Patient responses to swallowing safety cues: A comparison of traditional face-to-face and tele-dysphagia instructional methods

Stacy Gallese Cassel,Jennifer A Mcilvaine

doi:10.15761/srj.1000126

Abstract

Patient Responses To Swallowing Safety Cues: A Comparison Of Traditional Face-To-Face And Tele-Dysphagia Instructional Methods Stacy Gallese Cassel An estimated 15 million individuals in the United States have been formally diagnosed with dysphagia, defined as swallowing dysfunction — the fifth leading cause of death in Americans over the age of 65. Statistical findings indicate that at least 50% of these individuals have limited access to treatment. However, despite the rapid expansion of telepractice (defined as the use of telecommunications technology to provide services at a distance) as a statistically valid online method for the provision of medical and clinical intervention to those without access, telepractice has yet to consistently incorporate online dysphagia service delivery (referred to as tele-dysphagia) into its clinical scope. This investigation compared the outcomes of traditional face-to-face intervention to online tele-dysphagia intervention by measuring the correct and incorrect responses to visual and auditory cues presented by a clinician during dysphagia intervention sessions. Data analysis conducted via t-test indicated that there was no significant difference in the mean scores from tele-dysphagia method (M = 9.67, SD = 3.74) as compared to face-to-face method (M = 9.00, SD = 2.70), t (28) = 0.56, p = 0.580. Additionally, inter-rater reliability scores were obtained by determining a Cohen’s kappa coefficient in order to measure the degree of agreement between the two raters. Findings indicated a kappa statistic of k=1 for all items, given a 100% agreement for all trials. Additionally, results of a mixed-design analysis of variance suggested a significant within-subject effect with the use of cues, but there were no significant main effects of between-subject factors (gender, delivery type, etiology, or age) on the patients’ responses. Given that there was no significant statistical difference between the two delivery methods and inter-rater reliability scores demonstrated perfect agreement, we can suggest that the online tele-dysphagia method can potentially yield clinical outcomes similar to a traditional face-to-face method. Results from a mixed-design analysis of variance additionally suggested that there is a significant within-subject effect given the use of cues (F (1, 29)=14.99, p = .001) on patients’ responses. However, there were no significant main effects of between-subject factors (gender, delivery type, etiology, or age) on the patients’ responses. It is hoped that the results of this study will lend validity and direction to future attempts to provide much-needed dysphagia intervention via online service methods. Such attempts, in turn, would have the potential to promote increased longevity and quality of life in those populations currently unable to access such services.

Highlights

Aspiration pneumonia is the fifth leading cause of death in Americans over the age of sixty-five, and the third leading cause of death in those over eighty-five [1]
From 2010 to 2030, the elderly population is expected to increase from 39 million to 69 million Americans [2] likely increasing the need for dysphagia services
Thirty participants contributed to the parallel study upon meeting the following criteria: adult with a confirmed medical diagnosis of cerebrovascular accident (CVA) or traumatic brain injury (TBI) with positive findings according to computed tomography (CT Scan) or magnetic resonance imaging (MRI) of the brain

Summary

Introduction

Aspiration pneumonia is the fifth leading cause of death in Americans over the age of sixty-five, and the third leading cause of death in those over eighty-five [1]. From 2010 to 2030, the elderly population is expected to increase from 39 million to 69 million Americans [2] likely increasing the need for dysphagia services. Therapeutic intervention for dysphagia, primarily provided by speech-language pathologists, is an essential part of maintaining both nutritional and respiratory safety while allowing for the quality of life and socialization associated with oral intake. Given the growing geriatric population and the subsequent increase in the incidence of dysphagia, speech-language pathologists specializing in dysphagia anticipate an ever-increasing role in diagnosis and intervention [3]. In rural and socioeconomically challenged areas; access to such intervention remains even more limited due to distance, mobility challenges, and by the unavailability of speechlanguage pathologists to provide dysphagia services [3]. As noted by James Coyle, Ph.D., the number of individuals with dysphagia is quickly exceeding the number of qualified dysphagia therapists [3]

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Discussion

Conclusion