Specialists commentator comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Two of the 3 commentators were familiar with this technology. One expert is using IQoro with current patients.

Level of innovation

Two commentators felt that IQoro is a new concept. One noted other more complex devices for swallowing treatment are more costly. Another highlighted that there may be rehabilitation fatigue involved with lengthy exercises and felt that IQoro would offer a novel approach. Though the device would not replace a speech and language therapist, it could be a useful adjunct to therapy for patients who have continuing dysphagia either after treatment has stopped or in addition to continuing treatment.

None of the commentators was aware of any competing or alternative technologies.

Potential patient impact

Two commentators noted various potential benefits of IQoro. One felt that the benefits were unclear from the current evidence. One highlighted that IQoro is a relatively simple device that does not need modification, therefore it would be easy for healthcare professionals and patients to use. No training is needed for speech and language therapists to use the device and it would be easy to show to the patient, so treatment can be started immediately. The recommended amount of practice is 1.5 minutes of treatment, 3 times per day. The perceived ease of use and portability may help make sure the patient uses the device often enough. One commentator noted that the company claims IQoro exercises muscles throughout the oropharyngeal tract, and if so, patients would be able to exercise several components of swallow at the same time.

One commentator indicated that patients with oropharyngeal dysphagia are the main group that may benefit from use of IQoro. Another stated that IQoro may benefit patients with long-term dysphagia where other treatment is no longer available.

Two commentators felt that IQoro had the potential to change current pathways or clinical outcomes. One felt that this was unlikely. If IQoro improves swallowing outcomes, another felt this would allow patients to return to an oral diet sooner and reduce length of stay in hospital, and a second expert felt that this could result in fewer visits and less invasive treatment.

Potential system impact

Two commentators felt that IQoro was potentially cost effective, for example the device is low cost compared with some other high-tech electronic swallow treatment devices. One did not envisage cost savings but 2 felt that initial costs for IQoro may be more than standard care. If swallowing improvements are greater with IQoro, this could result in potential cost savings because of shorter lengths of stay in hospital and fewer medical complications and interventions (such as enteral feeding or antibiotic use). One commentator explained that IQoro could potentially be used to help reduce time needed for speech and language therapy in the community, which is helpful if there are shortages in this service. Another highlighted that IQoro can be used in inpatient, outpatient, and community settings, so treatment could continue after hospital discharge.

All 3 commentators felt that no changes to infrastructure or training would be necessary to use IQoro. One suggested IQoro would fit easily into the current clinical pathway in speech and language therapy for treating swallowing disorders.

General comments

One specialist noted that IQoro has been used with a small number of patients as part of their Early Adopter Programme, highlighting a patient who had shown improvements in swallowing after use of IQoro. A second noted that 2 patients had used IQoro and had noticed improvements in their swallowing. Both mentioned that these numbers were too low to draw conclusions. One specialist stated that they had received interest from patients (longer-term dysphagia patients in particular) who wanted to try the device.

Two commentators provided estimates for how many people might be eligible for IQoro per year. One suggested 30% of stroke patients in stroke units, reducing to about 5% to 10% of discharges. Another estimated 50 to 100 people per year might be eligible for speech and language therapy from a population of 180,000 and a hospital with 450 beds.

Two commentators felt further studies would be helpful. Future studies could include assessing changes to swallowing resulting from IQoro treatment as measured by video fluoroscopy or a study of IQoro treatment compared with a no treatment control group of similar stroke types, for example a blinded randomised control trial.