Dysphagia, Heart Transplant Recipients
Conditions
Keywords
dysphagia, deglutition, deglutition disorders, swallowing, breathing, cough, swallowing disorders, heart transplant recipients, respiratory muscle strength training
Brief summary
This research study is investigating whether completing breathing exercises before surgery helps heart transplant patients recover after surgery. Previous studies have shown that breathing exercises can improve breathing, cough, and swallow function in patients with other diseases/conditions. The current study will investigate the impact of a preoperative respiratory muscle strength training program on breathing and cough function, swallow function, patient-reported eating and swallowing fatigue, and health outcomes in individuals undergoing heart transplantation. Participants will: * undergo tests of breathing, cough, and swallow function * complete questionnaires about the treatment, their swallow function * complete breathing exercises daily
Detailed description
This study will involve three in-person research evaluations to our lab or in the hospital that will last 45 minutes- 1 hour and will consist of a screening, breathing and cough testing, swallow function testing, and completion of questionnaires. Following the initial research evaluation, individuals will complete daily exercises of active or sham respiratory muscle strength training for several weeks with one telehealth or in-person session per week. The exercises will take 10-15 minutes to complete, and individuals will fill out training logs daily. Prior to transplantation and after completion of the breathing exercises, individuals will undergo a second research evaluation. Then, following surgery, individuals will undergo a third research evaluation and outcomes will be tracked via the electronic health records system.
Interventions
DEVICEActive respiratory muscle strength training
Devices will be set to 60% of participants' maximum expiratory pressure and maximum inspiratory pressure. Participants will complete training 7 days per week by performing 5 sets of 5 repetitions for both expiratory and inspiratory muscle strength training (a total of 50 repetitions).
Springs will be removed from devices to ensure training is done without resistance. Participants will complete training 7 days per week by performing 5 sets of 5 repetitions for both expiratory and inspiratory sham muscle strength training (a total of 50 repetitions).
Sponsors
Vanderbilt University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Participants will be assigned to active or sham respiratory strength training using block randomization and will be blinded to their assigned treatment. Researchers performing evaluations and data analysis will also be blinded.
Intervention model description
randomized, sham controlled clinical trial
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
1. Adult (18-90 years old) 2. Not pregnant 3. Undergoing evaluation or actively waitlisted for heart transplantation at VUMC with a waitlist status of 1-6 4. Have a computer, tablet or electronic device with a stable internet connection for telehealth sessions (outpatient) 5. Be willing to undergo testing procedures and complete the exercise training program.
Exclusion criteria
1. Individual \<18 years old, \>90 years old 2. Pregnant 3. No access to a computer, tablet or electronic device with a stable internet connection for telehealth sessions 4. Unwilling or unable to undergo testing procedures and complete the exercise training program.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in maximum expiratory pressure between pre and post respiratory strength training | baseline, post-intervention/pre-surgery (an average of 2-6 weeks after baseline) | A measure of respiratory strength while breathing out |
| Change in maximum inspiratory pressure between pre and post respiratory strength training | baseline, post-intervention/pre-surgery (an average of 2-6 weeks after baseline) | A measure of respiratory strength while breathing in |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in cough peak expiratory flow between pre and post respiratory strength training | baseline, post-intervention/pre-surgery (an average of 2-6 weeks after baseline) | A measure of cough strength |
| Patient-reported treatment burden | post-intervention/pre-surgery (an average of 2-6 weeks after baseline) | Patients will complete the exercise therapy burden questionnaire (ETBQ). Scores on the ETBQ range from 0-100 with higher scores indicating greater burden. |
| Patient reported swallow function | pre-surgery (baseline), post-surgery | Patients will complete the swallowing and eating related fatigue (SERF) questionnaire. Scores on the SERF range from 0-48 with higher scores indicating greater impairment. |
| Change in penetration-aspiration scale scores between before and after surgery | pre-surgery (baseline), post-surgery | The penetration aspiration scale is a validated 8-point ordinal rating scale that measures the depth of airway invasion and the patient's response during swallowing. Scores range from 1 to 8 with a score of 1 indicating a safe swallow (best score) and 8 indicating silent aspiration (worst score). |
| Change in clinical frailty scale score | baseline, post-intervention/pre-surgery (an average of 2-6 weeks after baseline) | The Clinical Frailty Scale (CFS) is a measure of physical function. Scores on the CFS range from 1-9 with higher scores indicating greater impairment. |
Countries
United States
Contacts
CONTACTCara Donohue, Ph.D.
PRINCIPAL_INVESTIGATORCara Donohue, Ph.D.
Vanderbilt University Medical Center
Outcome results
None listed