A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment

Autor/inn/en	Vose, Alicia K.; Kesneck, Sara; Sunday, Kirstyn; Plowman, Emily; Humbert, Ianessa
Titel	A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment
Quelle	In: Journal of Speech, Language, and Hearing Research, 61 (2018) 11, S.2735-2756 (22 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	1092-4388
DOI	10.1044/2018_JSLHR-S-17-0212
Schlagwörter	Speech Language Pathology; Human Body; Psychomotor Skills; Physiology; Decision Making; Diagnostic Tests; Physical Disabilities; Difficulty Level; Clinical Diagnosis + Suchen Sie Ihr Suchwort? Menschlicher Körper; Psychomotorische Aktivität; Physiologie; Decision-making; Entscheidungsfindung; Diagnostic test; Diagnostischer Test; Physical handicap; Körperbehinderung; Schwierigkeitsgrad
Abstract	Purpose: Speech-language pathologists (SLPs) are the primary providers of dysphagia management; however, this role has been criticized with assertions that SLPs are inadequately trained in swallowing physiology (Campbell-Taylor, 2008). To date, diagnostic acuity and treatment planning for swallowing impairments by practicing SLPs have not been examined. We conducted a survey to examine how clinician demographics and swallowing complexity influence decision making for swallowing impairments in videofluoroscopic images. Our goal was to determine whether SLPs' judgments of swallowing timing impairments align with impairment thresholds available in the research literature and whether or not there is agreement among SLPs regarding therapeutic recommendations. Method: The survey included 3 videofluoroscopic swallows ranging in complexity (easy, moderate, and complex). Three hundred three practicing SLPs in dysphagia management participated in the survey in a web-based format (Qualtrics, 2005) with frame-by-frame viewing capabilities. SLPs' judgments of impairment were compared against impairment thresholds for swallowing timing measures based on 95% confidence intervals from healthy swallows reported in the literature. Results: The primary impairment in swallowing physiology was identified 67% of the time for the easy swallow, 6% for the moderate swallow, and 6% for the complex swallow. On average, practicing clinicians mislabeled 8 or more swallowing events as impaired that were within the normal physiologic range compared with healthy normative data available in the literature. Agreement was higher among clinicians who report using frame-by-frame analysis 80% of the time. A range of 19-21 different treatments was recommended for each video, regardless of complexity. Conclusions: Poor to modest agreement in swallowing impairment identification, frequent false positives, and wide variability in treatment planning recommendations suggest that additional research and training in healthy and disordered swallowing are needed to increase accurate dysphagia diagnosis and treatment among clinicians. (As Provided).
Anmerkungen	American Speech-Language-Hearing Association. 2200 Research Blvd #250, Rockville, MD 20850. Tel: 301-296-5700; Fax: 301-296-8580; e-mail: slhr@asha.org; Web site: http://jslhr.pubs.asha.org
Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2020/1/01