Intervention Effect Of Swallowing Function Training On Head And Neck Neoplasm Patients With Dysphagia Receiving Radiotherapy

Objective 1. To test the reliability and validity of the dysphagia scale for head and neck neoplasm patients. 2. To explore the intervention effect of swallowing function training on head and neck neoplasm patients with dysphagia receiving radiotherapy.Methods 1. The cross-sectional study was conducted in a tertiary hospital in Tianjin, China. 220 head and neck neoplasm patients with dysphagia were enrolled in the study. Cronbach’s alpha coefficient(Cronbach’s α) and correlation analysis were used to test the reliability and validity of the dysphagia scale for head and neck neoplasm patients. 2. The prospective randomized controlled trial study was conducted at the department of radiotherapy(RT) in a tertiary hospital in Tianjin, China. 64 head and neck neoplasm patients were divided into intervention group and control group by the random number generator, 32 in each group. The control group received the routine nursing and relevant health education, while the intervention group received swallowing function training provided by researcher since 2 weeks before to 3 months after RT. The Sociodemographic Questionnaire, Standardized Swallowing Assessment(SSA), Water Swallow Test(WST), Functional Oral Intake Scale(FOIS), M. D. Anderson Dysphagia Inventory(MDADI), weight, incisor distance and nutritional support were evaluated and recorded at 2 weeks before RT, 1 week and 3 months after RT, which could assess the patients’ swallowing function. Independent-sample t test, Chi-square test, Mann-Whitney U test, Repeated measure ANOVA were used for statistical analysis.Results 1. The overall Cronbach’s α coefficient and test-retest coefficient of the scale were 0.923 and 0.942. The criterion validity coefficients ranged from 0.610 to 0.777. The convergent validity coefficients ranged from-0.451 to-0.851. The discriminant validity coefficients were-0.135,-0.265 and 0.172.2. Results of within group analysis showed that the weight and incisor distance declined from baseline to post-intervention for patients in both groups, and the differences were statistically significant(P<0.05). After intervention, the score of SSA was higher than pre-intervention, the total score and each subscale score of MDADI were lower than pre-intervention, which showed that the differences were statistically significant(P<0.001). 3. Results of between groups analysis showed that the intervention group demonstrated less decline in weight than that in the control group at each time point after intervention. However, no significant differences were found between two groups(P>0.05). Comparing the incisor distance between groups after intervention, the intervention group was higher than the control group(P<0.05). Data showed no difference between the two groups in the rate of nutritional support at each time point after intervention(P>0.05). Significant differences were found between groups on each score of SSA, WST, FOIS, MDADI and subscale of MDADI, which showed that the scores in the intervention group were better than in the control group(P<0.05).Conclusions 1. The dysphagia scale demonstrated good psychometric properties and would be a valuable measurement to screen dysphagia rapidly and evaluate the impact of it on the quality of life for head and neck neoplasm patients. 2. Swallowing function training could improve the condition of dysphagia and the ability of oral feeding for patients with head and neck neoplasm receiving RT. It could decrease the stiffness of temporomandibular joint and the degree of muscle atrophy, and improve the quality of life for them.