Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.
Secteur de Kinésithérapie et Ergothérapie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
Dysphagia. 2022 Oct;37(5):1279-1287. doi: 10.1007/s00455-021-10392-3. Epub 2022 Jan 3.
Dysphagia is common in patients with neuromuscular diseases (NMDs). Its management differs by country and clinical setting. The purpose of this study was to describe current practices in the management of dysphagia in NMDs across Europe. An online survey of sixteen questions was developed, including basic information on facilities, existence of a management protocol, availability of dedicated therapists, tools used during screening, assessment, treatment stages, and treatment strategies. The survey was rolled out to European healthcare facilities providing care for NMDs. A total of 140 facilities across 25 European countries completed the survey. Substantial discrepancies in dysphagia management were identified among respondents. Seventy-two percent of the facilities reported having a protocol for at least one of the three management stages whereas only 39% had one for all. Speech and language therapists were reported as involved throughout the entire management stage while participation of other members from multidisciplinary teams varied depending on the stage. Clinical swallowing assessment was the most frequently reported tool in the assessment and treatment stages. For screening, questionnaires were the most frequently used while instrumental examinations were mainly reported in the assessment stage. For the treatment stage, adaptation strategies (diet, food, and posture) were the most reported approaches. In conclusion, the survey highlighted the absence of a defined protocol concerning the management of dysphagia in most of the surveyed healthcare facilities. Standardized training strategies and guidelines are necessary in the future to familiarize clinicians with each stage of the management of dysphagia.
吞咽困难在神经肌肉疾病（NMDs）患者中很常见。其管理因国家和临床环境而异。本研究的目的是描述欧洲各国 NMD 患者吞咽困难管理的现状。我们开发了一个包含 16 个问题的在线调查，其中包括设施的基本信息、管理方案的存在、专用治疗师的可用性、筛查、评估、治疗阶段使用的工具以及治疗策略。该调查面向为 NMD 提供护理的欧洲医疗机构进行。共有来自 25 个欧洲国家的 140 家医疗机构完成了这项调查。受访者在吞咽困难管理方面存在很大差异。72%的机构报告至少在三个管理阶段之一中制定了方案，而只有 39%的机构在所有阶段都制定了方案。言语和语言治疗师被报告在整个管理阶段都参与其中，而多学科团队的其他成员的参与则根据阶段而有所不同。临床吞咽评估是评估和治疗阶段最常报告的工具。在筛查阶段，问卷是最常用的工具，而仪器检查主要在评估阶段报告。在治疗阶段，适应策略（饮食、食物和姿势）是最常报告的方法。总之，该调查强调了大多数调查医疗机构在吞咽困难管理方面缺乏明确的方案。未来需要标准化的培训策略和指南，使临床医生熟悉吞咽困难管理的各个阶段。
