Implementation of the Home-Based mHealth App Intervention Program with Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Experimental Pilot Study.

Implementation of the Home-Based mHealth App Intervention Program with Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Experimental Pilot Study.:

Implementation of the Home-Based mHealth App Intervention Program with Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Experimental Pilot Study.

JMIR Mhealth Uhealth. 2020 Oct 03;:

Authors: Kim H, Cho NB, Kim J, Kim KM, Kang M, Choi Y, Kim M, You H, Nam SI, Shin S

Abstract

BACKGROUND: Tongue pressure is one of the effective indices of swallowing function, which decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue strengthening therapy on tongue function. Tongue exercises utilizing mobile Health (mHealth) technologies would have potential for advancing healthcare in the digital age to be more efficient for people with limited resources, especially older adults.

OBJECTIVE: The purpose of this study was to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention program with biweekly human mediation aimed at improving the swallowing tongue pressure in older adults.

METHODS: We developed a mobile health (mHealth) app for intervention which was utilized for 8 weeks (3 times/day, 5 days/week, a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age: 75.7 years) who complained of swallowing difficulties. The app included a SMIP (Swallowing Monitoring & Intervention Protocol) with three therapy maneuvers: effortful prolonged swallowing (EPS), effortful pitch glide (EPG), and effortful tongue rotation (ETR). The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant's progress and ability to implement the training sessions according to the given protocol. Pre-intervention and post-intervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument (IOPI). We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12-week post-intervention.

RESULTS: Eight out of 11 participants adhered to the home-based 8-week app therapy program with optimal intervention dosage. At the main trial endpoint (i.e., 8-week) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median = 17.5 kPa at pre-intervention and 26.5 kPa at post-intervention; P < .05). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12-week post-intervention were not observed.

CONCLUSIONS: Swallowing tongue pressure is known to be closely related with dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined method of EPS, EPG, and ETR mobile app training, accompanied by biweekly human mediation, on swallowing tongue pressure in older adults. The mHealth app is a promising platform which can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size as well as the long-term effects of the intervention program, further studies are warranted.

CLINICALTRIAL:

INTERNATIONAL REGISTERED REPORT: RR2-10.2196/19585.



PMID: 33012704 [PubMed - as supplied by publisher]