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Objective To identify core practices for workforce management of communication and swallowing functions in COVID-19 positive patients within the ICU. Design A modified Delphi methodology was utilized, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included. Setting Electronic modified Delphi process. Participants 35 speech-language pathologists (SLPs) from 6 continents representing 12 countries. Interventions Not applicable. Main Outcome Measures The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: “0” = strongly disagree, “10” strongly agree). Prioritization rank order of statements in a 4 th round was also conducted. Results SLPs with a median of 15 years ICU experience, working primarily in clinical (54%), in academic (29%) or managerial (17%) positions, completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance. Conclusions A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focus on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.

Objectives/Hypothesis: To identify, describe, and where possible meaningfully synthesize the reported risk factors for postextubation dysphagia (PED) in critically ill patients.Study Design: Systematic review and meta-analysis. Methods: A systematic search of peer-reviewed and grey literature was conducted in common scientific databases to identify previously evaluated risk factors of PED. Data extraction and risk of bias assessment used a double-blind approach. Random effects models were used for the meta-analyses. Meta-analyses were conducted where sufficient study numbers allowed after accounting for statistical and clinical heterogeneity.Results: Twenty-five studies were included, which investigated a total of 150 potential risk factors. Of these, 63 risk factors were previously identified by at least one study each as significantly increasing the risk of PED. After accounting for clinical and statistical heterogeneity, only two risk factors were suitable for meta-analysis, gender, and duration of intubation. In separate meta-analyses, neither gender (RR 1.00 [0.71, 1.43], I 2 = 0%) nor duration of intubation 3.49], I 2 = 0%) were significant predictors of PED.Conclusions: A large number of risk factors for PED have been reported in the literature. However, significant variability in swallowing assessment methods, patient populations, timing of assessment, and duration of intubation prevented meaningful meta-analyses for the majority of these risk factors. Where meta-analysis was possible, gender and duration of intubation were not identified as risk factors for PED. We discuss future directions in clinical and research contexts.

Stroke remains the main cause of severe disability in the UK with approximately one third of stroke survivors functionally dependent at 1 year after a stroke. Early access to cognitive and physical rehabilitation therapy after stroke is considered to be a hallmark of effective stroke services but evidence is also emerging to support longer term rehabilitation for these patients. This paper explores the evidence base for cognitive and physical rehabilitation therapy for patients 6 months or later after stroke. Intensively applied interventions appear to mediate more positive and sustained outcomes. Group interventions can be an efficient way to maximize intensity. All professions have a responsibility to ensure that practice is evidence based. In light of a paucity of quality research in rehabilitation interventions, it is incumbent on health professionals, service users and researchers to work together to study longer term rehabilitation in a more rigorous manner.