Noë Sofie, Goeleven Ann, Brouwers Hilde, Meurrens Tom, De Cock Alexander, Kos Daphne, Vanhaecht Kris
Speech and Language Department (SN), Melsbroek, Belgium.
Department of ENT-Head and Neck Surgery (AG), University Hospitals Leuven, Leuven, Belgium.
Int J MS Care. 2021 Sep-Oct;23(5):223-228. doi: 10.7224/1537-2073.2020-019. Epub 2021 Mar 19.
Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training.
An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed.
Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations ( ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve ( = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, = .002), and even more during follow-up (to >95%, = .009).
Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.
吞咽困难在多发性硬化症（MS）患者中很常见。言语治疗师会向MS患者及其护理人员提供吞咽困难相关建议。不遵守这些建议会增加误吸风险。我们调查了护理人员和厨房工作人员目前对吞咽困难建议的遵守情况，并通过针对性培训增加知识来评估遵守情况的改善。
进行了一项为期4周的观察性队列研究，在此期间监测康复中心护理人员和厨房工作人员的遵守情况。使用问卷评估不遵守的原因。为所有护理人员和厨房工作人员提供了一次为期2小时的培训课程，以提高他们的知识和技能。在培训后1个月和6个月再次观察遵守率。遵守情况通过是否遵循建议来定义。
结果显示，护理人员的总体遵守情况在培训后有显著改善（从58%提高到>81%，<.001）。6个月后仍观察到这种改善（80%）。培训后，在遵守以下建议方面发现了显著差异（≤.001）：汤的稠度、液体的稠度、食物准备、警觉性、速度、量、姿势和监督。餐具方面的建议没有改善（=.44）。厨房工作人员对饮食调整的遵守情况有显著改善（从74%提高到>86%，=.002），随访期间改善更大（提高到>95%，=.009）。
根据护理人员的需求量身定制的吞咽困难培训，以提高知识，显著改善了对吞咽困难建议的遵守情况和护理质量。
