PROJECT SUMMARY/ABSTRACT
Progressive disorders of airway protection, such as swallowing disorders (dysphagia) and cough disorders
(dystussia), are highly prevalent in PD and have significant negative implications for health and quality of life. In
fact, aspiration pneumonia, commonly associated with dysphagia/dystussia, is a leading cause of death in PD.
Despite this, there is currently no established standard of care for the treatment of airway protective disorders in
this population. Even more critically, approximately 40% of individuals with PD in the United States do not access
rehabilitation services or receive specialized care for these potentially life-threatening airway protective deficits.
Expiratory Muscle Strength Training (EMST) and Cough Skill Training (CST) have been found to improve airway
protective disorders in PD and be feasible via telehealth. However, a significant clinical-research gap remains in
that it has not been demonstrated that clinical outcomes are comparable (non-inferior) when these treatments
are delivered via telehealth versus in-person. This gap limits access to these important services with detrimental
effects to health and quality of life. The long-term goal of this line of research is to improve the health outcomes
of individuals with PD, specifically as they relate to airway protective dysfunction. The objective of this application
is to pair EMST + CST – and compare clinical and patient-centered outcomes when conducted in-person versus
via telehealth in the short- and the long-term. Also, we will assess the role of specific patient burden factors and
resultant treatment adherence on clinical outcomes. Therefore, the aims of this study are to: 1) Compare clinical
and patient-centered outcomes following four weeks of intensive in-person vs. telehealth EMST+CST treatment
in persons with PD, 2) Compare clinical and patient-centered outcomes from a long-term EMST+CST
maintenance program offered in-person vs. via telehealth in persons with PD, and 3) Identify the role of specific
patient burden factors (i.e., geographic location, cognitive function, disease severity, and caregiver burden) on
treatment adherence in the short- and long-term and the influence of treatment adherence on clinical outcomes.
We will achieve these aims by conducting a two-arm, two site, randomized clinical trial in 120 people with PD
comparing in-person vs. telehealth EMST+CST treatment after a four-week intensive period (aim1) and after a
one year maintenance treatment period (with assessments at six and 12 months – aim 2). We anticipate our
findings will result in immediately translatable clinical deliverables that will have broad impact for reduced burden
and improved accessibility of treatment. Further, these findings will inform our future studies investigating these
treatments and service delivery models on long-term outcomes (i.e., aspiration pneumonia, hospitalization,
death), accessibility, and healthcare costs.
