Clinical practice guidelines for videofluoroscopic swallowing studies: A systematic review

Abstract

Introduction: Clinical practice guidelines (CPGs) are expected to make evidence-based recommendations, thus guiding practice and reducing unwarranted variation. CPGs are particularly helpful in guiding complex procedures such as the Videofluoroscopic Swallowing Study (VFSS) for the assessment of dysphagia, but there is a suspected high level of variability among them. To explore the extent of this variation, this study aimed to systematically identify and appraise all VFSS CPGs available worldwide. Methods: A systematic search of 3 academic databases and other sources was conducted to identify relevant CPGs; independent reviews of each CPG were undertaken by a Speech and Language Therapist and a Radiographer. Both reviewers completed a predetermined checklist of expected professional content for each CPG. CPGs were then assessed for quality using the Appraisal of Guidance for Research & Evaluation II (AGREE II) instrument. Findings from the professional content review and the methodological quality review were synthesised to inform an assessment of suitability of each CPG to inform clinical practice. Results: Seven VFSS CPGs were identified worldwide, none of which were co-designed by radiographers or aimed at a radiographer audience. Each differs in their professional content, recommendations, underpinning evidence base and professional focus. Average AGREE ll scores across the quality domains vary considerably, ranging from 93-22%. No CPGs scored highly on all six AGREE II domains. Conclusion: There is no standardisation between VFSS guidelines. Six CPGs are not recommended for clinical use; only one of the seven identified CPGs is recommended for use following significant modification. Implications for practice: The lack of a comprehensive, evidence-based guideline encourages unwarranted variation in clinical practice which potentially compromises clinical care. Further research is needed to define VFSS best practice.

Swallowing Kinematic Analysis Might Be Helpful In Predicting Aspiration And Pyriform Sinus Stasis

“…Our ndings add to the growing body of evidence suggesting that the kinematic analysis of hyoid bone movement could aid in detecting aspiration [20]. Nonetheless, one of the huge drawbacks of VFSS is the limited patient accessibility, which favors patients with good cognition and mobility [7]. To expand the utility, further research is needed to investigate the diagnostic power of other tools such as ultrasound examination based on the results of the kinematic analysis obtained with VFSS studies.…”

“…On the other hand, a swallowing kinematic study using VFSS is a more objective method for analyzing swallowing biomechanical events, with excellent interrater and intrarater reliability [6]. Nonetheless, the VFSS has several disadvantages, including inevitable radiation exposure, altered food consistency and sensory feedback due to the use of contrast medium, and limited patient accessibility, which does not allow bedside evaluation [7]. On the contrary, displacement of the hyoid bone, one of the crucial kinematic parameters, can be assessed through physical examination, ultrasound, and accelerometry, indicating potentially greater applicability in swallowing evaluation [8][9][10].…”

“…The swallowing mechanism can be divided into the following four phases: the oral preparatory phase, oral propulsive phase, pharyngeal phase, and esophageal phase [7]. During the complex pharyngeal phase of swallowing, the anterior-superior displacement of the hyoid bone plays a signi cant role in securing the airway to prevent aspiration and the opening of the upper esophageal sphincter for the smooth forward passage of food [1,2].…”

Decision making and the bedside assessment: The Speech Language Therapists’ thinking when making a diagnosis at the bed

“…It is also often used as a primer for instrumental measures (Antonios et al, 2010). Videofluoroscopy (VFSS) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES) are considered the gold standard assessment measures because of the detailed visual information that can be obtained (Boaden, Nightingale, Bradbury, Hives, & Georgiou, 2019). The literature and policies from various international bodies have foregrounded the instrumental measures as gold standards.…”

The Modified Barium Swallow Study for Oropharyngeal Dysphagia: Recommendations From an Interdisciplinary Expert Panel

“…Several of these organizations have published guidelines/practice parameters/appropriateness criteria in the past 2 decades to assist clinicians in the diagnosis and treatment of dysphagia (see Table 1). Careful review of these practice guidelines and appropriateness criteria (ACR, 2017(ACR, , 2018(ACR, , 2020aASHA, 2020a;Boaden et al, 2020;Collins, 2013;Cook & Kahrilas, 1999) reveals that there is a lack of up-to-date, comprehensive, evidence-based information on the diagnosis of oropharyngeal dysphagia, and on the performance and reporting of the MBSS. The availability of high-quality guidance would serve to improve standardization, permit reliable intrapatient evaluation of repeat examinations, and allow for interpatient examination comparisons within and between institutions.…”