Pharyngociseは筋肉と嚥下機能維持に有効

Pharyngociseは頭頚部がんの化学放射線療法中の筋肉と嚥下機能の維持に有効というRCTを紹介します。

Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. "Pharyngocise": randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):210-9.

リサーチクエスチョンは以下の通りです。

P：頭頚部がんで化学放射線療法中の患者に
I：Pharyngociseを行うと
C：通常のケアもしくは偽の嚥下介入と比較して
O：嚥下の筋肉量を維持できるか
D：ランダム化比較試験

です。

結果ですが、介入群でオトガイ舌筋、舌骨舌筋、顎舌骨筋の筋肉量低下が有意に少なかったです。嚥下機能も介入群のほうがより保たれていました。これよりPharyngociseは頭頚部がんの化学放射線療法中の筋肉と嚥下機能の維持に有効という結論です。

RCTで有効性が検証されている嚥下訓練は少ないので、意味のある論文だと思います。まだ抄録しか読めていないので、後でPharyngociseの内容を調べてみます。

Abstract

PURPOSE:

Dysphagia after chemoradiotherapy is common. The present randomized clinical trial studied the effectiveness of preventative behavioral intervention for dysphagia compared with the "usual care."

METHODS AND MATERIALS:

A total of 58 head-and-neck cancer patients treated with chemoradiotherapy were randomly assigned to usual care, sham swallowing intervention, or active swallowing exercises (pharyngocise). The intervention arms were treated daily during chemoradiotherapy. The primary outcome measure was muscle size and composition (determined by T(2)-weighted magnetic resonance imaging). The secondary outcomes included functional swallowing ability, dietary intake, chemosensory function, salivation, nutritional status, and the occurrence of dysphagia-related complications.

RESULTS:

The swallowing musculature (genioglossus, hyoglossuss, and mylohyoid) demonstrated less structural deterioration in the active treatment arm. The functional swallowing, mouth opening, chemosensory acuity, and salivation rate deteriorated less in the pharyngocise group.

CONCLUSION:

Patients completing a program of swallowing exercises during cancer treatment demonstrated superior muscle maintenance and functional swallowing ability.