Speech-Language Pathologists’ Ratings of Airway Protection Behaviors and Treatment Recommendations for Dysphagia

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Ward, Matthew G
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Middle Tennessee State University
ABSTRACT This study investigated speech-language pathologists’ (SLPs) ability to utilize a novel 5-point airway protection scale (APS) when reviewing FEES videos, the frequency of airway protection behaviors visualized during FEES, and SLP practice patterns regarding the recommendation of modified texture diets (MTDs) for the improvement of airway protection. Five SLPs—trained in the use of the APS—were recruited to determine if they could reliably analyze FEES videos with the APS. For both scoring sessions, inter-rater reliability was “almost perfect” (κ = .91; 95% CI, .881 to .939, p < .0005) and intra-rater reliability was “substantial” (κ = .80) for one rater and was “almost perfect” (κ = .95 - 1.0) for the remaining four raters. After determining that these five SLPs could reliably utilize the APS, a medical records review of their FEES reports was completed. Four hundred seventy-seven FEES reports, totaling 25% of all reports created from January 1, 2023 to January 1, 2024, were randomly sampled. There was a significant association between sex and APS scores (p < .001). Despite accounting for only 43.4% of the sample, females accounted for 53.8% (n = 769) of all scores of APS “2,” which indicates a functionally normal airway protection score. APS scores of “5” denote the most severe complication for airway protection behaviors, and males accounted for 62.8% (n = 201) of all APS “5” scores. SLPs who treat dysphagia recommend MTDs to prevent airway protection issues like laryngeal penetration and aspiration that can lead to severe pulmonary complications. A survey of clinical practice patterns indicated that over 90% of respondents recommend MTDs when needed. However, the use of the MTDs is not without risk. Indisputably, the use of MTDs can cause significant and systemic health risks. Hence, informed consent for the use of MTDs in healthcare settings is required. However, when surveyed about the negative health outcomes associated with consuming MTD, SLPs demonstrated poor understanding of hazards associated with MTDs—calling into question the ability of SLPs to fully inform their patients regarding the standard practice of recommending MTDs to prevent pulmonary complications.
Dysphagia, Evaluation, Modified texture diets, Swallowing, Swallowing disorders, Treatment, Health sciences, Speech therapy, Public health