Discussion
radiation-induced dysphagia, HNC
SWALLOWING DIFFICULTIES, POSITIVE
The purpose of this randomized controlled study was to evaluate effect of HLE on patients’ perception of general and dysphagia-specific HRQL over time in patients with radiation-induced dysphagia. However, results did not reveal any convincing improvements in patients’ perception of general and dysphagia-specific HRQL in the intervention group. The current study makes an important contribution to the research field as it is, to our knowledge, the only larger randomized controlled study evaluating effect of the HLE on patients’ perception of swallowing and HRQL over a relatively long period of time.Positive treatment results of HLE following HNC have been seen in other research studies [If the HLE had been effective in improving swallowing function, the intervention group should have reported better results than the control group in at least some of the included domains of the HRQL instruments. In other studies evaluating preventive swallowing exercises for HNC patients, MDADI has, on the one hand, detected improvements by intervention in all domains and in total score [The intervention group did report their function as improved in swallowing on QLQ-H&N35 and for some of the domains of the MDADI after 8 weeks of HLE. This indicates that the participants felt more confident in spite of their swallowing difficulties, and that the difficulties posed less trouble in their daily lives. After 12 months, this positive trend had subsided. As previous studies within the research group found no improvement of the HLE in objectively measured swallowing function [It is essential to measure adherence to exercise when evaluating effect of an intervention. Although the HLE is a strenuous exercise to perform, and high intensity is a factor known to influence compliance negatively, adherence in the present study was high throughout the 12 months [We know from previous studies done on the present cohort that 33% of patients presented with PAS of ≥ 5 on FEES [The study participants in the present study knew which group they were allocated to, which may be considered a limitation. The study is strengthened by the fact that the adherence to exercise was high throughout the study. Furthermore, comparison of sociodemographic data as well as nutritional and swallowing variables revealed no statistically significant differences between the intervention and control group at either study start or at 12 months.