Adult Dysphagia Assessment in the UK and Ireland: Are SLTs Assessing the Same Factors?

This is the first study to examine dysphagia assessment practices of UK/Ireland speech and language therapists. The aims were to (1) examine practice patterns across clinicians, (2) determine levels of consistency in practice, and (3) compare practices of clinicians in the UK/Ireland with those previously reported of clinicians in the United States. A questionnaire, developed for earlier U.S. research, was adapted following a pilot study. The resulting email survey was completed by 296 speech and language therapists working with dysphagic adults. Respondents were asked to rate how frequently they use 31 components of a clinical dysphagia examination. Consistency was determined by calculating the percentage of respondents who agreed on frequency of use. Low frequency of use was reported for four components: trials with compensatory techniques, obtain patient’s drug history, assessment of speech articulation/intelligibility, and screening/assessment of mental abilities. Variability among clinicians was high, with inconsistency observed for 6/31 components (19%) and high consistency for only 10/31 (32%). Results were compared with data from the earlier U.S. study. Notable differences in practice were observed for five components: cervical auscultation, trials with compensatory techniques, gag reflex, assessment of sensory function, and screening/assessment of mental abilities. Inconsistency among UK/Ireland clinicians was higher than in the comparator U.S. study. The clinical implications of these findings are discussed.

[1]  M J Collins,et al.  Does pulse oximetry reliably detect aspiration in dysphagic stroke patients? , 1997, Stroke.

[2]  D. Oliver,et al.  The development and implementation of a standardized policy for the management of dysphagia in motor neurone disease , 2003, Palliative medicine.

[3]  D. Machin,et al.  Design of Studies for Medical Research: Machin/Design of Studies for Medical Research , 2005 .

[4]  H. Hodkinson Evaluation of a mental test score for assessment of mental impairment in the elderly. , 1972, Age and ageing.

[5]  M. Spieker,et al.  Evaluating dysphagia. , 2000, American family physician.

[6]  J. Rosenbek,et al.  Clinicians’ Preferences and Practices in Conducting Clinical/Bedside and Videofluoroscopic Swallowing Examinations in an Adult, Neurogenic Population , 1999 .

[7]  C. M. Wiles,et al.  Assessment of swallowing and referral to speech and language therapists in acute stroke. , 1998, QJM : monthly journal of the Association of Physicians.

[8]  S. Leder Gag reflex and dysphagia , 1996, Head & neck.

[9]  R. Martino,et al.  Screening for Oropharyngeal Dysphagia in Stroke: Insufficient Evidence for Guidelines , 2000, Dysphagia.

[10]  C. M. Wiles,et al.  Inter and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia , 2002, Clinical rehabilitation.

[11]  B. Mathers-Schmidt,et al.  Dysphagia Evaluation Practices: Inconsistencies in Clinical Assessment and Instrumental Examination Decision-Making , 2003, Dysphagia.

[12]  Paul Finn,et al.  Reliability and validity of cervical auscultation: A controlled comparison using videofluoroscopy , 2007, Dysphagia (New York. Print).

[13]  Lalit Kalra,et al.  Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients , 2003, Stroke.

[14]  R. Sagar,et al.  Dysphagia due to olanzepine, an antipsychotic medication. , 2005, Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology.

[15]  Maria Gabriella Ceravolo,et al.  Predictive value of clinical indices in detecting aspiration in patients with neurological disorders , 1997, Journal of neurology, neurosurgery, and psychiatry.

[16]  H. Beckerman,et al.  Functional recovery after cardiac rehabilitation , 2002, Clinical rehabilitation.

[17]  P. Carding,et al.  Investigation and management of chronic dysphagia , 2003, BMJ : British Medical Journal.

[18]  R. Martino,et al.  Oropharyngeal Dysphagia: Surveying Practice Patterns of the Speech–Language Pathologist , 2004, Dysphagia.

[19]  J. Rosenbek,et al.  Inter- and Intrajudge Reliability of a Clinical Examination of Swallowing in Adults , 2000, Dysphagia.

[20]  D. Fone,et al.  GOAL: a simplified mental test for emergency medical admissions. , 2004, QJM : monthly journal of the Association of Physicians.

[21]  Robert Baldwin National Service Framework for Older People , 2003 .

[22]  L. Perry,et al.  Screening swallowing function of patients with acute stroke. Part one: Identification, implementation and initial evaluation of a screening tool for use by nurses. , 2001, Journal of clinical nursing.

[23]  H. Allescher,et al.  Drug-induced dysphagia , 2005, Dysphagia.

[24]  M J Connolly,et al.  The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool. , 2000, Age and ageing.

[25]  J. Logemann,et al.  A Screening Procedure for Oropharyngeal Dysphagia , 1999, Dysphagia.

[26]  S. Langmore Issues in the Management of Dysphagia , 1999, Folia Phoniatrica et Logopaedica.

[27]  N. Bleach The gag reflex and aspiration: a retrospective analysis of 120 patients assessed by videofluoroscopy. , 1993, Clinical otolaryngology and allied sciences.

[28]  M. Reding,et al.  Validation of the 3-oz water swallow test for aspiration following stroke. , 1992, Archives of neurology.

[29]  P. Cornish,et al.  “Avoid the crush”: hazards of medication administration in patients with dysphagia or a feeding tube , 2005, Canadian Medical Association Journal.

[30]  Joseph A. Murray,et al.  Manual of Dysphagia Assessment in Adults , 1999 .