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It would be valuable for future research to focus on a larger range of thickened fluid samples making direct comparison to rheometry data provided by manufacturers of thickened fluids. This includes products from a range of different suppliers utilising a variety of thickening agents in addition to thickened fluid products with added nutritional supplementation. Compliance assessment of thickened fluids with added nutritional supplementation is of particular interest given the high number of patients requiring these products and the need for additional thickener with these products to ensure appropriate viscosity. With the introduction of IDDSI, further research examining the measurement of thickened fluids using the Flow Test compared with rheometry measurements would also be advantageous. Limitations This study has several significant limitations. The sample size of the number of thickened fluids audited was small and confined only to the range of nine pre-packaged thickened fluids provided to patients at the medium size hospital where the auditing took place. Furthermore, selection bias was present in the study impacting the study’s internal validity as there was a time gap of approximately three months between the samples audited using the Bostwick and those subsequently used in the LST and the Flow Test, leading to the potential for audited samples batches to be different. Also, five auditors completed the audits, increasing the potential rate of operational error. In addition, each sample was only rated once by a single rater, therefore interrater reliability was not assessed. It would have been highly advantageous to compare results from the three low technology devices to rheometry measurements in order to gain a complete understanding of the differences between each of the measuring methods. Conclusion This study utilised three low technology audit methods, the Bostwick, the Line Spread Test (LST) and the Flow Test to conduct an audit of pre-packaged thickened fluids to determine compliance against prescribed norms. Based on the results of this small pilot study, many of the thickened fluids audited were found to be non-compliant with prescribed norms and there was a only low level of agreement between the three audit methods as to which thickened fluid samples were compliant. Low levels of agreement found in this study suggest that further research would be beneficial to ensure auditing conducted with low technology tools is valid and reliable. References Adeleye, B., & Rachal, C. (2007). Comparison of the rheological properties of ready-to-serve and powdered instant food-thickened beverages at different temperatures for dysphagic patients. Journal of the American Dietetic Association , 107 (7), 1176–1182. Altman, K. W., Yu, G.-P., & Schaefer, S. D. (2010). Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Archives of Otolaryngology – Head & Neck Surgery , 136 (8), 784–789. Budke, J., Garcia, J. M., & Chambers IV, E. (2008). Comparisons of thickened beverages using line spread measurements. Journal of the American Dietetic Association , 108 (9), 1532–1535. Cho, H.-M., Yoo, W., & Yoo, B. (2015). Effect of NaCl addition on rheological behaviours of commercial gum-

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JCPSLP Volume 22, Number 2 2020

Journal of Clinical Practice in Speech-Language Pathology