Adherence to Swallowing Rehabilitation Exercises in Head and Neck Cancer

接受大野放射治疗的头颈部癌症患者， 永久性吞咽障碍为了防止这种情况，患者可以进行运动锻炼， 加强舌头，增加口咽结构的活动范围。然而，在这方面， 吞咽困难患者对吞咽练习的依从性较低;我们的初步数据表明， 只有9.5%的参与者在放射期间坚持吞咽练习（n=97）。我们 干预试点干预，干预效果评价（n=16）表明，它是高度有效和可行的。 确定关键调解人和主持人坚持吞咽练习将是有价值的 头颈部癌症患者。主要目的1）比较自我治疗的有效性， 在增加对药物治疗依从性方面， 在接受放射治疗的头颈癌患者样本中进行吞咽练习。Aim 1a） 评估拟议干预对自我报告吞咽依从性的介导因素 在6周和12个月随访时进行锻炼。要测试的介质将是感知 疾病、应对程序和应对程序评估。目的1b）确定是否 抑郁、疼痛、疲劳和社会支持会缓和干预对依从性的影响 在6周随访或12个月随访或两者时。目标2a）测试社区教育的影响 金标准放射学改良评估的解剖吞咽功能干预 钡剂吞咽（MBS），使用OPSE评分。目标2b）测试 根据MDADI和 PSS-HN。研究设计：从M. D.安德森和林登贝恩斯约翰逊 社区医院，主要服务于少数民族，低收入患者，将被随机分为 两组之一：1）加强产妇护理加上关于以下重要性的信息手册： 吞咽练习; 2）自我调节，一种基于自我调节理论的干预措施 提供针对粘膜炎、口干、疲劳、恶心的客观和积极的应对策略 和吞咽困难。评估时间点为进入研究的基线时，结束后6周 放射治疗后12个月。为了衡量干预措施对 吞咽解剖功能，100名参与者的子样本将通过改良的 基线和12个月随访时的钡剂吞咽。摘要：由此产生的纵向数据 将产生关于坚持吞咽练习及其与 解剖吞咽功能的理论框架内。

Head and neck cancer patients who are treated with large-field radiation are at high risk to develop permanent swallowing disorders. To prevent this, patients can perform motor exercises that strengthen the tongue and increase range of motion in oropharyngeal structures. However, adherence to swallowing exercises is low in dysphagic patients; our preliminary data indicated that just 9.5% of the participants were adherent to swallowing exercises during radiation (n=97). Our intervention pilot intervention, PREPARE (n=16) indicates that it is highly effective and feasible. Identifying key mediators and moderators in adherence to swallowing exercises would be valuable to head and neck cancer patients. Primary Aims Aim1) To compare the efficacy of a Self- Regulation intervention with an Enhanced Usual Care control group in increasing adherence to prescribed swallowing exercises in a sample of irradiated head and neck cancer patients. Aim1a) To evaluate the mediators of the proposed intervention on adherence to self-reported swallowing exercises at 6 week and twelve month follow-up. The mediators to be tested will be perception of illness, coping procedures and appraisal of coping procedures. Aim1b) To determine whether depression, pain, fatigue and social support moderate the impact of the intervention on adherence at 6 week follow-up or 12 month follow-up or both. Aim 2a) To test the impact of the PREPARE intervention on anatomic swallowing function as assessed by gold-standard radiographic Modified Barium Swallow (MBS), which is scored with the OPSE. Aim 2b) To test the impact of the PREPARE intervention on self-reported swallowing function as assessed by the MDADI and the PSS-HN. Study design: 288 patients recruited from M. D. Anderson and Lyndon Baines Johnson Community hospital, which serves primarily minority, low-income patients, will be randomized into one of two groups: 1) Enhanced Usual care plus an informational brochure about the importance of swallowing exercises, and 2) PREPARE, an intervention based on the Theory of Self-Regulation delivering objective and motivational coping strategies for mucositis, xerostomia, fatigue, nausea and dysphagia. Assessment timepoints are at baseline entry into the study, 6 weeks after the end of radiation therapy, and 12 months post-radiation. To measure the impact of the intervention on swallowing anatomic function, a subsample of 100 participants will be measured by modified barium swallow at baseline and at 12 month follow-up. Summary: The resulting longitudinal data will yield important information about adherence to swallowing exercises and its relationship to anatomic swallowing function within a theoretical framework.