Identification and nursing management of dysphagia in individuals with neurological impairment: a systematic review

Abstract

Background Dysphagia occurs in a significant number of individuals with neurological impairment. Complications such as asphyxiation, aspiration pneumonia or poor nutrition and hydration can be life threatening or result in decreased quality of life. There is limited available information that identifies effective nursing interventions related to the identification and management of dysphagia, although early identification and appropriate management has the potential to prevent these complications. Objectives The objective of the systematic review was to review all available evidence on the nursing role in recognition and management of swallowing difficulties in individuals with neurological impairment. The following research questions were addressed in this review: 1. What is the nursing role in the recognition and management of dysphagia in individuals with neurological impairment? 2. What evidence is there of the effectiveness/efficacy of nursing interventions in the recognition and management of dysphagia? 3. Does the available evidence provide information for a patient and family centred approach to the management and maintenance of oral feeding for patients with swallowing difficulties? Definition Dysphagia refers to the difficulty in swallowing. (1) Inclusion Criteria Types of participants All participants over 12 months of age with neurogenic dysphagia were included. Types of Intervention Interventions concerning the recognition, assessment and nursing management of neurogenic dysphagia. Types of outcome measures Outcome measures related to: • early detection of those with swallowing difficulties or those at risk of swallowing difficulties; • maintaining nutrition and hydration through oral intake in those with neurogenic dysphagia; • the prevention of aspiration; • evidence of successful safe oral feeding practices by family and/or carers of those with neurogenic dysphagia. Types of reports Published or unpublished original research studies were included (including randomised controlled trials, quasi-randomised trials, observational studies or research using other methodologies); along with literature reviews, expert opinion and conference proceedings. Search Strategy A search was undertaken for both published and unpublished research covering the period 1985 - 1998 (inclusive) using electronic databases, reference indexes and the internet. The databases searched included Medline, CINAHL, PsycLit, Sociological Abstracts, Science Citation Index, Current Contents, Embase, Dissertation Abstracts, Biological Abstracts, Sigma Theta Tau Database, The Australasian Medical Index, Healthstar, NIH Grants Database, The RCNA Directory of Nursing Research and the Cochrane Library Databases. Assessment of Quality All abstracts that appeared to meet the inclusion criteria (1423 abstracts) were assessed by two team members before retrieval. The retrieved articles (727) were then assessed by two reviewers for their suitability for inclusion as evidence; data that could be used as evidence was extracted; and the level of evidence was evaluated. Where there was disagreement, a third reviewer adjudicated. A check list adapted from the Data Extraction Sheet, NHS Centre for Reviews and Dissemination, University of York (2) was used for assessing the papers. A panel of experts was used to test the face validity of the instrument. A total of 66 articles were considered as evidence. Data Collection and Analysis As described above the data was extracted independently by two members of the team, and a third person adjudicated when necessary. As no randomised-controlled trials were found that met the inclusion criteria, this report is being presented in narrative form. TRUNCATED AT 600 WORDS