuvre [18]. The pulling force should be as high as possible without losing grip of the device. The oral neuromuscular training device (right).

Figure 1

(b) Flow-chart of the subject inclusion and data collection processes. Swallowing dysfunction was assessed for all participants at allocation, after the end-of-treatment and at 6 months post-treatment.