Chin tuck against resistance exercise with feedback to improve swallowing, eating and drinking in frail older people admitted to hospital with pneumonia: protocol for a feasibility randomised controlled study

David G Smithard; Ian Swaine; Salma Ayis; Alberto Gambaruto; Aoife Stone-Ghariani; Dharinee Hansjee; Stefan T Kulnik; Peter Kyberd; Elizabeth Lloyd-Dehler; William Oliff

doi:10.1186/s40814-022-01060-w

Chin tuck against resistance exercise with feedback to improve swallowing, eating and drinking in frail older people admitted to hospital with pneumonia: protocol for a feasibility randomised controlled study

Pilot Feasibility Stud. 2022 May 19;8(1):105. doi: 10.1186/s40814-022-01060-w.

Authors

David G Smithard^{1

2}, Ian Swaine³, Salma Ayis⁴, Alberto Gambaruto⁵, Aoife Stone-Ghariani⁶, Dharinee Hansjee⁷, Stefan T Kulnik⁸, Peter Kyberd⁹, Elizabeth Lloyd-Dehler¹⁰, William Oliff¹¹

Affiliations

¹ Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, SE18 4QH, Woolwich, UK. david.smithard@nhs.net.
² University of Greenwich, Avery Hill Campus, Avery Hill Rd., London, SE9 2BT, UK. david.smithard@nhs.net.
³ University of Greenwich, Avery Hill Campus, Avery Hill Rd., London, SE9 2BT, UK.
⁴ King's College London, Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Guy's Campus, London, SE1 1UL, UK.
⁵ Department of Mechanical Engineering, University of Bristol, Bristol, BS8 1TH, UK.
⁶ Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, SE18 4QH, Woolwich, UK.
⁷ University of Greenwich, Medway Campus, Central Avenue, Gillingham, ME4 4TB, UK.
⁸ Ludwig Boltzmann Institute for Digital Health and Prevention, Lindhofstrasse 22, 5020, Salzburg, Austria.
⁹ School of Energy and Electronic Engineering, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth, PO1 3DJ, UK.
¹⁰ Independent Service User Representation, London, UK.
¹¹ University of Greenwich, Old Royal Naval College, Park Row, London, SE10 9LS, UK.

Abstract

Background: Swallowing difficulties (dysphagia) and community-acquired pneumonia are common in frail older people and maybe addressed through targeted training of the anterior neck musculature that affects the swallow. We have developed a swallowing exercise rehabilitation intervention (CTAR-SwiFt) by adapting a previously established swallowing exercise to ensure patient safety and ease of execution in the frail elderly population. The CTAR-SwiFt intervention consists of a feedback-enabled exercise ball that can be squeezed under the chin, with real-time feedback provided via a mobile application. The aim of this study is to evaluate the feasibility of assessing the effectiveness of the CTAR-SwiFt intervention in reducing dysphagia and community-acquired pneumonia, prior to a larger-scale multi-centre randomised controlled trial.

Methods: We will recruit 60 medically stable patients over the age of 75 years who have been admitted with a diagnosis of pneumonia to the acute frailty wards at two participating hospitals in the UK. Study participants will be randomised into one of three groups: standard care, low intensity (once daily) CTAR-SwiFt exercise or high intensity (twice daily) CTAR-SwiFt exercises. The intervention period will last for 12 weeks, the final follow-up assessment will be conducted at 24 weeks. We will assess the feasibility outcomes, including rates of participant recruitment and retention, compliance with the exercise regime and adverse incidents. Additionally, we will assess the usability and acceptability of the intervention device and the performance of different clinical outcome measures (e.g. chin tuck strength, Functional Oral Intake Scale, SWAL-QOL, EQ-5D and swallow speed). A sub-sample of study participants will complete videofluoroscopic assessments of swallowing function before and after the intervention to evaluate the physiological changes (e.g. bolus flow rates, laryngeal elevation, base-of-tongue retraction).

Conclusions: By improving the ability to swallow, using our chin tuck exercise intervention, in frail older patients admitted to hospital with pneumonia, it is anticipated that patients' oral intake will improve. It is suggested that this will further impact clinical, patient and healthcare economic outcomes, i.e. reduce the need for supplemental feeding, improve patient satisfaction with oral intake and swallowing-related quality of life, decrease the occurrence of chest infections and reduce hospital admissions and related healthcare costs.

Trial registration: ISRCTN, ISRCTN12813363 . Registered on 20 January 2020.

Keywords: Chin tuck against resistance; Dysphagia; Frailty; Old age; Rehabilitation; Swallowing.

Grants and funding

PB-PG-1217-20005/National Institute for Health Research