Therapy Manuals for Clinically Implementing Proactive and Reactive Swallowing Therapies During Head and Neck Radiotherapy: Using the TIDieR Framework to Disseminate PRO-ACTIVE Trial Interventions

The purpose of this report is to describe swallowing therapy delivered before or during head and neck radiotherapy (RT) to promote swallowing preservation. Three models of therapy that were tested in the Comparing the Effectiveness of PROphylACTic swallow InterVEntion for patients receiving Radiation Therapy for Head and Neck Cancer (PRO-ACTIVE) randomized clinical trial (NCT03455608) are described according to the Template for Intervention Description and Replication (TIDieR) framework. PRO-ACTIVE compared the relative effectiveness of different timing and intensity of delivering EAT and EXERCISE swallowing therapies during head and neck RT. Therapy manuals used by speech-language pathologists participating in the trial are disseminated in this report as a resource for the clinical implementation of trial results. The therapy models represent different timing (proactive vs. reactive) and intensity (± swallowing exercise) of implementing swallowing therapies to promote maximal pharyngeal activity during head and neck RT. Swallowing therapies integrated standardized assessment and monitoring techniques, the Eat All Through Radiotherapy and/or swallowing exercises.