Abstract
BackgroundNotwithstanding its value, there are challenges and limitations to implementing a dysphagia screening tool from a developed contexts in a developing context. The need for a reliable and valid screening tool for dysphagia that considers context, systemic rules and resources was identified to prevent further medical compromise, optimise dysphagia prognosis and ultimately hasten patients’ return to home or work.MethodologyTo establish the validity and reliability of the South African dysphagia screening tool (SADS) for acute stroke patients accessing government hospital services. The study was a quantitative, non-experimental, correlational cross-sectional design with a retrospective component. Convenient sampling was used to recruit 18 speech-language therapists and 63 acute stroke patients from three South African government hospitals. The SADS consists of 20 test items and was administered by speech-language therapists. Screening was followed by a diagnostic dysphagia assessment. The administrator of the tool was not involved in completing the diagnostic assessment, to eliminate bias and prevent contamination of results from screener to diagnostic assessment. Sensitivity, validity and efficacy of the screening tool were evaluated against the results of the diagnostic dysphagia assessment. Cohen’s kappa measures determined inter-rater agreement between the results of the SADS and the diagnostic assessment.Results and conclusionThe SADS was proven to be valid and reliable. Cohen’s kappa indicated a high inter-rater reliability and showed high sensitivity and adequate specificity in detecting dysphagia amongst acute stroke patients who were at risk for dysphagia. The SADS was characterised by concurrent, content and face validity. As a first step in establishing contextual appropriateness, the SADS is a valid and reliable screening tool that is sensitive in identifying stroke patients at risk for dysphagia within government hospitals in South Africa.
Highlights
There are many challenges surrounding effective identification of patients who present with dysphagia within government hospitals in developing contexts
Speech-language therapists (SLTs) from less developed contexts have relied on internationally developed tools to guide assessment and intervention in dysphagia, as these had a research and evidence-based underpinning (Emanuel, Wendler, Killen & Grady, 2004)
The results showed the South African Dysphagia Screening (SADS) to be sensitive in detecting patients at risk for dysphagia
Summary
There are many challenges surrounding effective identification of patients who present with dysphagia within government hospitals in developing contexts. Some of these challenges include timing of identification of a swallowing difficulty, timing of the assessment and use of non-standardised contextualised protocols for assessment and intervention (Seedat, 2013). The lack of standardisation contributes to variable service delivery from one patient to the next. The lack of standardisation contributes to variable service delivery from one patient to the Notwithstanding its value, there are challenges and limitations to implementing a dysphagia screening tool from a developed contexts in a developing context. The need for a reliable and valid screening tool for dysphagia that considers context, systemic rules and resources was identified to prevent further medical compromise, optimise dysphagia prognosis and hasten patients’ return to home or work
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