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中风后吞咽困难治疗:澳大利亚言语病理学家的实践与临床决策探索

Dysphagia therapy post stroke: An exploration of the practices and clinical decision-making of speech-language pathologists in Australia.

作者信息

Jones Olivia, Cartwright Jade, Whitworth Anne, Cocks Naomi

机构信息

a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and.

b Department of Audiology and Speech Pathology , School of Health Sciences, The University of Melbourne , Melbourne , Australia.

出版信息

Int J Speech Lang Pathol. 2018 Apr;20(2):226-237. doi: 10.1080/17549507.2016.1265588. Epub 2017 Jan 12.

Abstract

PURPOSE

A variety of dysphagia management options are available for the treatment of dysphagia following a stroke, however, it is unknown which of these approaches are most commonly utilised by Australian speech-language pathologists (SLPs) and whether particular factors influence decision-making.

METHOD

The aim of this study was to investigate, through an online survey, the treatment practices of SLPs in Australia for the treatment of dysphagia post-stroke and identify the factors influencing treatment decisions.

RESULT

A total of 118 SLPs completed the online survey. Descriptive statistics identified large variability in the dysphagia treatments utilised, with all 24 therapies listed in the online survey reported as being routinely used. Compensatory therapies were ranked as being utilised more frequently than rehabilitative approaches, with six of the seven highly utilised therapies being compensatory in nature. A client's cognitive capacity was the most prominent factor influencing SLPs' treatment decisions.

CONCLUSION

This study provides insight into the practices of SLPs in Australia for the treatment of dysphagia following stroke and discusses potential for shifts in practice. It highlights the complexity involved in the decision-making process and that clinicians consider evidence, as well as client, clinician and service factors, when selecting between the range of options available.

摘要

目的

中风后吞咽困难的治疗有多种管理方案可供选择,然而,澳大利亚言语病理学家(SLP)最常采用哪种方法以及特定因素是否会影响决策尚不清楚。

方法

本研究的目的是通过在线调查,探究澳大利亚言语病理学家对中风后吞咽困难的治疗实践,并确定影响治疗决策的因素。

结果

共有118名言语病理学家完成了在线调查。描述性统计显示,所采用的吞咽困难治疗方法存在很大差异,在线调查列出的所有24种疗法均被报告为常规使用。代偿性疗法的使用频率高于康复性方法,七种高使用频率的疗法中有六种本质上是代偿性的。患者的认知能力是影响言语病理学家治疗决策的最突出因素。

结论

本研究深入了解了澳大利亚言语病理学家对中风后吞咽困难的治疗实践,并讨论了实践转变的可能性。它强调了决策过程的复杂性,以及临床医生在从可用选项中进行选择时,要考虑证据以及患者、临床医生和服务因素。

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