Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia
Effects of Device-Facilitated Isometric Progressive Resistance Oropharyngeal Therapy on Swallowing and Health-Related Outcomes in Older Adults with Dysphagia
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DOI：
10.1111/jgs.13933
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发表时间：
2016-02-01
影响因子：
6.3
通讯作者：
Robbins, JoAnne
中科院分区：
文献类型：
--
作者：
Rogus-Pulia, Nicole;Rusche, Nicole;Robbins, JoAnne
吞咽障碍（吞咽困难）与老年人的营养不良、吸入性肺炎和死亡率有关。加强干预措施已显示出有希望的结果，但治疗老年人吞咽困难的有效性仍有待确定。Swallow STRENGTH OropharyNGeal（Swallow STRONG）计划是一项多学科计划，采用口咽增强器械促进（D-F）等长渐进阻力口咽（I-PRO）治疗的特定方法，旨在减少吞咽困难退伍军人的健康相关后遗症。参与者完成了8周的D-F I-PRO治疗，同时接受营养咨询和呼吸状态监测。在基线、第4周和第8周完成评估。在每次访视时，进行视频荧光透视吞咽研究。饮食和吞咽相关的生活质量问卷进行管理。入组后6-17个月的长期监测允许将肺炎发病率和住院率与计划前6-17个月进行比较。招募了经视频荧光透视证实患有吞咽困难的退伍军人（N = 56; 55名男性，1名女性;平均年龄70岁）。在8周内，舌压力在前部（效应估计值= 92.5，P <0.001）和后部（效应估计值= 85.4，P <0.001）增加。吞咽障碍生活质量问卷（SWAL-QOL）11个分量表中的8个分量表（效应估计值= 6.5-19.5，P <0.04）和自我报告的努力感（效应估计值=-18.1，P = 0.001）出现统计学显著改善。较高的功能性口服摄入量表评分（效应估计值= 0.4，P = 0.02）表明参与者能够吃限制较少的饮食。肺炎诊断减少了67%，尽管差异没有统计学意义。从入组前到入组后，住院人数显著下降（效应估计值= 0.96; P = 0.009）。研究结果表明，Swallow STRONG多学科口咽强化计划可能是老年人吞咽困难的有效治疗方法。
Swallowing disorders (dysphagia) are associated with malnutrition, aspiration pneumonia, and mortality in older adults. Strengthening interventions have shown promising results, but the effectiveness of treating dysphagia in older adults remains to be established. The Swallow STRengthening OropharyNGeal (Swallow STRONG) Program is a multidisciplinary program that employs a specific approach to oropharyngeal strengtheningdevice-facilitated (D-F) isometric progressive resistance oropharyngeal (I-PRO) therapywith the goal of reducing health-related sequelae in veterans with dysphagia. Participants completed 8 weeks of D-F I-PRO therapy while receiving nutritional counseling and respiratory status monitoring. Assessments were completed at baseline, 4, and 8 weeks. At each visit, videofluoroscopic swallowing studies were performed. Dietary and swallowing-related quality of life questionnaires were administered. Long-term monitoring for 6-17 months after enrollment allowed for comparison of pneumonia incidence and hospitalizations to the 6-17 months before the program. Veterans with dysphagia confirmed with videofluoroscopy (N = 56; 55 male, 1 female; mean age 70) were enrolled. Lingual pressures increased at anterior (effect estimate = 92.5, P < .001) and posterior locations (effect estimate = 85.4, P < .001) over 8 weeks. Statistically significant improvements occurred on eight of 11 subscales of the Quality of Life in Swallowing Disorders (SWAL-QOL) Questionnaire (effect estimates = 6.5-19.5, P < .04) and in self-reported sense of effort (effect estimate = -18.1, P = .001). Higher Functional Oral Intake Scale scores (effect estimate = 0.4, P = .02) indicated that participants were able to eat less-restrictive diets. There was a 67% reduction in pneumonia diagnoses, although the difference was not statistically significant. The number of hospital admissions decreased significantly (effect estimate = 0.96; P = .009) from before to after enrollment. Findings suggest that the Swallow STRONG multidisciplinary oropharyngeal strengthening program may be an effective treatment for older adults with dysphagia.