Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

Abstract

Background: Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. Methods: A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP. Inter-rater reliability was analyzed using percent agreement, Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank tests. Logistic regression models accounting for age and gender were used to test the impact of stroke severity and stroke location on agreement. Results: We found excellent agreement for both liquid (91% agreement; kappa = 0.808; Kendall's tau-b = 0.813, p < 0.001; Wilcoxon signed rank = -0.818, p = 0.417) and solid (87% agreement; kappa = 0.792; Kendall's tau-b = 0.844, p < 0.001; Wilcoxon signed rank = 0.243, p = 0.808) dietary textures. From regression modeling, there is suggestive but inconclusive evidence that higher National Institute of Health Stroke Scale (NIHSS) scores correlate with lower levels of agreement for liquid diet recommendations (OR [95% CI] 0.895 [0.793-1.01]; p = 0.07). There was no impact of NIHSS score for solid diet recommendations and no impact of stroke location on solid or liquid diet recommendations. Qualitatively, we identified professional, logistical, technical, and patient barriers to implementation, many of which resolved with experience over time. Conclusions: Dysphagia evaluation by a remote SLP via telehealth is safe and effective following stroke. We plan to implement teleswallow across our multistate telestroke network as standard practice for poststroke dysphagia evaluation.

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

“…In the current climate, another barrier to implementing ideal clinical practices is the very real threats associated with COVID-19. Telehealth for swallowing therapy has been deemed “safe and effective” [ 93 ]. However, this does not take into account the need for imaging assessments, particularly in the acute phases of stroke, where a patient’s status is in a constant state of flux.…”

Speech therapy practice in hospital settings and COVID-19 pandemic

“…call center approach, suggesting that it promotes increased access to clinical rehabilitation and guarantees adequate services for patients with swallowing disorders, requiring periods of intensive treatment followed by long-term management [11][12][13] . In the current scenario, call centers can be an alternative means of providing services, in a complementary way or replacing face-to-face treatments.…”

Management of Dysphagia During COVID-19 Pandemic: Gazi University Faculty of Medicine ENT Clinical Experience

“…26 Çeşitli hacim ve kıvamlarda yutma denemelerinin yapılacağı zamanlarda, kıvamların doğru ayarlanabilmesi için hastanın yanında klinikte görevli ve bireyin medikal durumunu bilen bir hemşirenin olması oldukça önemlidir. 27 Bu yutma denemeleri belirli bir algoritma ile yapılmaktadır. Öncelikle 5 cc nektar kıvamında hazırlanmış olan lokma ile başlanıp sırayla bu miktar 10 cc'ye daha sonra 20 cc'ye çıkarılır.…”