A survey of clinician decision making when identifying swallowing impairments and determining treatment

Purpose: Speech-language pathologists (SLPs) are the of impairment were compared against impairment thresholds primary providers of dysphagia management; however, for swallowing timing measures based on 95% confidence this role has been criticized with assertions that SLPs are intervals from healthy swallows reported in the literature. inadequately trained in swallowing physiology (Campbell-Results: The primary impairment in swallowing physiology Taylor, 2008). To date, diagnostic acuity and treatment was identified 67% of the time for the easy swallow, 6% planning for swallowing impairments by practicing SLPs for the moderate swallow, and 6% for the complex swallow. have not been examined. We conducted a survey to examine On average, practicing clinicians mislabeled 8 or more how clinician demographics and swallowing complexity swallowing events as impaired that were within the normal influence decision making for swallowing impairments in physiologic range compared with healthy normative data videofluoroscopic images. Our goal was to determine available in the literature. Agreement was higher among whether SLPs’ judgments of swallowing timing impairments clinicians who report using frame-by-frame analysis 80% align with impairment thresholds available in the research of the time. A range of 19–21 different treatments was literature and whether or not there is agreement among recommended for each video, regardless of complexity. SLPs regarding therapeutic recommendations. Conclusions: Poor to modest agreement in swallowing Method: The survey included 3 videofluoroscopic swallows impairment identification, frequent false positives, and wide ranging in complexity (easy, moderate, and complex). Three variability in treatment planning recommendations suggest hundred three practicing SLPs in dysphagia management that additional research and training in healthy and disordered participated in the survey in a web-based format (Qualtrics, swallowing are needed to increase accurate dysphagia 2005) with frame-by-frame viewing capabilities. SLPs’ judgments diagnosis and treatment among clinicians.