Nonpharmacological intervention for ILO ready for evaluation

Researchers have recently developed a nonpharmacological intervention, dubbed the upper airway control therapy (U-ACT), for inducible laryngeal obstruction (ILO).

“[T]he U-ACT intervention is derived from prior practice-based evidence of ILO treatment and is not an antagonistic approach,” the researchers said. “However, to the best of our knowledge, this work is the first to apply a well-established framework to develop a standardized nonpharmacological intervention for ILO, linked to behavioural change.”

The research team followed the Medical Research Council for complex intervention development and structured their approach using the INDEX principles.

Multi-phase research was applied, with the following stages: (1) evidence review, (2) qualitative data collection from speech and language therapists (n=7) and patients (n=22), (3) intervention design and theoretical underpinning, (4) prototype survey feedback from stage 2 participants, and (5) final intervention description using a validated reporting framework.

Fourteen studies, including 527 participants, were included in a systematic review and synthesis to identify key uncertainties and to facilitate stage 2 interviews. A framework analysis of qualitative data yielded five overarching themes for inclusion.

The U-ACT intervention consisted of two core components (education and empowerment, reliever breath control), four supporting components (bio-feedback training, prevention methods, supporting co-existing conditions, managing others’ reactions to ILO), and a cross-cutting home practice component. Its mechanism of action also included 36 behaviour change techniques.

Survey feedback regarding the prototype was positive, with 23 responders (87 percent) strongly agreeing to acceptability statements for all parameters surveyed.

“The U-ACT intervention, developed with key stakeholders and underpinned with a programme theory, is fully manualized and ready for evaluation,” the researchers said. “If future testing proves clinical and cost effectiveness, it could be incorporated into existing ILO services.”