“Response to Treatment” in Dysphagia Rehabilitation: Factors for Consideration in Clinical Practice and Future Research

Abstract

Purpose: Some patients experience dysphagia that is not responsive to treatment. Despite application of appropriate evidence-based interventions, decreased swallow safety and/or efficiency persists. In order to provide the best opportunity for therapeutic efficacy, it is important to attempt to identify and characterize source of nonresponse. The definition of “nonresponse” will likely vary based on each patient depending on etiology and patient-specific goals. The purpose of this article is to outline some potential sources for patient nonresponse to dysphagia rehabilitation. We also aim to identify gaps in the literature that should be addressed in future research, to both further our understanding of nonresponse to dysphagia therapies and to better understand how to address nonresponse to improve patient outcomes. Method: Several potential sources of nonresponse are described, and specific areas of dysphagia rehabilitation research that require further investigation are discussed. Results: Based on available evidence, several sources of nonresponse to treatment are possible. First, application of interventions that are nonspecific to visualized impairments in swallow physiology could result in lack of treatment response. Patient population and etiology of dysphagia should also be considered when selecting a treatment approach to ensure that the available evidence supports use of that approach within the specific patient group. Patient adherence with rehabilitation protocols may affect response to treatment, although effects of adherence on dysphagia therapy efficacy are not fully understood. Furthermore, optimal dosing protocols to maximize benefit from rehabilitation approaches have not been fully appreciated in the literature. Conclusions: Understanding sources of nonresponse to treatment in dysphagia rehabilitation is multifaceted. Use of current literature to guide practice and therapy planning will help maximize patient benefit. However, in cases where the reason for nonresponse cannot be identified, it may be that the source lies in an area of dysphagia rehabilitation that has yet to be fully explored, including therapy dose and patient adherence among others.