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

(A part of the SOFIA study)

Patricia Hägglund, Mary Hägg, Per Wester, Eva Levring Jäghagen
Age and Ageing, Volume 48, Issue 4, July 2019, Pages 533–540, https://doi.org/10.1093/ageing/afz042.
Published: 07 May 2019.

Abstract as published

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.

Relevance to conditions

Dysphagia: A study to show the effectiveness of IQoro in treating swallowing difficulties in an elderly cohort.

Study type

Peer reviewed, Prospective, Cohort pre- and post- study, Randomised Controlled Trial (RCT).

Aim

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

Patients

385 participants who had been in one of 36 intermediate care units for at least 3 days were screened, and 116 participants were randomly assigned to IQoro neuromuscular training or usual care . No other selection criteria were applied. The cohort included residents with neurological disabilities, Parkinsons, stroke, Acquired Brain Injury (ABI), Traumatic Brain Injury (TBI), dementia, Chronic Obstructive Pulmonary Disease (COPD), cardiovascular diseases, musculoskeletal disorders, more. All recruited residents had diagnosed conditions affecting at least three different organs / organ systems.

  • intervention group
    • (n = 49, F = 22, M = 27)
    • median age 83 (range 72 – 87)
  • control group
    • (n = 67, F = 38, M = 29)
    • median age 85 (range 80 – 89)

The two groups were matched for gender, age, functional ability, BMI, comorbidities, dysphagia related illness, cognitive ability, and educational level.

Methods

Older people with swallowing dysfunction were cluster randomised according to care units for either:

  • intervention group: IQoro neuromuscular training 3 x 10 seconds, three times per day for 5 weeks,
  • control group: traditional and compensatory care.

Residents were measured at three time points: before training, at end of training and at late follow up (6 months post-treatment).

Outcome measurements

Residents were tested at each time point for:

  • Primary endpoint: swallowing rate assessed by Timed Water Swallow Test (TWST) – lower normal value for swallowing rate ≥ 10 ml / sec
  • The secondary endpoints were changes in signs of aspiration during the TWST and swallowing-related quality of life (QOL).

Results

  • At 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).
  • Signs of aspiration significantly reduced in the intervention group compared with controls (p = 0.01).
  • At 6 months post-treatment, the swallowing rate of the intervention group remained significantly better (p = 0.031).
  • No significant between-group differences were found for swallowing-related QOL.

Statistical significance of result

(p < 0.007) improved swallowing rate in intervention compared with control group.
(p < 0.01) reduced signs of aspiration in intervention compared with control group.
(p < 0.031) swallowing rate in intervention compared with control group at 6 months after end of treatment.
(p < 0.46) signs of aspiration were similar in the both groups at 6 months after end of training.

Conclusion

Oral neuromuscular training is a new promising swallowing rehabilitation method for older people in intermediate care with impaired swallowing. 5 weeks’ training showed good improvements, but a longer treatment period would have been preferable.