Effectiveness of Expiratory Muscle Strength Training on Dysphagia Risk in Pre-Frail Elderly

Authors

  • Ida Ayu Putu Diana Janaki Sari Departemen Ilmu Kedokteran Fisik dan Rehabilitasi, Fakultas Kedokteran, Universitas Diponegoro
  • Erna Setiawati Departemen Ilmu Kedokteran Fisik dan Rehabilitasi, Fakultas Kedokteran, Universitas Diponegoro
  • Lisa Nurhasanah Departemen Ilmu Kedokteran Fisik dan Rehabilitasi, Fakultas Kedokteran, Universitas Diponegoro

DOI:

https://doi.org/10.33533/jpm.v17i2.6653

Keywords:

Dysphagia, Elderly, Expiratory muscle training, Pre-frailty

Abstract

Pre-frail dan frail elderly are susceptible to dysphagia. Dysphagia leads to vulnerability to aspiration pneumonia, undernutrition, and dehydration, which negatively affect physical condition and quality of life. Expiratory muscle strength training (EMST) is an intervention for dysphagia. However, the effects of EMST on pre-frail elderly are still unclear. This  study  aimed  to investigate effectiveness of expiratory muscle training on dysphagia risk of pre-frail elderly. The study design was a randomized clinical trial. Twenty-four pre-frail elderly at Rindang Asih I and II Elderly Social Service Institution randomly assigned into experimental group (n=12) or control group (n=12). The experimental group received expiratory muscle training using PEP Threshold® device 5 times per week for 6 weeks. Both of group also received typical multicomponent exercise for elderly 3 times per week for 6 weeks. Outcome measure was risk of dysphagia assessed using Swallowing Disturbance Questionnaire (SDQ). The intra-group analysis showed significant differences pre- and post-intervention in experimental group but not in control group (p<0,001 and p=0,107, respectively). Inter-group analysis showed significant differences between experimental and control group post-intervention (p<0,001). This finding indicate that expiratory muscle training effective on reducing dysphagia risk in pre-frail elderly.

References

[1]. Bahat G, Yilmaz O, Durmazoglu S, Kilic C, Tascioglu C, Karan MA. Association between Dysphagia and Frailty in Community Dwelling Older Adults. Journal of Nutrition, Health and Aging. 2019 Jun 1;23(6):571–7. doi: 10.1007/s12603-019-1191-0.

[2]. Wang T, Zhao Y, Guo A. Association of swallowing problems with frailty in Chinese hospitalized older patients. Int J Nurs Sci. 2020 Oct 10;7(4):408–12. doi: 10.1016/j.ijnss.2020.09.005.

[3]. Smithard DG, Shazra M, Hansjee D, Swaine I. Frailty, Swallowing and Dysphagia. Curr Phys Med Rehabil Rep. 2018 Aug 1;6(3):192–6. doi: 10.1007/s40141-018-0194-9.

[4]. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in Older Adults: Evidence for a Phenotype. J Gerontol. 2001;56(3):146–56. doi: 10.1093/gerona/56.3.m146.

[5]. Serra-Prat M, Sist X, Domenich R, Jurado L, Saiz A, Roces A, et al. Effectiveness of an intervention to prevent frailty in pre-frail community-dwelling older people consulting in primary care: A randomised controlled trial. Age Ageing. 2017 May 1;46(3):401–7. doi: 10.1093/ageing/afw242.

[6]. Smithard DG. Dysphagia: A Geriatric Giant? Med Clin Rev. 2016;2(5):1–7. doi: 10.21767/2471-299X.1000014.

[7]. Gené Huguet L, Navarro González M, Kostov B, Ortega Carmona M, Colungo Francia C, Carpallo Nieto M, et al. Pre Frail 80: Multifactorial Intervention to Prevent Progression of Pre-Frailty to Frailty in the Elderly. J Nutr Health Aging. 2018;22(10):1266–74. doi: 10.1007/s12603-018-1089-2.

[8]. Park JS, Oh DH, Chang MY. Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial. Gerodontology. 2017 Mar 1;34(1):121–8. doi: 10.1111/ger.12234

[9]. Eom MJ, Chang MY, Oh DH, Kim HD, Han NM, Park JS. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. NeuroRehabilitation. 2017;41(4):747–52. doi: 10.3233/NRE-172192.

[10]. Claus I, Muhle P, Czechowski J, Ahring S, Labeit B, Suntrup-Krueger S, et al. Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson’s Disease. Movement Disorders. 2021 Aug 1;36(8):1815–24. doi: 10.1002/mds.28552.

[11]. Maki N, Sakamoto H, Takata Y, Kobayashi N, Kikuchi S, Goto Y, et al. Effect of respiratory rehabilitation for frail older patients with musculoskeletal disorders: A randomized controlled trial. J Rehabil Med. 2018;50(10):908–13. doi: 10.2340/16501977-2490.

[12]. Cohen JT, Manor Y. Swallowing disturbance questionnaire for detecting dysphagia. Laryngoscope. 2011 Jul;121(7):1383–7. doi: 10.1002/lary.21839

[13]. Manor Y, Giladi N, Cohen A, Fliss DM, Cohen JT. Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson’s disease. Movement Disorders. 2007 Oct 15;22(13):1917–21. doi: 10.1002/mds.21625.

[14]. González-Fernández M, Humbert I, Winegrad H, Cappola AR, Fried LP. Dysphagia in old-old women: Prevalence as determined according to self-report and the 3-ounce water swallowing test. J Am Geriatr Soc. 2014;62(4):716–20. doi: 10.1111/jgs.12745.

[15]. Wang Z, Wang Z, Fang Q, Li H, Zhang L, Liu X. Effect of expiratory muscle strength training on swallowing and cough functions in patients with neurological diseases. Am J Phys Med Rehabil. 2019 Dec 1;98(12):1060–6. doi: 10.1097/PHM.0000000000001242.

[16]. Tout R, Tayara L, Halimi M. The effects of respiratory muscle training on improvement of the internal and external thoraco-pulmonary respiratory mechanism in COPD patients. Ann Phys Rehabil Med. 2013 Apr;56(3):193–211. doi: 10.1016/j.rehab.2013.01.008.

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Published

2023-11-27

How to Cite

Ida Ayu Putu Diana Janaki Sari, Erna Setiawati, & Lisa Nurhasanah. (2023). Effectiveness of Expiratory Muscle Strength Training on Dysphagia Risk in Pre-Frail Elderly. Jurnal Profesi Medika : Jurnal Kedokteran Dan Kesehatan, 17(2), 187–191. https://doi.org/10.33533/jpm.v17i2.6653