Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 6, 2020
Date Accepted: Oct 3, 2020
Date Submitted to PubMed: Oct 5, 2020
Implementation of the Home-Based mHealth App Intervention Program with Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Experimental Pilot Study
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 may have tremendous potential in advancing healthcare in the digital age to be more efficient for people with limited resources, especially for 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 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 was used for three therapy maneuvers: effortful prolonged swallowing (EPS), effortful pitch glide (EPG), and effortful tongue rotation (ETR). 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:
Since swallowing tongue pressure is closely related with dysphagia symptoms, the combined methods of EPS, EPG, and ETR training have positively affected swallowing tongue pressure with their use as indirect and direct exercises. The mHealth app is a promising platform which can be used to deliver effective therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size as well as long-term effects of the intervention program, further studies are warranted.
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