JMIR Form Res. 2026 Nov 13;10:e79146. doi: 10.2196/79146.
ABSTRACT
BACKGROUND: Community-acquired pneumonia in frail older people requiring hospital admission is considered to be commonly associated with swallowing difficulties (dysphagia). A rehabilitation program (chin tuck against resistance [CTAR]) targeting the anterior neck musculature involved in laryngeal movement can improve swallowing safety. We have developed a swallowing exercise rehabilitation intervention (CTAR-SwiFt [Chin Tuck Against Resistance Exercise With Feedback to Improve Swallowing, Eating, and Drinking in Frail Older People Admitted to Hospital With Pneumonia]) by adapting a previously established swallowing exercise. The CTAR-SwiFt intervention consists of a feedback-enabled exercise ball that can be squeezed under the chin, with real-time feedback provided via a mobile app.
OBJECTIVE: This study aimed to assess the usability of the CTAR-SwiFt intervention and the feasibility of recruiting participants to take part in a larger-scale multicenter randomized controlled trial.
METHODS: We recruited participants aged 75 years and older who were admitted with a diagnosis of pneumonia to the acute frailty wards at 2 participating hospitals in the United Kingdom. Patients had to be medically stable. Study participants were randomized to 1 of 3 groups: standard care (control), low intensity (once daily), or high intensity (twice daily) CTAR-SwiFt exercises. The intervention period lasted for 12 weeks; the final follow-up assessment was conducted at 24 weeks. Feasibility outcomes were assessed descriptively and included participant recruitment rate, retention, compliance with the exercise regimen, and adverse incidents. The Eating Assessment Tool-10 (EAT-10) and 4 Question Test (4QT) measures were used to screen for oropharyngeal dysphagia. Additionally, we assessed the usability and acceptability of the intervention device and performance of different clinical outcome measures (chin tuck strength, Functional Oral Intake Scale [FOIS], Quality of Life in Swallowing Disorders [SWAL-QOL] questionnaire, EuroQol 5-Dimension 3-Level [EQ-5D-3L] questionnaire, and swallow speed).
RESULTS: A total of 24 participants were recruited, and 21 were randomized at the rate of 0.91 recruits per month (95% CI 0.59-1.0). Of those approached, 32% (24/75) were willing to take part, and of those randomized, 52% (11/21) completed the study. The major reason for failing to complete the study was medical, with people becoming unwell or being readmitted to hospital. The outcome measures assessed suggested that there was an improvement in the EAT-10 and 4QT and a minimal impact on FOIS. Quality of life as measured by the EQ-5D-3L showed improvement with time. The low-intensity intervention demonstrated the best improvement. Participants were able to partake in the CTAR-SwiFt exercises. There was an improvement in the consistency of ball squeeze over the course of the intervention and an increase in maximum chin tuck strength by a mean of 0.8 (SD 0.9) kgf.
CONCLUSIONS: The literature supports the benefit of CTAR in improving swallowing in community-dwelling older adults. Our study has demonstrated that older, frail adults are able to perform CTAR and could use the ExerPhager. A future study should investigate the benefits of CTAR-SwiFt in community-dwelling older, frail adults after pneumonia.
TRIAL REGISTRATION: ISRCTN Registry ISRCTN12813363; https://www.isrctn.com/ISRCTN12813363.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s40814-022-01060-w.
PMID:43025847 | DOI:10.2196/79146
