Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial.
Yoko Fujimaki, Koichi Tsunoda, Rika Kobayashi and 32 others
PMID 27742752WHAT IT FOUND
In older adults with age-related vocal cord atrophy, adding a two-minute daily guided vocal exercise to a brochure lowered six-month pneumonia hospitalizations (2 of 199 vs 18 of 216) compared with a brochure alone.
Key findings
01Hospitalization for pneumonia within six months was lower in the group that received a brochure, a DVD, and live explanation of the exercise than in the group that received a brochure alone: 2 of 199 versus 18 of 216.
02Maximum phonation time improved significantly with the exercise (p < 0.001), and the improvement did not depend on the initial maximum phonation time.
03Only three intervention patients showed hyperadduction of the false vocal cords, and it resolved after the exercise was corrected.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
60 intervention patients and 75 control patients did not complete the six-month trial, and the pneumonia comparison used 199 intervention completers versus 216 control patients, including seven who dropped out because of pneumonia. Physicians who examined the patients at one, three, and six months were not blinded to allocation, which could affect voice and endoscopy findings. The exercise group received a brochure, a DVD, and live explanation, while the control group received only the brochure, so the effect of extra instruction and contact cannot be separated from the exercise itself. Patients were not stratified for co-morbidities or medications, and cognition and frailty were not measured. The study enrolled only people with age-related glottal closure insufficiency due to vocal cord atrophy or sulcus vocalis, so it does not cover paralysis, tumors, polyps, nodules, granulomas, or acute inflammation.
Declared interests
The study was supported by the National Hospital Organization Network Joint Research Fund. The authors declared no conflicts of interest.
The easy way to misread this
Do not read the pneumonia result as proof that the vocal exercise alone prevents aspiration pneumonia. The exercise group also received a brochure, a DVD, and live explanation, and the pneumonia counts compared 199 intervention completers with 216 control patients including seven who dropped out because of pneumonia.