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DysphagiaNCT05074784

Effects of IOPI on Swallowing Function and Functional Status in Geriatric Patients

A study testing IOPI Therapy and Tongue Depressor Traditional Intervention in people with Dysphagia, run by Khoo Teck Puat Hospital.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This project is an exploratory study that aims to investigate the effects of IOPI therapy on the swallowing function and tongue strength of geriatric patients in a geriatric ward in an acute hospital. Its secondary aim is to investigate the correlation between IOPI readings and functional status. Read more about this study

Who is it for?
Ages 78 to 99 years
Conditions the study is for
Dysphagia
What is being tested?
IOPI Therapy and Tongue Depressor Traditional Intervention
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
84 participants
Where
No sites listed yet
Study dates
1 Oct 2021to 1 Nov 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 78 to 99 years
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • aged 78-99 years old
  • CFS rating of 4-7
  • able to sit out of bed
  • able to follow at least 2-step directions (even for patients with cognitive condition e.g. dementia )
  • diagnosed with dysphagia by the ward speech therapist and assessed to be suitable for therapy
  • have not been admitted for more than 2 days

Who cannot join

  • acute neurological conditions such as traumatic brain injury or stroke
  • history of head and neck cancer, surgery or radiotherapy to head and neck region and 3) patients on long term tube feeding

About this study

This project is an exploratory study that aims to investigate the effects of IOPI therapy on the swallowing function and tongue strength of geriatric patients in a geriatric ward in an acute hospital. Its secondary aim is to investigate the correlation between IOPI readings and functional status. The result of this study could help to improve current practice of dysphagia intervention in the geriatric population. If results are significant, there will be research evidence to put forth a change to work processes for speech therapists. IOPI will be more widely used in the clinical context and will then result in better functional outcomes.

Read the detailed description

In recent years, there have been increasing evidence that tongue strengthening exercises have the ability to improve tongue muscle strength and tongue muscle thickness in the geriatric population. These improvements have a direct impact on the oral phase of swallow, specifically resulting in better orolingual manipulation and propulsion, and increasing intra-oral pressure for better bolus clearance. Reduction in tongue strength and other swallowing parameters can lead to swallowing disorder known as dysphagia. In the healthy ageing population, weakness in swallowing muscles is termed presbyphagia. Geriatric patients have an even higher chance of transitioning from presbyphagia to dysphagia when they become acutely unwell. Studies have also shown that deterioration of the whole-body muscle strength is associated with poorer oral function. Additionally, other studies have also shown that a lower isometric tongue strength might represent diminished functional reserves, which may increase the risk of dysphagia once an insult to the body occurs. There is also evidence that people who have episodes of aspiration have significantly weaker tongue strength at both the anterior and posterior regions. Thus, frail geriatric adults who have weaker skeletal muscles are at a higher risk of developing dysphagia. The tongue is amendable to therapy but current practices in Singapore lack an objective measure. Conventional dysphagia oromotor exercises employ the use of a tongue depressor. This method lacks a quantifiable measure to track outcome and is quite subjective to individual therapists. There is also a lack of practice guideline on recommended resistive load and frequency of exercise in the geriatric population in the acute setting. Other than outcome measures and practice guidelines, there is also a lack of research investigating the correlation of tongue strength and functional status. A few studies have explored the effects of different resistive load used in tongue strengthening exercises, although it was recommended to use a resistive load between 60% to 80% for more positive and extrinsic feedback, and for target population with a lower frustration threshold. Studies also used a longer timeframe of 3-4 weeks of rehabilitation to attain significant effects from skeletal muscle exercise. This, however, is not realistic in the acute geriatric setting in Singapore where the mean length of stay is 10 days. Thus, this study is an exploratory study to investigate the efficacy of using IOPI in this population to improve swallowing function and tongue strength. This study also aims to investigate if a correlation exists between IOPI reading and functional status.

Conditions
Dysphagia
Being tested
IOPI Therapy, Tongue Depressor Traditional Intervention
Medical subject headings
Deglutition Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • IOPI TherapyDevice

    Obtain IOPI reading at start of session, record the best of 3 readings as baseline strength. Calculate exercise resistance for session at 60% of baseline strength. Using the IOPI, participants will perform 24 sets of 5 repetition at anterior position, allowing for 30 secs rest in between sets.

  • Tongue Depressor Traditional InterventionDevice

    Using the tongue depressor, participants will be prompted to stick their tongue out as much as they can and to push hard against the tongue depressor for 10 seconds. They will be required to repeat this action 10 times, constituting one set. They will be asked to perform 3 sets, with 30 secs of rest between each set

Study groups in NCT05074784
Study groupRoleWhat they receive
Control GroupActive comparatorTongue depressor exercise protocol for tongue strengthening for control group. Using the tongue depressor, participants will be prompted to stick their tongue out as much as they can and to push hard against the tongue depressor for 10 seconds. They will be required to repeat this action 10 times, constituting one set. They will be asked to perform 3 sets, with 30 secs of rest between each set. Arrange for 5 sessions for a week; sessions can take place on consecutive days.
Receives: Device: Tongue Depressor Traditional Intervention
Intervention GroupExperimentalIOPI exercise protocol for tongue strengthening for intervention group. Using the IOPI, participants will perform 24 sets of 5 repetition at anterior position, allowing for 30 secs rest in between sets. Arrange for 5 sessions for a week; sessions can take place on consecutive days.
Receives: Device: IOPI Therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of increase in tongue strength

    The IOPI device will be used to measure tongue strength at the anterior position on the last day of intervention. This will be compared to the baseline tongue strength collected on the first day of intervention.

    Measured: 5 intervention days

  2. Improvement in score on Functional Oral Intake Scale (FOIS)

    The speech therapist will rate the participant's FOIS score at the start and end of intervention according to the type of diet that the participant is prescribed.

    Measured: 5 intervention days

Secondary outcomes (6)
  1. Improvement in AusTOMs Swallowing Scale Rating

    The speech therapist will rate the participant on the AusTOMs swallowing scale at the beginning and end of intervention with accordance to the severity of dysphagia.

    Measured: 5 intervention days

  2. Improvement in Modified Barthel Index (MBI) Score

    The occupational therapist will provide a baseline and outcome rating on the MBI for each participant. This will contribute to the evaluation of the patient's functional status at the end of intervention.

    Measured: 5 intervention days

  3. Improvement in hand grip strength (HGS)

    The speech therapist administering the intervention will assess for hand grip strength at the beginning and end of intervention. This will contribute to the evaluation of the patient's functional status at the end of intervention.

    Measured: 5 intervention days

  4. Improvement in timed sit-to-stand duration

    The speech therapist administering the intervention will assess for timed sit-to-stand at the beginning and end of intervention. This will contribute to the evaluation of the patient's functional status at the end of intervention.

    Measured: 5 intervention days

  5. Improvement in the score of the SARC-F questionnaire

    The speech therapist administering the intervention will complete the questionnaire with the participant at the beginning and end of intervention. This will contribute to the evaluation of the patient's functional status at the end of intervention.

    Measured: 5 intervention days

  6. Improvement in overall functional status.

    The investigators of the study will compare the baseline and outcome measures for the AusTOMs swallowing scale rating, MBI, HGS, timed sit-to-stand and SARC-F scores to evaluate if participants show an improvement in their overall functional status.

    Measured: 5 intervention days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Oct 2021
  2. Study start1 Oct 2021 (estimated)
  3. Primary completion1 Oct 2022 (estimated)
  4. Study completion1 Nov 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients will be randomized into control group or intervention group.
Masking
Triple blind
Who is masked
Care provider, Investigator, Outcomes assessor
Enrolment
84 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05074784
Sponsor's protocol ID
2021/00223
Status last verified
Sep 2021
First submitted
18 Sep 2021
Last updated
12 Oct 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Adams V, Mathisen B, Baines S, Lazarus C, Callister R. Reliability of measurements of tongue and hand strength and endurance using the Iowa Oral Performance Instrument with elderly adults. Disabil Rehabil. 2015;37(5):389-95. doi: 10.3109/09638288.2014.921245. Epub 2014 May 22.

    PubMed 24854105
  • Aoki, Y., Kabuto, S., Ozeki, Y., Tanaka, T., amp; Ota, K. (2015). The effect of tongue pressure strengthening exercise for dysphagic patients. Japanese Journal of Comprehensive Rehabilitation Science, 6, 129-136.

  • Butler SG, Stuart A, Leng X, Wilhelm E, Rees C, Williamson J, Kritchevsky SB. The relationship of aspiration status with tongue and handgrip strength in healthy older adults. J Gerontol A Biol Sci Med Sci. 2011 Apr;66(4):452-8. doi: 10.1093/gerona/glq234. Epub 2011 Feb 7.

    PubMed 21300744
  • Kim, S., Kim, M., Lee, S., Choi, B., amp; Heo, Y. (2019). The Effects of Orofacial Myofunctional Training on the Changes of Lip and Tongue Strength in Elderly People. Journal of Dental Hygiene Science, 19(4), 279-287. doi:https://doi.org/10.17135/jdhs.2019.19.4.279

  • Namasivayam-MacDonald AM, Riquelme LF. Presbyphagia to Dysphagia: Multiple Perspectives and Strategies for Quality Care of Older Adults. Semin Speech Lang. 2019 Jun;40(3):227-242. doi: 10.1055/s-0039-1688837. Epub 2019 Jun 3.

    PubMed 31158906
  • Park JS, Lee SH, Jung SH, Choi JB, Jung YJ. Tongue strengthening exercise is effective in improving the oropharyngeal muscles associated with swallowing in community-dwelling older adults in South Korea: A randomized trial. Medicine (Baltimore). 2019 Oct;98(40):e17304. doi: 10.1097/MD.0000000000017304.

    PubMed 31577721
  • Sagawa K, Furuya H, Ohara Y, Yoshida M, Hirano H, Iijima K, Kikutani T. Tongue function is important for masticatory performance in the healthy elderly: a cross-sectional survey of community-dwelling elderly. J Prosthodont Res. 2019 Jan;63(1):31-34. doi: 10.1016/j.jpor.2018.03.006. Epub 2018 Sep 7.

    PubMed 30197226
  • Van den Steen L, Schellen C, Verstraelen K, Beeckman AS, Vanderwegen J, De Bodt M, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Specificity of Bulb Position and Detraining Effects. Dysphagia. 2018 Jun;33(3):337-344. doi: 10.1007/s00455-017-9858-3. Epub 2017 Oct 19.

    PubMed 29052051
  • Van den Steen L, Vanderwegen J, Guns C, Elen R, De Bodt M, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial. Dysphagia. 2019 Jun;34(3):315-324. doi: 10.1007/s00455-018-9940-5. Epub 2018 Sep 12.

    PubMed 30209561
  • Van den Steen L, De Bodt M, Guns C, Elen R, Vanderwegen J, Van Nuffelen G. Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency - A Randomized Trial. Folia Phoniatr Logop. 2021;73(2):109-116. doi: 10.1159/000505153. Epub 2020 Feb 5.

    PubMed 32023617
  • Yoshimi K, Nakagawa K, Hara K, Yamaguchi K, Nakane A, Kubota K, Furuya J, Tohara H. Relationship between tongue pressure and back muscle strength in healthy elderly individuals. Aging Clin Exp Res. 2020 Dec;32(12):2549-2555. doi: 10.1007/s40520-020-01484-5. Epub 2020 Jan 31.

    PubMed 32006384
  • Zhang H, Guo F, Tang M, Dai H, Sheng J, Chen L, Liu S, Wang J, Shi Y, Ye C, Hou G, Wu X, Jin X, Chen K. Association between Skeletal Muscle Strength and Dysphagia among Chinese Community-Dwelling Elderly Adults. J Nutr Health Aging. 2020;24(6):642-649. doi: 10.1007/s12603-020-1379-3.

    PubMed 32510118

Questions about this trial

What is this clinical trial studying?

A study testing IOPI Therapy and Tongue Depressor Traditional Intervention in people with Dysphagia, run by Khoo Teck Puat Hospital.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 12 Oct 2021. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of increase in tongue strength (time frame: 5 intervention days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05074784, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Oct 2021.

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