Dysphagia Recommendations Research Articles

Adherence of Primary Caregiver To Post Stroke Dysphagia Recommendations In Pakistan

Objective: To find the adherence of primary caregivers to post-stroke dysphagia recommendations in Pakistan. Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jun 2019 to April 2020. Methodology: We recruited 92 primary caregivers of either gender aged ≥ 18 years, assisting stroke patients with dysphagia in feeding and activities of daily living. Caregivers of cases with multiple disabilities, those not aware of dysphagia recommendations and those not involved in the implementation of dysphagia recommendations were excluded. Caregiver Mealtime and Dysphagia Questionnaire (CMDQ) were used for data collection. Results: Out of 92 Caregivers 17(18.48%) were non-compliant while 75(82%) reported significant compliance to dysphagia recommendations with mean scores of 3.11±0.48 and 1.98±0.51, respectively. In addition, the significant difference between scores of compliant and non-compliant groups was noted for the domains of Quality, Avoidance and Disagreement (p<0.001). Conclusion: Most primary caregivers were compliant and adhered to the dysphagia recommendation of stroke in Pakistan

Adherence to swallowing recommendations during (chemo)radiotherapy in head and neck cancer survivors: a scoping review.

There is a paucity of knowledge regarding patient adherence to dysphagia recommendations. It is recognized that unique barriers and facilitators contribute to poor treatment adherence in head and neck cancer (HNC) survivors. This review aims to identify the key themes and knowledge gaps regarding adherence to swallowing recommendations in HNC survivors during (chemo)radiotherapy (C)RT. Seven studies were identified. Six facilitators to adherence were extracted, namely pain relief, behavioural intervention, attendance at multidisciplinary clinic, individualised swallowing therapy, absence of prophylactic percutaneous endoscopic gastronomy (PEG) and positive social control from a spouse. Barriers to adherence included pain, depression and presence of prophylactic PEG. Adherence to swallowing recommendations positively impacted swallowing outcomes in one study. Little is known about adherence to swallowing recommendations during (C)RT in HNC survivors. Capturing adherence is challenging. Several knowledge gaps were identified. Further research is needed to better understand the barriers and facilitators from the survivors' perspective. This will inform development of best practice regarding how swallowing recommendations are provided to promote adherence and improve outcomes.

Training for Caregivers and Compliance with Dysphagia Recommendations in a Tertiary Multiple Sclerosis Rehabilitation Center.

Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training. An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed. Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, P < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations (P ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve (P = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, P = .002), and even more during follow-up (to >95%, P = .009). Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.

Perceived barriers to compliance with speech-language therapist dysphagia recommendations of South African nurses.

BackgroundLiterature has shown that there is limited compliance amongst nurses with the dysphagia recommendations made by speech-language therapists (SLTs). Poor compliance could have a significant impact on the health outcomes of patients with dysphagia.ObjectivesThis study aimed to determine the specific barriers to compliance with dysphagia recommendations experienced by South African nurses, with the goal of identifying viable strategies to overcome these barriers.MethodThis cross-sectional study made use of a self-administered questionnaire to obtain quantitative data on nurses’ perceptions of barriers to the implementation of SLT dysphagia recommendations. Eighty-one nurses were recruited from two tertiary hospitals in two South African provinces. Descriptive statistics were used to analyse the reported barriers to compliance.ResultsThree main barriers to compliance were identified, namely a lack of knowledge regarding dysphagia, patient-related barriers and workplace concerns. Knowledge barriers included poor familiarity with the role of the SLT in dysphagia management, lack of knowledge regarding SLT terminology, disagreement with dysphagia recommendations and insufficient dysphagia training. Workplace concerns included staff shortages, heavy workloads and time constraints. Poor patient cooperation was emphasised as a patient-related barrier.ConclusionFor dysphagia recommendations to be followed by nurses, SLTs need to be aware of the barriers experienced by nurses within the relevant facility. Speech-language therapists need to consider the provision of appropriate in-service dysphagia training and include nurses in the decision-making process when recommendations are made. Speech-language therapists need to consider their role in both clear communication with the nurses and the development of supporting material, such as glossaries and visual aids.

Improving the communication of dysphagia recommendations in the inpatient setting

Improving the communication of dysphagia recommendations in the inpatient setting

A service evaluation of parent adherence with dysphagia management therapy guidelines: reports from family carers supporting children with complex needs in Greece

Purpose: Many children with complex needs exhibit eating, drinking, and/or swallowing disorders (dysphagia). These children often have associated learning needs, and require assistance from carers for daily tasks such as eating and drinking. The aim of this study was to identify which strategies to manage dysphagia were challenging for family carers, and reasons for any non-adherence.Method: In this service evaluation researchers observed carers during mealtimes, and investigated carer opinions of strategies used to minimise the risks of dysphagia. Eight children with complex needs aged 3.4–7.5 years and their primary family caregiver participated.Results: Adherence with speech and language pathologists’ dysphagia recommendations overall was over 50% in all but one case. For specific strategies, the highest adherence was observed for diet modifications of foods (89%), communication during the mealtime (83%), amount of food to present (81%), and the pacing of fluids and foods (81%). Lower levels of adherence were identified in relation to postural management (58%), environmental changes (58%), utensils (56%), and preparatory strategies (49%).Conclusions: Adherence with use of strategies to support mealtimes was over 50% in all but one case. Findings suggest that support is essential to promote safe mealtimes, reduce family carers’ stress and increase knowledge, confidence, and adherence in implementing dysphagia guidelines in the family home. Implications for rehabilitationDifficulties with eating, drinking and swallowing (dysphagia) can impact on the parent–child mealtime experience.Mealtime strategies as recommended by a speech-language pathologist can support children who have difficulties eating, drinking, and swallowing.Some strategies to support eating, drinking, and swallowing are easier for carers to adhere to than others.

Correction to: Patient Adherence to Dysphagia Recommendations: A Systematic Review.

The original version of this article unfortunately contains mistakes. The second sentence in the section "Results", under the heading "Study Design" was incorrect. It should read as: Two studies [24, 29] used a prospective cohort study design with a JAMA rating of 2. Four studies [17, 25, 27, 34] completed retrospective studies earning a JAMA score of 3. Four studies [26, 28, 30, 33] earned a JAMA quality rating score of 4 and used the following designs: case series [26, 28, 33], and pilot study [30]. In Table1, "Study Population (n)" and "Design (JAMA quality rating)" values were incorrect for Shinn et al. (2013) [24]. The correct information is given here. HNC (n = 109) Prospective Cohort (2).

Are Others Questioning Your Dysphagia Recommendations?

When complex dysphagia patients, their caregivers or their physicians disagree with SLPs’ recommendations, treatment can get tricky. In a recent live chat from an ASHA dysphagia conference, swallowing disorders expert Paula Leslie shared how you can navigate resistance in such situations. The Leader listened in.

Exploring scale-up, spread, and sustainability: an instrumental case study tracing an innovation to enhance dysphagia care

BackgroundAdoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts. An instrumental case study will track the adoption and adaptation, or not, of a locally developed innovation about dysphagia as a patient safety issue. The case study will examine a conceptual framework with a continuum of spread comprising hierarchical control or ‘making it happen’, participatory adaptation or ‘help it happen’, and facilitated evolution or ‘let it happen’.MethodsThis case study is a prospective, longitudinal design using mixed methods. The fifteen-month (October 2012 to December 2013) instrumental case study is set in large, healthcare organisation in England. The innovation refers to introducing a nationally recognised, inter-disciplinary dysphagia competency framework to guide workforce development about fundamental aspects of care. Adoption and adaptation will be examined at an organisational level and along two, contrasting care pathways: stroke and fractured neck of femur. A number of educational interventions will be deployed, including training a cadre of trainers to cascade the essentials of dysphagia management and developing a Dysphagia Toolkit as a learning resource. Mixed methods will be used to investigate scale-up, spread, and sustainability in acute and community settings. A purposive sample of senior managers and clinical leaders will be interviewed to identify path dependency or the context specific particularities of implementation. A pre- and post-evaluation, using mealtime observations and a survey, will investigate the learning effect on staff adherence to patient specific dysphagia recommendations and attitudes towards dysphagia, respectively. Official documents and an ethnographic field journal allow critical junctures, temporal aspects and confounding factors to be explored.DiscussionResearching spread and sustainability presents methodological and practical challenges. These include fidelity, adaptation latitude, time, and organisational changes. An instrumental case study will allow these confounding factors to be tracked over time and in place. The case study is underpinned by, and will test a conceptual framework about spread, to explore theoretical generalizability.

Omission of dysphagia therapies in hospital discharge communications.

Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. The aim of this study was to examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk subacute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. We performed a retrospective cohort study that included all stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to subacute care from 2003 through 2005 from a single large academic medical center (N=187). Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included dietary (food and liquid), postural/compensatory techniques (e.g., chin tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Forty-five percent of discharge summaries omitted all SLP dysphagia recommendations. Forty-seven percent (88/186) of patients with SLP dietary recommendations, 82% (93/114) with postural, 100% (16/16) with rehabilitation, 90% (69/77) with meal pacing, 95% (21/22) with medication, and 79% (96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to subacute care.

RN Compliance With SLP Dysphagia Recommendations in Acute Care

The purpose of this study was to examine acute care registered nurses’ (RNs’) self-reported lev- els of compliance with speech-language pathologists’ (SLPs’) recommendations for safe feeding and swallowing techniques and proper oral hygiene care techniques in the care of adult with dysphagia. A survey was distributed to approximately 230 acute care RNs in which they were asked to respond to statements regarding their behaviors when treating adult with dysphagia. Seventy-seven responses were received. Results revealed that RNs report their compliance with SLPs’ recommendations to be high. No significant differences between compliance with safe feeding, safe swallowing, and oral hygiene care techniques were observed. However, more than 80% of RNs report a desire for more education regarding dysphagia; the time necessitated to feed individuals with dysphagia was the most common frustration. Disparities between RNs’ and SLPs’ expectations are addressed, as is the need for multidisciplinary team care, especially as it relates to the care of the frail elderly in acute care settings.

Compliance with Dysphagia Recommendations by Carers of Adults with Intellectual Impairment

Health risks associated with dysphagia in adults with intellectual impairment are well documented. There is little research into compliance with dysphagia recommendations in environments where care is provided for adults with intellectual impairment. This is a pilot study into carer compliance with Speech-Language Pathology recommendations. We aimed to investigate the level of compliance with dysphagia recommendations in day centers and the factors that might affect compliance using a questionnaire. Twenty-seven clients were observed. Results showed an overall high level of compliance with recommendations (82%), with figures ranging from 64% compliance with appropriate utensils to 100% with direct support recommendations. Areas of noncompliance were evident, with level of dependence of clients and training of carers being key issues. Implications for practitioners are discussed.