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.
J Speech Lang Hear Res. 2018 Nov 8;61(11):2735-2756. doi: 10.1044/2018_JSLHR-S-17-0212.
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.
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.
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.
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.
言语语言病理学家（SLP）是吞咽障碍管理的主要提供者；然而，有人批评说，SLP 在吞咽生理学方面的培训不足（Campbell-Taylor，2008）。迄今为止，尚未对从事 SLP 的吞咽障碍的诊断敏锐度和治疗计划进行检查。我们进行了一项调查，以检查临床医生的人口统计学特征和吞咽复杂性如何影响对视频荧光透视图像中吞咽障碍的决策。我们的目标是确定 SLP 对吞咽时间障碍的判断是否与研究文献中可用的障碍阈值一致，以及 SLP 之间是否在治疗建议方面存在一致性。
该调查包括 3 个复杂程度不同的视频荧光透视吞咽（简单、中度和复杂）。303 名从事吞咽障碍管理的 SLP 以基于网络的格式（Qualtrics，2005）参与了这项调查，该格式具有逐帧查看功能。将 SLP 的损伤判断与基于文献中健康吞咽者 95%置信区间报告的吞咽时间测量损伤阈值进行比较。
在简单吞咽中，67%的时间确定的主要吞咽生理障碍，中度吞咽中为 6%，复杂吞咽中为 6%。平均而言，与文献中可用的健康正常数据相比，临床医生错误地将 8 个或更多的吞咽事件标记为异常。报告 80%的时间使用逐帧分析的临床医生之间的一致性更高。无论复杂性如何，每个视频都推荐了 19-21 种不同的治疗方法。
吞咽障碍识别的一致性差或中等，假阳性频繁，治疗计划建议的差异很大，这表明需要在健康和障碍性吞咽方面进行更多的研究和培训，以提高临床医生的准确吞咽障碍诊断和治疗水平。
