Upper Airway Control Therapy (U-ACT): The Development of a Non-Pharmacological Intervention for Inducible Laryngeal Obstruction.

Abstract

Background and objective: Non-pharmacological intervention is the recommended gold standard for inducible laryngeal obstruction (ILO) treatment. Despite this, there is no standardised approach and interventions are poorly described. The objective was to develop and describe a standardised non-pharmacological intervention for ILO, for future testing of effectiveness.

Methods: MRC guidelines for complex intervention development were followed; the methodological approach was structured using the INDEX principles. The multi-phase research stages were: (1) evidence review; (2) qualitative data collection from speech and language therapists (n = 7) and patients (n = 22); (3) intervention design and theoretical underpinning; (4) prototype survey feedback from Stage 2 participants; and (5) final intervention description, using a validated reporting framework.

Results: Systematic review and synthesis of 14 studies (n = 527) identified key uncertainties and steered Stage 2 interviews. Framework analysis of qualitative data collected identified five overarching key themes for inclusion. The resulting 'Upper Airway Control Therapy' (U-ACT) intervention comprises two core components (education & empowerment; reliever breath control), four supporting components (bio-feedback training; prevention methods; supporting co-existing conditions; managing others' reactions to ILO) and a cross-cutting home practice component. U-ACT's mechanisms of action to bring about change includes 36 behaviour change techniques. Feedback on U-ACT protype was extremely positive; survey responders (n = 23; 87% response rate) strongly agreed to acceptability statements for all parameters surveyed [5-point Likert scale; median (range), 4.5, 3-5].

Conclusion: The U-ACT intervention, developed with keystakeholders and underpinned with a programme theory, is fully manualised and ready for evaluation. If future testing proves clinical and cost effectiveness, it could be incorporated into existing ILO services.