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

Abstract

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. Trial registration ClinicalTrials.gov: NCT02825927.

Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review

“…As Table 1 shows, only one study used a qualitative design [ 41 ], and the topic was related to feeding experiences from nursing aides. Two studies were randomized controlled trials [ 29 , 42 ]. Three were classified as pseudo randomized controlled trials and another three were quasi-experimental studies [ 25 , 31 , 34 , 37 , 39 , 40 ].…”

“…As Table 1 shows, of the nineteen studies [13,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], six were conducted in the USA, three were conducted in Japan, two were conducted in Australia, and one was conducted in the UK, France, Sweden, Brazil, South Korea, Mainland China, Hongkong and Taiwan, respectively. Most were conducted in developed countries or regions (89.5%).…”

Oral neuromuscular training in patients with dysphagia after stroke: a prospective, randomized, open-label study with blinded evaluators

“…This suggested that patients with dysphagia could use an oral device to self-train their weak oral and pharyngeal muscles; that is, for neuromuscular training. Improvement in swallowing function has been reported among older people with dysphagia after oral neuromuscular training [ 9 ]. Until now, no randomized, controlled study has been performed to investigate the effect of oral neuromuscular training as treatment for post-stroke dysphagia.…”

Oral neuromuscular training in patients with dysphagia after stroke: a prospective, randomized, open-label study with blinded evaluators

“…This suggested that patients with dysphagia could use an oral device to selftrain their weak oral and pharyngeal muscles; that is, for neuromuscular training. Improvement in swallowing function has been reported among older people with dysphagia after oral neuromuscular training [9]. Until now, no randomized, controlled study has been performed to investigate the effect of oral neuromuscular training as treatment for poststroke dysphagia.…”