Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial

members of the Belgian PRESTO-group, Belgian PRESTO Group

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5 Citations (Scopus)

Abstract

Background: Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence. Methods: A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. Results: Adherence and evolution of adherence over time was significantly different between the three groups (p <.001). Adherence rates decreased in all three groups during the 4 training weeks (p <.001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. Conclusions: PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. Trial Registration: 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.

Original languageEnglish
Pages (from-to)886-895
Number of pages10
JournalDysphagia
Volume38
Issue number3
Early online date19 Sept 2022
DOIs
Publication statusPublished - Jun 2023

Keywords

  • (Chemo)radiotherapy
  • (Chemo)radiotherapy; Adherence; Deglutition; Deglutition disorders; Dysphagia; Head-and-neck cancer; Prophylactic swallowing exercises; Telehealth application.
  • Adherence
  • Deglutition
  • Deglutition disorders
  • Dysphagia
  • Head-and-neck cancer
  • Prophylactic swallowing exercises
  • Telehealth application

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