Mathers-Schmidt Barbara A, Kurlinski Mary
Department of Communication Sciences and Disorders, Western Washington University, Bellingham, Washington 98225, USA.
Dysphagia. 2003 Spring;18(2):114-25. doi: 10.1007/s00455-002-0094-z.
The purpose of this study was to determine the nature of swallowing evaluation practices in western Washington, specifically in terms of (a) components of the clinical examination most commonly used, (b) consistency of clinical examination practices across clinicians, and (c) consistency of clinical decision-making (instrumental vs. noninstrumental) given specific patient scenarios. A 21-question survey was sent to 150 speech-language pathologists who provide services to dysphagia patients. Of the 72 (48%) surveys that were returned, 64 provided the data for the study. The results revealed that clinicians who responded to the survey differ somewhat regarding which components they include in a clinical examination of swallowing. There was a high degree of consistency for 11 of the 19 components. Inconsistency across clinicians was revealed in four areas: assessment of sensory function, assessment of the gag reflex, cervical auscultation, and assessment of trial swallows using compensatory techniques. Clinicians agreed in their recommendations on two of the six clinical case scenarios. In general, participating clinicians varied widely in their clinical decision-making. These findings are compared with other studies where variability in clinical practice has raised concerns.
本研究的目的是确定华盛顿州西部吞咽评估实践的性质，具体涉及以下方面：（a）最常用的临床检查组成部分；（b）不同临床医生临床检查实践的一致性；（c）在特定患者情况下临床决策（器械检查与非器械检查）的一致性。向150名向吞咽困难患者提供服务的言语治疗师发送了一份包含21个问题的调查问卷。在收回的72份（48%）调查问卷中，64份为该研究提供了数据。结果显示，参与调查的临床医生在吞咽临床检查中所包含的组成部分上存在一定差异。19个组成部分中有11个具有高度一致性。临床医生之间在四个方面存在不一致：感觉功能评估、咽反射评估、颈部听诊以及使用代偿技术进行试吞咽评估。临床医生在六个临床病例场景中的两个场景的建议上达成了一致。总体而言，参与研究的临床医生在临床决策方面差异很大。这些发现与其他因临床实践差异而引发关注的研究进行了比较。
