Adherence to Home-Based Swallowing Therapy

Written by Gabi Constantinescu

Gabi is an Adjunct Assistant Professor in the Department of Communication Sciences and Disorders at the University of Alberta. She is also the CPO for True Angle. Her doctoral work directly influenced the design and development of the Mobili-T®, a mobile therapy system for swallowing exercise.

December 10, 2021

In this article, we sent patients home with our Minimum Viable Product (MVP) of Mobili-T. We were interested in what adherence to home-based dysphagia exercise was when using a mobile health system that also provides biofeedback. We found that adherence over a 6 week period remained high, from an average of 84% of all recommended reps being completed in Week 1 to 72% in Week 6. We also found that dysphagia-specific quality of life improved following this 6-week treatment program.



A large knowledge gap related to dysphagia treatment adherence was identified by a recent systematic review: Few existing studies report on adherence, and current adherence tracking relies heavily on patient self-report. This study aimed to report weekly adherence and dysphagia-specific quality of life following home-based swallowing therapy in head and neck cancer (HNC).


This was a quasi-experimental pretest–posttest design. Patients who were at least 3 months post–HNC treatment were enrolled in swallowing therapy using a mobile health (mHealth) swallowing system equipped with surface electromyography (sEMG) biofeedback. Participants completed a home dysphagia exercise program across 6 weeks, with a target of 72 swallows per day split between three different exercise types. Adherence was calculated as percent trials completed of trials prescribed. The M. D. Anderson Dysphagia Inventory (MDADI) was administered before and after therapy.


Twenty participants (75% male), with an average age of 61.9 years (SD = 8.5), completed the study. The majority had surgery ± adjuvant (chemo)radiation therapy for oral (10%), oropharyngeal (80%), or other (10%) cancers. Using an intention-to-treat analysis, adherence to the exercise regimen remained high from 84% in Week 1 to 72% in Week 6. Radiation therapy, time since cancer treatment, medical difficulties, and technical difficulties were all found to be predictive of poorer adherence at Week 6. A statistically significant improvement was found for composite, emotional, and physical MDADI subscales.


When using an mHealth system with sEMG biofeedback, adherence rates to home-based swallowing exercise remained at or above 72% over a 6-week treatment period. Dysphagia-specific quality of life improved following this 6-week treatment program.

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