What Information Do Clinicians Use in Recommending Oral versus Nonoral Feeding in Oropharyngeal Dysphagic Patients?

Abstract

There is little evidence regarding the type(s) of information clinicians use to make the recommendation for oral or nonoral feeding in patients with oropharyngeal dysphagia. This study represents a first step toward identifying data used by clinicians to make this recommendation and how clinical experience may affect the recommendation. Thirteen variables were considered critical in making the oral vs. nonoral decision by the 23 clinicians working in dysphagia. These variables were then used by the clinicians to independently recommend oral vs. nonoral feeding or partial oral with nonoral feeding for the 20 anonymous patients whose modified barium swallows were sent on a videotape to each clinician. Clinicians also received data on the 13 variables for each patient. Results of clinician agreement on the recommendation of full oral and nonoral only were quite high, as measured by Kappa statistics. In an analysis of which of the 13 criteria clinicians used in making their recommendations, amount of aspiration was the criterion with the highest frequency. Recommendations for use of postures and maneuvers and the effect of clinician experience on these choices were also analyzed.

Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

“…Using the eight main diagnostic categories used in the Chicago Classification scheme, we found ‘substantial’ agreement for the key diagnosis of achalasia and ‘fair–moderate’ agreement for classification of esophageal spasm, hypertensive, and hypotensive dysmotility for a large number of participants with a wide range of HRM experience. This performance compares well with inter‐observer agreement reported for ‘conventional manometry’ and is similar to the level of agreement documented for medical imaging in other areas of practice …”

“…It should be noted that there is no consensus as to what constitutes an acceptable level of inter‐observer agreement for clinical investigations; however, comparison with similar studies performed for medical imaging (e.g. assessment of barium swallows after dysphagic stroke, tumor volume by computed tomography) and endoscopic investigations (e.g. classification of esophagitis) show similar levels of agreement.…”

Impact of Dysphagia Severity on Clinical Decision Making via Telerehabilitation

“…Cough strength has been ranked as fifth in the top 10 factors therapists use to inform their oral/nonoral recommendations. 36,37 Other oromotor parameters, when incomplete, have also been shown to be associated with increased odds for aspiration. 38 The ability to conduct valid and reliable online assessment of oromotor function has been reported previously [15][16][17][18][29][30][31]39 and is confirmed by the current data.…”

“…Determining patient safety for oral or nonoral feeding is a primary objective of the CSE. Recent research 36,37 has demonstrated that in the FTF environment, clinicians use a range of clinical information collected during a CSE to help determine patient safety for oral/nonoral IMPACT OF DYSPHAGIA SEVERITY feeding. Considering the high level of exact agreement observed between the online and FTF clinicians across all groups, the current data support prior research 15,16 that concluded that sufficient clinical information can be observed/collected via an online CSE assessment to enable accurate assessment of patient risk for oral intake.…”

Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemo-radiotherapy for Head and Neck Malignancies

“…Surgical options include pharyngeal or cervical esophageal dilatation for hypopharyngeal or esophageal strictures, crycopharyngeal muscle myotomy for upper esophageal sphincter spasm, and application of fillers to reduce glottal insufficiency or tongue base deficits (Bergamini et al 2010). Tube feeding is frequently adopted in the early phase after head and neck cancer treatment and a percentage of these patients remain on enteral feeding, even if there is not enough evidence to decide on the optimal feeding method (PEG or nasogastric tube); criteria to stop enteral feeding are mainly related to the severity of aspiration, even though there are differences in different centers (Logemann et al 2008;Nugent et al 2010).…”