A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment 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 ... Research Article
Research Article  |   November 08, 2018
A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment
 
Author Affiliations & Notes
  • Alicia K. Vose
    Rehabilitation Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
    Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
    Breathing Research and Therapeutics Training Program (T32 HL134621), Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville
  • Sara Kesneck
    Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
  • Kirstyn Sunday
    Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
  • Emily Plowman
    Rehabilitation Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
    Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
  • Ianessa Humbert
    Rehabilitation Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
    Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Alicia K. Vose: avose1@ufl.edu
  • Editor-in-Chief: Julie Liss
    Editor-in-Chief: Julie Liss×
  • Editor: Michelle Ciucci
    Editor: Michelle Ciucci×
Article Information
Swallowing, Dysphagia & Feeding Disorders / Speech / Research Articles
Research Article   |   November 08, 2018
A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment
Journal of Speech, Language, and Hearing Research, November 2018, Vol. 61, 2735-2756. doi:10.1044/2018_JSLHR-S-17-0212
History: Received June 24, 2017 , Revised November 8, 2017 , Accepted June 19, 2018
 
Journal of Speech, Language, and Hearing Research, November 2018, Vol. 61, 2735-2756. doi:10.1044/2018_JSLHR-S-17-0212
History: Received June 24, 2017; Revised November 8, 2017; Accepted June 19, 2018

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.

Acknowledgments
Research reported in this publication was supported by an American Speech-Language-Hearing Foundation Grant (Award number 00125466, awarded to Ianessa Humbert, PhD).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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