Andrews Mckinley, Pillay Mershen
Discipline of Speech-Language Pathology, University of KwaZulu-Natal.
S Afr J Commun Disord. 2017 Jan 23;64(1):e1-e14. doi: 10.4102/sajcd.v64i1.158.
Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns.
The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.)Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis.
There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38). Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%), moderate (35.9%) and poor (33.3%) consistency of practice each. Nurses, food and liquids and medical consumables were used usually and always by more than 90% of participants.
Infrequent use of clinical components and high variability in clinical practice among speech-language therapists calls for uniform curricula in the clinical evaluation of swallowing at South African universities and for continued professional development post-graduation. Different contexts and patient symptoms contribute towards varied practice; however, there is still a need to improve consistency of practice for quality health care delivery. A research-based policy for the clinical swallowing evaluation for a resource-limited context is also needed.
言语治疗师经过专门培训，可对急性中风成人患者的吞咽功能进行临床评估。在南非，急性中风后吞咽困难的发生率很高，其对健康的影响可能是致命的，因此对这一患者群体进行优化管理至关重要。然而，尽管有针对急性中风成人患者吞咽功能临床评估的培训和最佳实践指南，但这些实践模式的一致性水平较低。
旨在探讨言语治疗师在急性中风成人患者吞咽功能临床评估中的临床实践活动。所审查的实践活动包括临床组成部分的使用情况及所利用资源的一致性。临床组成部分是指在吞咽功能临床评估中所评估的各个要素（如唇闭合、嗓音质量等）。
本研究使用的问卷是在一项研究的基础上复制并改编的，以提高内容效度和标准效度。通过叙述性文献综述确定成人吞咽功能临床评估中存在哪些实践模式。进行了一项预试验以提高效度和信度。采用目的抽样法，向南非言语-语言-听力协会的成员发送一份自行填写的电子问卷。38名参与者参与了该研究。使用描述性统计分析数据，对少量定性部分进行文本分析。
超过90%的参与者（n = 38）对41%的临床组成部分使用频率较高。不到50%的参与者经常评估感觉功能和咽反射，并使用脉搏血氧饱和度测定、颈部听诊和间接喉镜检查。大约三分之一的参与者分别表现出较高（30.8%）、中等（35.9%）和较差（33.3%）的实践一致性。超过90%的参与者通常或总是使用护士、食物和液体以及医疗耗材。
言语治疗师对临床组成部分的使用频率不高，临床实践差异较大，这就要求南非各大学在吞咽功能临床评估方面制定统一课程，并在毕业后持续进行专业发展。不同的背景和患者症状导致了实践的差异；然而，为了提供高质量的医疗服务，仍需要提高实践的一致性。还需要制定一项基于研究的、针对资源有限环境下临床吞咽评估的政策。
