TY - JOUR
T1 - Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy
T2 - The Multicenter, Randomized Controlled PRESTO-Trial
AU - Baudelet, Margot
AU - Duprez, Fréderic
AU - van den Steen, Leen
AU - Nuyts, Sandra
AU - Nevens, Daan
AU - Goeleven, Ann
AU - Vandenbruaene, Caroline
AU - Massonet, Hanne
AU - Vergauwen, Alice
AU - Bollen, Heleen
AU - Deschuymer, Sarah
AU - Wouters, Kristien
AU - Peeters, Marc
AU - van Laer, Carl
AU - Mariën, Steven
AU - van den Brekel, Michiel
AU - van der Molen, Lisette
AU - Vauterin, Tom
AU - members of the Belgian PRESTO-group
AU - van Dinther, Joost
AU - Verstraete, Hilde
AU - Hutsebaut, Isabel
AU - Meersschout, Sabine
AU - Vanderveken, Olivier
AU - de Bodt, Marc
AU - van Nuffelen, Gwen
AU - Belgian PRESTO Group
AU - Vergauwen, L.
N1 - Funding Information: This work has been performed with the aid of a research grant from Kom Op Tegen Kanker, partially funded with the grant from the Fonds Monique Declercq. This funding source had no role in the design of the study, its implementation, the analyses, the interpretation of the data, or the decision to submit the results. Publisher Copyright: © 2022, The Author(s).
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
KW - (Chemo)radiotherapy
KW - (Chemo)radiotherapy; Adherence; Deglutition; Deglutition disorders; Dysphagia; Head-and-neck cancer; Prophylactic swallowing exercises; Telehealth application.
KW - Adherence
KW - Deglutition
KW - Deglutition disorders
KW - Dysphagia
KW - Head-and-neck cancer
KW - Prophylactic swallowing exercises
KW - Telehealth application
UR - http://www.scopus.com/inward/record.url?scp=85138325909&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00455-022-10513-6
DO - https://doi.org/10.1007/s00455-022-10513-6
M3 - Article
C2 - 36121560
SN - 0179-051X
VL - 38
SP - 886
EP - 895
JO - Dysphagia
JF - Dysphagia
IS - 3
ER -