Modified consistency dysphagia diet protocol for Pakistan: Development perspective

Abstract

Background: Increased in life expectancy has led to the increased need for texture-modified foods for dysphagia patients, to maintain their nutrition status. At present clinical practices in Pakistan are marred with no standard diet protocols resulting in misunderstanding in recommended consistencies of both food and fluid, hence compromising patients’ safety, necessitating the work of dysphagia diet protocol. Objectives: To develop a dysphagia diet consistency protocol for Pakistan. Methods: A descriptive study recruited 16 Speech-Language Pathologists and dieticians from Rawalpindi & Islamabad using convenient sampling from October 2018 to March 2019. The sample included SLPs and dieticians working for at least 1 year with dysphagia patients. To ensure the process of standardization list of food and fluids was generated by the professionals to analyze the various food textures with the help of a viscometer that contributed to labeling and defining the textures. With the help of the International Dysphagia Diet Standardization Initiative Flow Test, Fork Drip Test, Spoon tilt test, Fork Pressure Test, Spoon Pressure Test, and Finger Test, a list of food and fluid items categorized into 8 levels which help the management of dysphagia patients in clinical practice. Results: The current study developed a dysphagia diet protocol and categorized 29 foods and fluids as per the IDDSI framework. 10 items were placed in level 0 (Thin). 2 items were placed in level 1 (slightly thick). 2 items were placed in 2 (mildly thick) 1 item was placed at level 3. Level 4 included 2 items. Level 5 included 3 items. Level 6 included 4 items and Level 7 included 6 regular daily food items. Conclusion: The study successfully developed a standardized dysphagia diet consistency protocol consisting of 29 commonly readily available and popular foods consumed by Pakistanis and placed these items under 8 levels of the International Dysphagia Diet Standardization Initiative (IDDSI) recommendations. Keywords: Dysphagia; food consistency; IDDSI; swallowing disorders; texture modification.