Dysphagia最新文献

{"title":"Pharyngeal Dysphagia in Cancer: Characterizing Functional and Physiological Swallow Targets Across 12 Cancer Types.","authors":"Beatrice Manduchi, Carla L Warneke, Carly E A Barbon, Xiaohui Tang, Ariana J Sahli, Sheila N Buoy, Katherine A Hutcheson","doi":"10.1007/s00455-026-10965-0","DOIUrl":"10.1007/s00455-026-10965-0","url":null,"abstract":"<p><p>Dysphagia is common across cancer populations, yet it remains poorly characterized outside of head and neck (HN) cancer. Defining swallowing profiles in diverse cancer groups is essential to guide targeted supportive care and rehabilitation. We analyzed 10,677 MBSs from 6,423 adult cancer patients referred for dysphagia assessment (2016-2021) across 12 cancer diagnoses, at a designated comprehensive cancer center. Swallowing safety and efficiency were graded using the DIGEST scale. Multivariable mixed-effects ordinal logistic regression assessed differences in DIGEST impairment (≥ 1) across diagnoses. In a subset of 704 studies, physiologic impairments were examined with the MBSImP and correlated with DIGEST outcomes. Dysphagia frequency varied significantly across cancer types for overall, safety, and efficiency domains (all p < 0.05). Overall dysphagia (DIGEST ≥ 1) was most frequent in patients with multiple cancers including HN (71%) and gastrointestinal (64%) and lowest in breast and endocrine/thyroid cancers. Safety impairments were highest in patients with multiple cancers including HN (59%), gastrointestinal (52%), and CNS (51%), while efficiency deficits predominated in patients with multiple cancers including HN (54%), HN alone (46%), CNS and multiple non-HN cancers (both 44%). Pharyngeal swallow initiation, anterior hyoid excursion, and laryngeal vestibular closure were the most frequently impaired physiologic components. Correlations between MBSImP and DIGEST varied across cancer types. Swallowing impairment profiles differ substantially by cancer type, and link to distinct physiologic targets. These findings support developing cancer-specific dysphagia pathways and integrating physiologic and functional metrics to optimize rehabilitation.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Feeding and Aspiration Risk in Preterm Infants Receiving Nasal High-Flow Respiratory Support: A Cross-Sectional Study.","authors":"Kelly A Weir, Angie Canning, Timothy Hong, Manbir Chauhan, Shane George, Thuy Frakking, Susan Moloney, Rachael Fairhurst, Robert S Ware, Keith Grimwood","doi":"10.1007/s00455-026-10959-y","DOIUrl":"https://doi.org/10.1007/s00455-026-10959-y","url":null,"abstract":"<p><p>To objectively assess aspiration risk with oral feeding during nasal high-flow (NHF) and to correlate NHF rate and presence and depth (degree) of Oropharyngeal Aspiration (OPA). Cross-sectional study. Single-center, Level III, neonatal unit. Infants born preterm (< 37-weeks gestational age [GA]), aged ≥ 35-weeks to 4-weeks corrected gestational age (CGA) at an oral feeding trial, whilst receiving NHF (> 1 L/min), demonstrating oral feeding readiness cues, managing oral secretions, and clinically stable. Participants underwent a clinical feeding evaluation (CFE) and videofluoroscopic swallow study (VFSS). Aspiration status was determined using the Penetration-Aspiration Scale (PAS) on VFSS. Flow rate (L/min), weight-adjusted flow rate (L/kg/min), and fraction of inspired oxygen (FiO₂) were recorded at CFE and VFSS, with PAS data used for analysis. Twenty preterm infants, (13 males) were recruited. They were born at 24 weeks + 0-days to 36-weeks + 6-days GA, and aged 34-weeks + 6-days to 42-weeks + 5-days CGA at their CFE. One infant had suspected aspiration on CFE, and two had silent aspiration confirmed on VFSS. PAS ranged from 1 to 8 (median 2.00, interquartile range 1.00-2.00). Unadjusted and weight-adjusted flow rates at VFSS were 4-8 (mean±standard deviation 5.60 ± 1.27) L/min and 1.2-3.88 (2.24 ± 0.61) L/kg/min, respectively. Level of laryngeal penetration-aspiration was not correlated with flow rate (L/min; p = 0.11) but significantly inversely correlated with weight-adjusted flow rate (L/kg/min; p = 0.01). These early findings suggest that it may be safe to orally feed some clinically stable preterm infants receiving NHF under controlled conditions. Aspiration risk should be based upon patient-specific factors and not just from receiving NHF. However, additional research is needed.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-site Vibration Signal Analysis for Estimating Post-Swallow Residue: A Pilot Study.","authors":"Jee Hyun Suh, Jaewon Lee, Hyun Jin Kim, Jung-Min Kim, Jinju Lee, Ju Seok Ryu","doi":"10.1007/s00455-026-10958-z","DOIUrl":"https://doi.org/10.1007/s00455-026-10958-z","url":null,"abstract":"<p><p>This pilot study investigated whether multi-site acoustic signal analysis could detect post-swallow residue and aimed to identify the most effective sensor location and parameters for detection. Three contact microphone-based acoustic sensors and one air-conduction-based conventional audio recorder were positioned at four anatomical sites: the jugular notch, near the pyriform sinus, near the vallecular sinus, and over the right deltoid muscle. Patients with dysphagia were recorded during pre-swallow, thin-fluid swallowing, and yogurt (YP) swallowing conditions. Acoustic parameters, including harmonic-to-noise ratio (HNR), noise-to-harmonic ratio, jitter, shimmer, and formant frequencies, were extracted from each recording. The videofluoroscopic swallowing study findings served as the reference standard for detecting pharyngeal residue. Pre-swallow and post-YP swallowing conditions yielded the most reliable acoustic indicators of post-swallow residue. Among the sensor locations, the right-lateral vallecular sinus sensor demonstrated the highest accuracy in reflecting pharyngeal retention. HNR emerged as the most robust single parameter, with high values paradoxically associated with the presence of residue. Multisite acoustic analysis, particularly HNR measurement from a vallecular sinus-placed sensor in the pre-swallow or post-YP swallowing state, may serve as a noninvasive and accessible method for detecting post-swallow residue in patients with dysphagia. Notably, the vallecular sensor demonstrated the highest diagnostic performance, suggesting that a simplified single-sensor approach may be feasible, although this requires validation in larger-scale studies. Largescale studies are needed to validate these findings and assess the feasibility of real-time dysphagia screening.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a Regression-Based Approach to Norming the Test of Masticating and Swallowing Solids (ToMaSS): A Comparison with Traditional Stratified Methods.","authors":"Esther Guiu Hernandez, Nicole Lewis, Sarah Perry, Maggie-Lee Huckabee","doi":"10.1007/s00455-026-10949-0","DOIUrl":"https://doi.org/10.1007/s00455-026-10949-0","url":null,"abstract":"<p><p>The Test of Masticating and Swallowing Solids (ToMaSS) is a commonly-used adjunctive assessment to quantify solid bolus ingestion. However, published norms are characterised by relatively small sample sizes and wide age brackets, increasing the risk of skew, influence by outliers, and reduced statistical power. Regression-based approaches to norming may mitigate some of these limitations. To evaluate whether a regression-based approach offered a significant advantage over the traditional stratified approach for the refinement of ToMaSS norms. Prospective-retrospective design, with prospectively collected data combined with historical data from published and unpublished laboratory datasets. All data consisted of healthy adults (aged 20 to 80 + years) recruited from the general public. McFadden's Pseudo R² and Root Mean Squared Error (MSE) were calculated and compared for both statistical approaches. Regression-based norms (GAM Gamma and COM-Poisson models) showed a modest improvement in model fit over traditional stratified norms, with McFadden's Pseudo R² increasing by 6% to 43% across outcomes. MSE values followed a similar trend, with regression-based norms reducing prediction error by up to 12%. Findings support that a regression-based approach offered a significant advantage over a traditional stratified approach to constructing ToMaSS norms. Advantages included smaller sample size requirements and individualised estimates across continuous age ranges. This flexibility allows for a more nuanced understanding of individual ToMaSS performance, which may be of particular relevance to clinical populations where changes in the oral phase of swallowing may vary greatly within a short time frame.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement Techniques and Properties of Single-item Measures for the Evaluation of Oropharyngeal Muscle Function in Adults with Dysphagia: A Systematic Review using the COSMIN Framework.","authors":"Eileen Kelly, Joelle Hako, Anna Creagh Chapman, Brigitta Fazzini, Timothy J Stephens, Renée Speyer, Anna-Liisa Sutt, Zudin Puthucheary","doi":"10.1007/s00455-026-10957-0","DOIUrl":"https://doi.org/10.1007/s00455-026-10957-0","url":null,"abstract":"<p><p>Muscle dysfunction is a critical construct in dysphagia. Despite the availability of diverse techniques to evaluate muscle function, a comprehensive synthesis of measurement items and their properties is lacking. A systematic review of studies examining the measurement techniques used to directly evaluate oropharyngeal muscle function was performed. Studies investigating the use of surface electromyography, tongue dynamometry, ultrasound, high-resolution pharyngeal manometry, magnetic resonance imaging and computed tomography and reporting measurement properties in line with the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) were included. Measurement outcomes derived from these techniques were operationalised as single-item measures. Methodological quality was evaluated using the QualSyst tool. From the 6279 records, 125 eligible studies were identified. The breakdown of techniques was surface electromyography (n = 33), tongue dynamometry (n = 34), ultrasound (n = 17), high-resolution pharyngeal manometry (n = 15), magnetic resonance imaging (n = 5), computed tomography (n = 4) and combined techniques (n = 17). Single-item measures were heterogenous, covering a range of domains including muscle activation, coordination, strength, endurance, composition, thickness, and kinematics. Studies focused predominantly on oral rather than pharyngeal musculature. Validity (n = 117) was widely reported, primarily via known-group validity or hypothesis testing. Fewer studies examined reliability (n = 20) and responsiveness (n = 25); however, where reported, results indicated excellent intra- and inter-rater reliability and responsiveness to therapeutic interventions. A diverse range of single-item measures were identified across included measurement techniques. Measurement properties were sparsely reported. Future research should focus on rigorous measurement instrument design and standardisation to comprehensively evaluate the underlying mechanisms of dysphagia.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery Trajectories and Predictors of Post-Extubation Dysphagia in Intensive Care Unit Patients Following Orotracheal Intubation: A Longitudinal Study.","authors":"Limi Shan, Haifang Wang, Weixia Yu, Jianzheng Cai, Yuyu Wang, Yingying Zhang, Xin Wang","doi":"10.1007/s00455-026-10941-8","DOIUrl":"https://doi.org/10.1007/s00455-026-10941-8","url":null,"abstract":"<p><p>Post-extubation dysphagia (PED) is a prevalent and debilitating complication in intensive care unit (ICU) patients, yet the longitudinal heterogeneity of swallowing recovery remains poorly understood. This study was aimed to characterize distinct recovery trajectories of swallowing function in ICU patients with PED and to identify the clinical predictors associated with each pattern. This longitudinal observational study utilized convenience sampling to enroll ICU patients from a tertiary hospital. Swallowing function was evaluated using the Standard Swallowing Assessment (SSA) at seven time points post-extubation, at 4-6, 24, 48, and 72 h and 7, 14, and 28 days. Latent recovery trajectories were identified using growth mixture modeling (GMM), and independent predictors of group membership were determined by multivariate logistic regression. Of 495 intubated patients, 248 (54.98%) developed PED and were included; 209 completed all follow-up assessments. Three distinct trajectories emerged: Group HS (high level, slow improvement; 10.0%), Group HR (high level, rapid improvement; 22.5%), and Group LE (low level, early recovery; 67.5%). For both Group HR and Group HS, membership was predicted by older age, neurological diagnosis, higher peak inspiratory pressure, longer intubation duration, and early pharyngeal pain. In addition, membership in Group HR was uniquely associated with an APACHE II score of 10-14 and exposure to fiberoptic bronchoscopy. Post-extubation swallowing recovery follows distinct trajectories shaped by physiological, procedural, and disease-related factors. Early trajectory identification allows for personalized, stage-specific interventions to optimize functional outcomes and mitigate long-term morbidity.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of and Experiences with Dysphagia in People with hypermobile Ehlers Danlos Syndrome (hEDS) with or Without Dysautonomia - A Qualitative Study.","authors":"Deanna Britton, Karyssa Stonick, Diana Lopez, Donna Graville","doi":"10.1007/s00455-026-10952-5","DOIUrl":"https://doi.org/10.1007/s00455-026-10952-5","url":null,"abstract":"<p><p>Ehlers Danlos Syndromes (EDS) are hereditary connective tissue disorders. The purpose of this participatory action qualitative research study is to describe experiences of dysphagia in people with hypermobile EDS (hEDS). Ten participants (8 F, 1 M, and 1 nonbinary-assigned F at birth; ages 19-52 years) with hEDS completed the Eating Assessment Tool (EAT-10; Belafsky et al., 2008), Reflux Symptom Index (RSI; Belafsky et al., 2002), and semi-structured interviews. The interviews were audio-recorded, transcribed and verified. Phenomenological qualitative research methods were used to code (Atlas.ti Web) and develop themes. All participants affirmed dysphagia symptoms via the EAT-10 (M = 17.65; SD = 6.93; Range = 4-29) with 6/10 requiring a feeding tube at some point. Most participants also affirmed reflux symptoms on the RSI (M = 20.30; SD = 8.3; Range 7-36). Four preliminary themes related to dysphagia in people with hEDS were identified: (1) Swallowing discomfort is common, requiring cognitive and physical effort; (2) Gastrointestinal symptoms impact deglutition and often lead to a need for supplemental nutrition / hydration; (3) Dyspnea is common, and may intermittently impact respiratory-swallowing coordination; and (4) Dismissal of physiological symptoms as \"anxiety\" by at least one provider prior to acknowledgment of an underlying condition occurs frequently. Dysphagia is commonly reported by people with hEDS and appears to be related to underlying symptoms of hEDS and/or dysautonomia. Further research is needed to elucidate the impact and mechanisms of impairments associated with hEDS and dysautonomia across all phases of swallowing.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Swallowing Related Muscle Loss on Dysphagia: A Cohort Study Based on Ultrasound Monitoring of Postoperative Patients with Intracranial Hemorrhage.","authors":"Jin-Ting Wei, Hai-Ping Wu, Yue Hu, Xin Zhang, Shi-Jing Ma, Tao Feng, Bin Zhong, Zhi-Kun Bai, Ling-Ling Huang, Qiu-Yan Zhang, Jin-Hua Wang","doi":"10.1007/s00455-026-10954-3","DOIUrl":"https://doi.org/10.1007/s00455-026-10954-3","url":null,"abstract":"<p><p>Acquired dysphagia is a common complication after intracranial hemorrhage (ICH) and leads to poor prognosis. The relationship between dysphagia and stroke-related sarcopenia has recently received attention, but the related factors and prediction models are still poorly understood. The purpose of this study was to investigate the risk factors of dysphagia in patients after ICH and the effect of swallowing-related muscle loss on swallowing function during endotracheal intubation (IET) retention, and to establish a simplified dysphagia prediction model. Bedside ultrasound was used to monitor swallowing-related changes during IET in patients after ICH surgery, and swallowing function information was collected when patients entered the rehabilitation medicine department for rehabilitation. Total of 97 patients with ICH were included for analysis, and the incidence of dysphagia was 70.10%. Masseter muscle thickness (MMT), temporal muscle thickness (TMT), duration of IET, operation time (OT), and Barthel Index were significantly different between the dysphagia group and the non-dysphagia group. Logistic regression analysis showed that the changes in MMT, duration of IET, and OT were risk factors for dysphagia. The cutoff values were MMT reduction of 0.85 mm, duration of ETI were 6.5 days, and OT were 225 min. ROC analysis showed that the nomogram AUC was 0.882 (0.807-0.957). The model based on Ultrasound assessment of swallowing-related muscle loss combined with objective clinical data revealed that the changed of MMT, the ETI duration and OT are risk factors for dysphagia in patients after ICH, and are also effective indicators for predicting dysphagia after ICH.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transitional Foods in Dysphagia and Feeding Management: Perspectives of Speech-Language Therapists in Singapore.","authors":"Seh Ling Kwong, Julia M W Lee, Valerie P C Lim, Benjamin J W Chow, Simeon D Stoyanov, Suk M Goh","doi":"10.1007/s00455-026-10955-2","DOIUrl":"https://doi.org/10.1007/s00455-026-10955-2","url":null,"abstract":"<p><p>Transitional foods (TFs) are foods that change texture with moisture and/or temperature. Despite their potential to aid chewing development and swallowing rehabilitation, TFs remain underutilized in clinical practice. This study explored the perspectives of speech and language therapists (SLTs) in Singapore regarding TFs in dysphagia and feeding management, aiming to inform the development of TF products to expand available food options. A cross-sectional online survey was conducted among actively practicing SLTs. The survey included closed and open-ended questions on understanding of TFs and its usage, and perceived facilitators and barriers to the use of TFs. Fifty-eight registered SLTs who had managed clients with feeding difficulties and/or dysphagia within the last five years participated. Most worked in public health institutions with adult clients. While 93.1% had heard of TFs, only 22.4% accurately described them per the International Dysphagia Diet Standardisation Initiative (IDDSI) definition; 56.9% provided partially correct descriptions lacking key defining features, and 12.1% gave erroneous definitions. Over half (58.6%) had recommended TFs, primarily to expand food options and support therapy, despite infrequent client-driven requests for TFs. Key barriers included concerns about swallowing safety, variability in texture transitions, limited training, and institutional constraints. The findings highlight a gap in SLTs' knowledge and confidence regarding TFs. Despite the perceived benefits of TFs, unclear definitions, lack of safety data, and systemic barriers hinder consistent use. The broad IDDSI definition may limit clinical applicability; refining it through subcategorization based on specific characteristics could improve safety assessment and support wider adoption in dysphagia and feeding management.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Prophylactic Swallowing Exercises in Patients with Head and Neck Cancer Receiving (Chemo) Radiotherapy Across Two Service Delivery Modes in South India.","authors":"Jasmine Lydia Selvaraj, Lakshmi Venkatesh, Laurelie R Wishart, Satish Srinivas Kondaveeti","doi":"10.1007/s00455-026-10953-4","DOIUrl":"https://doi.org/10.1007/s00455-026-10953-4","url":null,"abstract":"<p><p>This study aimed to investigate adherence to a six-week prophylactic swallowing exercise (PSE) program delivered in two service delivery modes among patients with head and neck cancer (HNC) undergoing (chemo)radiotherapy (C)RT in South India. The study also explored the influence of patient-related and clinical factors on adherence rates. In a prospective study at a quaternary care hospital, 104 HNC patients were randomized to clinician-directed (n = 53) or self-directed (n = 51) PSE programs. The clinician-directed group received weekly in-person supervision by a speech-language pathologist, while the self-directed group practiced independently at home with weekly phone counseling. All received pre-treatment counseling and standardized instructions for a 6-week PSE program involving 10 exercises (mobility & swallowing), performed three times daily, six days a week. Adherence was tracked using weekly logs and calculated as a percentage of completed repetitions (1,800/week; 10,800 total), categorized as high (≥ 76%), moderate (51-75%), or low (< 50%). Overall adherence was higher in the clinician-directed group (87.7%) than in the self-directed group (61.6%, p = .004), and declined over time in both groups. Participants adhered more to mobility exercises than swallowing exercises across all weeks (p < .01), with large effect sizes in weeks 4-6 (r =0.441-0.464). Chi-square analysis showed adherence classification was significantly associated with service delivery mode (p = .006). No significant associations were found with patient-related (age, gender, lifestyle) or clinical factors (tumor site, treatment type). HNC patients demonstrated moderate adherence to PSEs, higher in clinician-directed programs. Declining adherence, particularly in self-directed programs, underscores the need for strategies that promote self-monitoring and motivation to optimize rehabilitation in resource-limited settings.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}