Effects of Tongue Strength Training on Quality of Life in Head and Neck Cancer Patients: Results From a Pilot Interventional Clinical Trial.

IF 1.3 4区 医学 Q3 OTORHINOLARYNGOLOGY
August Culbert, Amy Fullerton, Kaitlyn Edwards, Kathryn Hitchcock, Paul Davenport, Jamie Ku, Natalie L Silver
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引用次数: 0

Abstract

Background: Head and neck cancer (HNC) patients often have dysphagia following surgical and/or chemoradiation treatment, which can lead to reduced quality of life. Some patients suffer from decreased tongue strength and mobility that may cause discomfort and difficulty with swallowing. Our group has developed a patented genioglossus muscle strength trainer (GMST) to increase tongue protrusive force that has been used in patients with sleep apnea. We hypothesized that the GMST device would increase tongue strength in the HNC population.

Methods: We conducted an IRB approved, non-randomized, interventional clinical trial of HNC patients with dysphagia to determine the effect of GMST on tongue strength. Our secondary objective was to assess dysphagia quality of life, as determined by questionnaires. Genioglossus muscle strength measurements (measured in Newtons, N) and dysphagia quality of life scores (SWAL-QoL questionnaire) were obtained from enrolled patients at baseline and following 4 weeks of intervention. Treatment was at-home GMST exercise regimen 3 times daily, 5 days per week. Compliance was assessed via review of training logs. Two-sided paired t-tests at significance level α = .05 were performed to assess difference in mean GG muscle strength pre- and post-treatment.

Results: Out of 10 patients initially enrolled, 7 patients completed the trial. Eighty-six percent were male and the average age was 60. About 5 patients had surgery plus adjuvant radiation and 2 patients had primary radiation. All patients had baseline dysphagia as determined by patient complaint and/or objective measurement (prior modified barium swallow). No adverse events were reported. We observed a statistically significant increase in genioglossus muscle strength (mean change: 4.0 N, 95% CI 1.1-6.9, P = .015) after 4 weeks of treatment. Patients reported reduced swallowing burden and feeling of stigma around eating based on SWAL-QoL results.

Conclusions: Our data suggest that protrusive tongue-training exercises utilizing a novel tongue trainer device is well-tolerated and increases genioglossus muscle strength in treated HNC patients complaining of dysphagia. Patient-reported outcomes based on the SWAL-QoL survey indicate improvements in quality-of-life post-treatment, although our results are limited by small sample size. Larger studies are needed to see if this device could have clinically meaningful results for this difficult-to-treat patient population.

舌力训练对头颈部癌症患者生活质量的影响:先导性干预临床试验的结果。
背景:头颈部癌症(HNC)患者在接受手术和/或化疗后经常会出现吞咽困难,从而导致生活质量下降。一些患者的舌头力量和活动能力下降,可能会导致吞咽不适和困难。我们的研究小组开发了一种获得专利的舌根肌力量训练器(GMST),以增加舌前伸力量,该训练器已用于睡眠呼吸暂停患者。我们假设 GMST 设备将增加 HNC 患者的舌肌力量:我们对患有吞咽困难的 HNC 患者进行了一项经 IRB 批准的非随机干预性临床试验,以确定 GMST 对舌肌力的影响。我们的次要目标是通过问卷调查评估吞咽困难患者的生活质量。在基线和 4 周干预后,对入选患者进行舌根肌力测量(以牛顿为单位,N)和吞咽困难生活质量评分(SWAL-QoL 问卷)。治疗方法为在家进行 GMST 锻炼,每周 5 天,每天 3 次。治疗依从性通过查看训练日志进行评估。采用显著性水平为 α = .05 的双侧配对 t 检验来评估治疗前后平均 GG 肌肉力量的差异:结果:在最初注册的 10 名患者中,有 7 名患者完成了试验。86%的患者为男性,平均年龄为 60 岁。约 5 名患者接受了手术加辅助放射治疗,2 名患者接受了原发性放射治疗。根据患者的主诉和/或客观测量结果(之前的改良吞钡法),所有患者均存在基线吞咽困难。无不良事件报告。治疗 4 周后,我们观察到舌根肌力有了统计学意义上的显著增强(平均变化:4.0 N,95% CI 1.1-6.9,P = .015)。根据 SWAL-QoL 结果,患者表示吞咽负担减轻,进食时的耻辱感减少:我们的数据表明,使用新型舌训练器进行舌前训练的耐受性良好,并能增强主诉吞咽困难的 HNC 患者的舌根肌肉力量。基于 SWAL-QoL 调查的患者报告结果表明,治疗后患者的生活质量有所改善,但我们的结果因样本量较小而受到限制。我们还需要进行更大规模的研究,以确定该设备是否能对这一难以治疗的患者群体产生有临床意义的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
7.10%
发文量
171
审稿时长
4-8 weeks
期刊介绍: The Annals of Otology, Rhinology & Laryngology publishes original manuscripts of clinical and research importance in otolaryngology–head and neck medicine and surgery, otology, neurotology, bronchoesophagology, laryngology, rhinology, head and neck oncology and surgery, plastic and reconstructive surgery, pediatric otolaryngology, audiology, and speech pathology. In-depth studies (supplements), papers of historical interest, and reviews of computer software and applications in otolaryngology are also published, as well as imaging, pathology, and clinicopathology studies, book reviews, and letters to the editor. AOR is the official journal of the American Broncho-Esophagological Association.
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