JCPSLP Vol 20 No 3 November 2018

In addition to reporting the dysphagia therapies they employ, responding SLPs were asked to nominate the factors that influence their treatment recommendations. Of the 33 factors identified, the most commonly reported factors included a client’s cognitive status (41.94%), the results of an instrumental assessment (i.e., video fluoroscopy/FEES) (18.71%) and the acute nature of the client’s medical condition (18.06%). Overall, consideration of the evidence base was reported by only 10.97% of SLPs and ranked as the 10th most frequent influencing factor for the selection of a dysphagia therapy approach post stroke. The continued predominance of compensatory approaches to dysphagia therapy post stroke, as identified in this study, challenges the assumption that the emergent evidence base supporting the use of rehabilitative therapies has fostered a shift in practice. The authors surmise that in the context of few randomised control trials, uncertainty of the dosage and intensity requirements of specific rehabilitative approaches, and the heterogeneity of dysphagia presentations post stroke, SLPs may continue to make therapy recommendations based foremost on client factors (i.e., cognition, medical acuity, motivation), clinician experience/training and service related constraints (i.e., access to instrumental assessment; service location and setting) in preference to the evidence base and/ or dysphagia clinical guidelines (i.e., Speech Pathology Australia, National Stoke Guidelines). Although the results of this study support the tenets of person-centred care, the limited agreement in dysphagia therapy utilisation among Australian SLPs, specifically the uptake of rehabilitative therapies, may leave certain subgroups of those with dysphagia post stroke (i.e., those with concomitant cognitive and communication impairments) susceptible to poorer outcomes. This paper highlights the need for further research into the use of dysphagia practices of Australian SLPs, with emphasis on fostering the translation of an expanding understanding of rehabilitative dysphagia therapies to practice. Furthermore, the results and discussion sections of this paper potentially provide clinicians with opportunities to “benchmark” their current dysphagia treatment practices and, perhaps more importantly, foster reflection about the factors that influence their clinical decision-making – challenging even the most experienced dysphagia clinician to consider their provision of best practice (i.e., underpinned by the emerging evidence around rehabilitation approaches and clinical guidelines) rather than the status quo of “usual care”.

approaches (i.e., exercise-based interventions such as the head lift and effortful swallow). The resulting shift in focus from predominantly maintaining swallowing safety to enabling long-term physiological changes to swallowing function, has had an undetermined influence on the dysphagia therapy practices and clinical decision-making of Australian SLPs. In this paper, Jones, Cartwright, Whitworth and Cox (2018) present the results of an exploratory survey of Australian SLPs (n = 118) providing dysphagia services to clients following a stroke. Specifically, the aims of their research were to (a) identify the range of compensatory/ rehabilitative dysphagia therapies being utilised by SLPs; (b) describe the consistency with which these therapies are being implemented; (c) determine whether compensatory or rehabilitation approaches were employed more frequently than the other, and (d) report the factors that influence SLPs’ recommendations for treatment. The data collected from the specifically designed 26- item online survey (see online supplementary material for a copy of the survey) is presented using descriptive statistics and content analysis. Consistent with the findings of similar studies of SLPs in the US, UK and Ireland, the implementation of dysphagia therapies by Australian SLPs post stroke is highly variable. On average, responding SLPs reported the use of 13–14 dysphagia therapies as part of their routine practice; with the greatest consistency of use noted for modified diets (97.46%), thickened fluids (94.07%) and postural strategies (94.07%). Of the top 10 most frequently utilised dysphagia therapies, only three were rehabilitative in nature and included supervised swallow trials with a bolus (72%), the effortful swallow exercise (50.66%) and the Shaker exercise (48%). Significant patterns of therapy utilisation were associated with years of clinical experience, work region and practice setting. Experienced SLPs (i.e., more than 7 years’ experience) employed the dysphagia therapies of modified body postures, pharyngeal expectoration and surface electromyography (sEMG) with greater consistency than those with less experience. SLPs in metropolitan locations reported a greater utilisation of the Massako manoeuvre, Mendelson exercise and Shaker exercise than those SLPs in rural and remote regions. Similarly, the rehabilitative approaches of Massako manoeuvre, Mendelson exercise, Shaker exercise and supervised swallow trials with a bolus were more frequently utilised in acute, subacute and outpatient settings in comparison to aged care and community settings.

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JCPSLP Volume 20, Number 3 2018

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