Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial
Background Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter...
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| Veröffentlicht in: | Dysphagia 2023-06, Vol.38 (3), p.886-895 |
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| creator | Baudelet, Margot Duprez, Fréderic Van den Steen, Leen Nuyts, Sandra Nevens, Daan Goeleven, Ann Vandenbruaene, Caroline Massonet, Hanne Vergauwen, Alice Bollen, Heleen Deschuymer, Sarah Wouters, Kristien Peeters, Marc Van Laer, Carl Mariën, Steven Van den Brekel, Michiel van der Molen, Lisette Vauterin, Tom van Dinther, Joost Verstraete, Hilde Hutsebaut, Isabel Meersschout, Sabine Vanderveken, Olivier De Bodt, Marc Van Nuffelen, Gwen |
| description | Background
Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence.
Methods
A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group;
n
= 49), app-supported (app group;
n
= 49) or therapist-supported (therapist group;
n
= 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction.
Results
Adherence and evolution of adherence over time was significantly different between the three groups (
p
|
| doi_str_mv | 10.1007/s00455-022-10513-6 |
| format | Article |
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Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence.
Methods
A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group;
n
= 49), app-supported (app group;
n
= 49) or therapist-supported (therapist group;
n
= 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction.
Results
Adherence and evolution of adherence over time was significantly different between the three groups (
p
< .001). Adherence rates decreased in all three groups during the 4 training weeks (
p
< .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates.
Conclusions
PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population.
Trial Registration
Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered,
https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search
.]]></description><identifier>ISSN: 0179-051X</identifier><identifier>EISSN: 1432-0460</identifier><identifier>DOI: 10.1007/s00455-022-10513-6</identifier><identifier>PMID: 36121560</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Analysis ; Cancer ; Chemoradiotherapy - adverse effects ; Chemotherapy ; Clinical trials ; Deglutition ; Deglutition Disorders - etiology ; Deglutition Disorders - prevention & control ; Dysphagia ; Exercise Therapy ; Gastroenterology ; Head & neck cancer ; Head and Neck Neoplasms - radiotherapy ; Hepatology ; Humans ; Imaging ; Language ; Medicine ; Medicine & Public Health ; Original ; Original Article ; Oropharyngeal cancer ; Oropharyngeal Neoplasms - radiotherapy ; Otorhinolaryngology ; Paper industry ; Radiation therapy ; Radiology ; Radiotherapy ; Speech ; Speech therapists ; Statistical analysis ; Swallowing ; Telemedicine ; Therapists ; Throat cancer</subject><ispartof>Dysphagia, 2023-06, Vol.38 (3), p.886-895</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>COPYRIGHT 2023 Springer</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c541t-2598924814276b0ed40a0e06bd2771b0b04779a9ed726b1650998b268e75b1293</citedby><cites>FETCH-LOGICAL-c541t-2598924814276b0ed40a0e06bd2771b0b04779a9ed726b1650998b268e75b1293</cites><orcidid>0000-0003-0431-5854</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00455-022-10513-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00455-022-10513-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36121560$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baudelet, Margot</creatorcontrib><creatorcontrib>Duprez, Fréderic</creatorcontrib><creatorcontrib>Van den Steen, Leen</creatorcontrib><creatorcontrib>Nuyts, Sandra</creatorcontrib><creatorcontrib>Nevens, Daan</creatorcontrib><creatorcontrib>Goeleven, Ann</creatorcontrib><creatorcontrib>Vandenbruaene, Caroline</creatorcontrib><creatorcontrib>Massonet, Hanne</creatorcontrib><creatorcontrib>Vergauwen, Alice</creatorcontrib><creatorcontrib>Bollen, Heleen</creatorcontrib><creatorcontrib>Deschuymer, Sarah</creatorcontrib><creatorcontrib>Wouters, Kristien</creatorcontrib><creatorcontrib>Peeters, Marc</creatorcontrib><creatorcontrib>Van Laer, Carl</creatorcontrib><creatorcontrib>Mariën, Steven</creatorcontrib><creatorcontrib>Van den Brekel, Michiel</creatorcontrib><creatorcontrib>van der Molen, Lisette</creatorcontrib><creatorcontrib>Vauterin, Tom</creatorcontrib><creatorcontrib>van Dinther, Joost</creatorcontrib><creatorcontrib>Verstraete, Hilde</creatorcontrib><creatorcontrib>Hutsebaut, Isabel</creatorcontrib><creatorcontrib>Meersschout, Sabine</creatorcontrib><creatorcontrib>Vanderveken, Olivier</creatorcontrib><creatorcontrib>De Bodt, Marc</creatorcontrib><creatorcontrib>Van Nuffelen, Gwen</creatorcontrib><creatorcontrib>members of the Belgian PRESTO-group</creatorcontrib><title>Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial</title><title>Dysphagia</title><addtitle>Dysphagia</addtitle><addtitle>Dysphagia</addtitle><description><![CDATA[Background
Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence.
Methods
A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group;
n
= 49), app-supported (app group;
n
= 49) or therapist-supported (therapist group;
n
= 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction.
Results
Adherence and evolution of adherence over time was significantly different between the three groups (
p
< .001). Adherence rates decreased in all three groups during the 4 training weeks (
p
< .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates.
Conclusions
PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population.
Trial Registration
Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered,
https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search
.]]></description><subject>Analysis</subject><subject>Cancer</subject><subject>Chemoradiotherapy - adverse effects</subject><subject>Chemotherapy</subject><subject>Clinical trials</subject><subject>Deglutition</subject><subject>Deglutition Disorders - etiology</subject><subject>Deglutition Disorders - prevention & control</subject><subject>Dysphagia</subject><subject>Exercise Therapy</subject><subject>Gastroenterology</subject><subject>Head & neck cancer</subject><subject>Head and Neck Neoplasms - radiotherapy</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Imaging</subject><subject>Language</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Original Article</subject><subject>Oropharyngeal cancer</subject><subject>Oropharyngeal Neoplasms - radiotherapy</subject><subject>Otorhinolaryngology</subject><subject>Paper industry</subject><subject>Radiation therapy</subject><subject>Radiology</subject><subject>Radiotherapy</subject><subject>Speech</subject><subject>Speech therapists</subject><subject>Statistical analysis</subject><subject>Swallowing</subject><subject>Telemedicine</subject><subject>Therapists</subject><subject>Throat 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den Steen, Leen</creator><creator>Nuyts, Sandra</creator><creator>Nevens, Daan</creator><creator>Goeleven, Ann</creator><creator>Vandenbruaene, Caroline</creator><creator>Massonet, Hanne</creator><creator>Vergauwen, Alice</creator><creator>Bollen, Heleen</creator><creator>Deschuymer, Sarah</creator><creator>Wouters, Kristien</creator><creator>Peeters, Marc</creator><creator>Van Laer, Carl</creator><creator>Mariën, Steven</creator><creator>Van den Brekel, Michiel</creator><creator>van der Molen, Lisette</creator><creator>Vauterin, Tom</creator><creator>van Dinther, Joost</creator><creator>Verstraete, Hilde</creator><creator>Hutsebaut, Isabel</creator><creator>Meersschout, Sabine</creator><creator>Vanderveken, Olivier</creator><creator>De Bodt, Marc</creator><creator>Van Nuffelen, Gwen</creator><general>Springer US</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-0431-5854</orcidid></search><sort><creationdate>20230601</creationdate><title>Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial</title><author>Baudelet, Margot ; Duprez, Fréderic ; Van den Steen, Leen ; Nuyts, Sandra ; Nevens, Daan ; Goeleven, Ann ; Vandenbruaene, Caroline ; Massonet, Hanne ; Vergauwen, Alice ; Bollen, Heleen ; Deschuymer, Sarah ; Wouters, Kristien ; Peeters, Marc ; Van Laer, Carl ; Mariën, Steven ; Van den Brekel, Michiel ; van der Molen, Lisette ; Vauterin, Tom ; van Dinther, Joost ; Verstraete, Hilde ; Hutsebaut, Isabel ; Meersschout, Sabine ; Vanderveken, Olivier ; De Bodt, Marc ; Van Nuffelen, Gwen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c541t-2598924814276b0ed40a0e06bd2771b0b04779a9ed726b1650998b268e75b1293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Analysis</topic><topic>Cancer</topic><topic>Chemoradiotherapy - adverse effects</topic><topic>Chemotherapy</topic><topic>Clinical trials</topic><topic>Deglutition</topic><topic>Deglutition Disorders - etiology</topic><topic>Deglutition Disorders - prevention & control</topic><topic>Dysphagia</topic><topic>Exercise Therapy</topic><topic>Gastroenterology</topic><topic>Head & neck cancer</topic><topic>Head and Neck Neoplasms - radiotherapy</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Imaging</topic><topic>Language</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original</topic><topic>Original Article</topic><topic>Oropharyngeal cancer</topic><topic>Oropharyngeal Neoplasms - radiotherapy</topic><topic>Otorhinolaryngology</topic><topic>Paper industry</topic><topic>Radiation therapy</topic><topic>Radiology</topic><topic>Radiotherapy</topic><topic>Speech</topic><topic>Speech therapists</topic><topic>Statistical analysis</topic><topic>Swallowing</topic><topic>Telemedicine</topic><topic>Therapists</topic><topic>Throat cancer</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baudelet, Margot</creatorcontrib><creatorcontrib>Duprez, Fréderic</creatorcontrib><creatorcontrib>Van den Steen, Leen</creatorcontrib><creatorcontrib>Nuyts, Sandra</creatorcontrib><creatorcontrib>Nevens, Daan</creatorcontrib><creatorcontrib>Goeleven, Ann</creatorcontrib><creatorcontrib>Vandenbruaene, Caroline</creatorcontrib><creatorcontrib>Massonet, Hanne</creatorcontrib><creatorcontrib>Vergauwen, Alice</creatorcontrib><creatorcontrib>Bollen, Heleen</creatorcontrib><creatorcontrib>Deschuymer, Sarah</creatorcontrib><creatorcontrib>Wouters, Kristien</creatorcontrib><creatorcontrib>Peeters, Marc</creatorcontrib><creatorcontrib>Van Laer, Carl</creatorcontrib><creatorcontrib>Mariën, Steven</creatorcontrib><creatorcontrib>Van den Brekel, Michiel</creatorcontrib><creatorcontrib>van der Molen, Lisette</creatorcontrib><creatorcontrib>Vauterin, Tom</creatorcontrib><creatorcontrib>van Dinther, Joost</creatorcontrib><creatorcontrib>Verstraete, Hilde</creatorcontrib><creatorcontrib>Hutsebaut, Isabel</creatorcontrib><creatorcontrib>Meersschout, Sabine</creatorcontrib><creatorcontrib>Vanderveken, Olivier</creatorcontrib><creatorcontrib>De Bodt, Marc</creatorcontrib><creatorcontrib>Van Nuffelen, Gwen</creatorcontrib><creatorcontrib>members of the Belgian PRESTO-group</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Dysphagia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baudelet, Margot</au><au>Duprez, Fréderic</au><au>Van den Steen, Leen</au><au>Nuyts, Sandra</au><au>Nevens, Daan</au><au>Goeleven, Ann</au><au>Vandenbruaene, Caroline</au><au>Massonet, Hanne</au><au>Vergauwen, Alice</au><au>Bollen, Heleen</au><au>Deschuymer, Sarah</au><au>Wouters, Kristien</au><au>Peeters, Marc</au><au>Van Laer, Carl</au><au>Mariën, Steven</au><au>Van den Brekel, Michiel</au><au>van der Molen, Lisette</au><au>Vauterin, Tom</au><au>van Dinther, Joost</au><au>Verstraete, Hilde</au><au>Hutsebaut, Isabel</au><au>Meersschout, Sabine</au><au>Vanderveken, Olivier</au><au>De Bodt, Marc</au><au>Van Nuffelen, Gwen</au><aucorp>members of the Belgian PRESTO-group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial</atitle><jtitle>Dysphagia</jtitle><stitle>Dysphagia</stitle><addtitle>Dysphagia</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>38</volume><issue>3</issue><spage>886</spage><epage>895</epage><pages>886-895</pages><issn>0179-051X</issn><eissn>1432-0460</eissn><abstract><![CDATA[Background
Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence.
Methods
A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group;
n
= 49), app-supported (app group;
n
= 49) or therapist-supported (therapist group;
n
= 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction.
Results
Adherence and evolution of adherence over time was significantly different between the three groups (
p
< .001). Adherence rates decreased in all three groups during the 4 training weeks (
p
< .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates.
Conclusions
PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population.
Trial Registration
Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered,
https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search
.]]></abstract><cop>New York</cop><pub>Springer US</pub><pmid>36121560</pmid><doi>10.1007/s00455-022-10513-6</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-0431-5854</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0179-051X |
| ispartof | Dysphagia, 2023-06, Vol.38 (3), p.886-895 |
| issn | 0179-051X 1432-0460 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9484351 |
| source | MEDLINE; SpringerNature Complete Journals |
| subjects | Analysis Cancer Chemoradiotherapy - adverse effects Chemotherapy Clinical trials Deglutition Deglutition Disorders - etiology Deglutition Disorders - prevention & control Dysphagia Exercise Therapy Gastroenterology Head & neck cancer Head and Neck Neoplasms - radiotherapy Hepatology Humans Imaging Language Medicine Medicine & Public Health Original Original Article Oropharyngeal cancer Oropharyngeal Neoplasms - radiotherapy Otorhinolaryngology Paper industry Radiation therapy Radiology Radiotherapy Speech Speech therapists Statistical analysis Swallowing Telemedicine Therapists Throat cancer |
| title | Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T07%3A38%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Increasing%20Adherence%20to%20Prophylactic%20Swallowing%20Exercises%20During%20Head%20and%20Neck%20Radiotherapy:%20The%20Multicenter,%20Randomized%20Controlled%20PRESTO-Trial&rft.jtitle=Dysphagia&rft.au=Baudelet,%20Margot&rft.aucorp=members%20of%20the%20Belgian%20PRESTO-group&rft.date=2023-06-01&rft.volume=38&rft.issue=3&rft.spage=886&rft.epage=895&rft.pages=886-895&rft.issn=0179-051X&rft.eissn=1432-0460&rft_id=info:doi/10.1007/s00455-022-10513-6&rft_dat=%3Cgale_pubme%3EA749278289%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2813082563&rft_id=info:pmid/36121560&rft_galeid=A749278289&rfr_iscdi=true |