Development of an Intervention for Improving Ingestion in Elders with Oropharyngeal Dysphagia

To describe the development of a dysphagia management intervention for elders with sarcopenic oropharyngeal dysphagia (OD). The intervention development was guided by the UK Medical Research Council framework for developing and evaluating complex interventions. The steps included identification of the problem theory, the evidence base, the theory underpinning the intervention, the expected change mechanisms and a first draft of an intervention manual. This involved literature reviews and involvement of stakeholders, experts, and members of the target group. A manualized client-centered and activity-based intervention that integrates functional resistance training of skills essential for a safe and efficient swallowing during ingestion of daily meals was developed for elders with sarcopenic OD. The intervention is informed by occupational therapy theory, self-determination theory, motor learning and affordance theory, and international standards for OD diets. The development steps resulted in a multicomponent intervention ready for feasibility testing before examining intervention efficacy.

本研究旨在阐述针对肌少症性口咽吞咽障碍（sarcopenic oropharyngeal dysphagia, OD）老年人群的吞咽障碍管理干预方案的开发全过程。本次干预方案的开发遵循英国医学研究委员会（UK Medical Research Council, MRC）制定的复杂干预方案开发与评估框架，开发流程涵盖问题理论梳理、证据基础构建、干预方案支撑理论明确、预期作用机制解析以及干预手册初稿撰写等环节，工作内容包含系统文献综述，以及利益相关方、领域专家与目标人群代表的参与。针对肌少症性OD老年人群，本研究开发了一套手册化、以服务对象为中心且基于活动的干预方案，该方案整合了日常进食过程中保障安全高效吞咽所需技能的功能性抗阻训练内容。该干预方案的设计依据作业治疗理论、自我决定理论、运动学习理论与可供性理论，同时遵循口咽吞咽障碍膳食的国际标准。本次开发流程最终形成一套多组分干预方案，可在开展干预疗效评估前先行开展可行性测试。