Date Presented 04/04/19
The purpose of this study was to evaluate the effectiveness of a brief pill swallowing intervention that included behavioral, adaptive, and positioning approaches. Sixteen individuals with Barth syndrome, ages 6 to 34, participated. Pill-swallowing milestones were evaluated pretraining, immediately posttraining, and at six-months posttraining. Overall, there was a statistically significant change in pill swallowing ability from pretraining to posttraining; changes were maintained after six months.
Primary Author and Speaker: Stacey Reynolds
Additional Authors and Speakers: Mary Tucker
PURPOSE: For children and adults with chronic disease, taking medication is a critical component of daily life. Inability to swallow pills can lead to a variety of problems which add stress on the family and may reduce quality of life. Limited ability to swallow pills may also restrict an individual’s ability to participate in clinical trial research. Overall, learning to swallow pills opens up more options for managing medical conditions and may reduce family stress1. The purpose of this study was to evaluate the effectiveness of a brief, multi-faceted pill swallowing program that used evidence-based training methods for a specific population of individuals with a rare genetic disorder, Barth syndrome (BTHS). Individuals with BTHS have normal intelligence, but have features such as oral motor weakness and sensory sensitivity that make pill swallowing difficult2.
DESIGN: This study was a retrospective review of data collected from the 2016 International BTHS Conference. During conference, individuals with BTHS participated in a pill-swallowing intervention. Six months after the conference, participants rated their pill-swallowing ability via e-mail survey. While data was initially collected for program evaluation purposes only, IRB approval obtained retrospectively to analyze the data for research purposes.
METHODS: Subjects were 16 boys and men with a genetically confirmed diagnosis of BTHS. The participants ranged in age from 6-34 years (M=14.5 years). Training sessions were ∼40 minutes in length and were conducted by an occupational therapist with advanced training in pediatric feeding/eating disorders. Possible intervention strategies included a behavioral approaches (shaping with candy ranging in size from ∼4mm- 2cm), adaptive strategies (use of pill glide spray or an adapted cup), or positioning strategies (e.g., turning head to the side or chin tuck)3-4. Intervention strategies and progression was based on the participant’s prior experience with pill-swallowing, age, and comfort level.
A pill-swallowing milestone scale was developed for this study. Pill-swallowing skills were listed in order of difficulty and assigned a numerical value. A score of “0” indicated no experience with pill-swallowing. Scores in the 1-5 range indicated that participant would engage with a pill (e.g., put pill on tongue) but not swallow. Scores 6-12 indicated that the participant would swallow a pill or candy ranging in size from a very small cake decoration to a very large Mike & Ike®. Participants were scored pre-training, immediately post-training, and at 6-months post-training. Paired t-tests were used to compare pre-training scores to post-training scores, and post-training scores to 6-month follow up scores.
RESULTS: Fourteen out of the sixteen participants showed an increase in their pill-swallowing ability after the initial training session. Paired t-test analysis comparing pre-training milestone scores (M=5.06,) to post-training milestone scores (M=9.56) indicated a statistically significant difference in pill swallowing performance; t(15)= -6.529, p<.001.
Twelve of sixteen participants returned our 6-month follow up e-mail. Based on these responses, there was no difference between milestone scores at post-training (M=10.25) and at the six-month follow up (M=10.67); t(11)=-1.449, p=.175. Results suggest that pill swallowing abilities were maintained over the six month period.
CONCLUSION: This study suggests that a brief multi-faceted training approach, led by trained occupational therapists may be effective for helping individuals with sensory and motor deficits learn to swallow pills independently. This evidence can support OTs as they aim to enhance the quality of life for individuals dealing with chronic conditions and their families.
References
1. Meltzer, E.O., Welch, M.J., & Ostrom, N.K. (2006). Pill swallowing ability and training in children 6-11 years of age. Clinical Pediatrics, 45, 725-733. DOI: 10.1177/0009922806292786.
2. Reynolds, S., Kreider, C.M., Meeley, L.E., & Bendixen, R.M. (2015). Taste perception and sensory sensitivity: Relationship to feeding problems in boys with Barth syndrome. Journal of Rare Disorders, 3, 1-9. DOI: 10.1002/ajmg.a.35413
3. Patel, A., Jacobsen, L., Jhaveri, R., & Bradford, K.K. (2015). Effectiveness of pediatric pill swallowing interventions: A systematic review. Pediatrics, 135, 883-889. DOI: 10.1542/peds.2014-2114
4. Jagani, M., Legay, H., Ranmal, S.R., Bertrand, J., Ooi, K., & Tuleu, C. (2016). Can a flavored spray (Pill Glide) help children swallow their medicinies? A pilot study. Pediatrics , 138, e1-e9. DOI: 10.1542/peds.2016-0608
