Dysphagia Practice Patterns of Virginia Speech-Language Pathologists

Currently, there are a variety of screening tools, clinical, and instrumental assessments used by speech-language pathologists (SLPs) to diagnose dysphagia and plan for treatment. Anecdotal reports and empirical evidence suggest that dysphagia assessment and treatment practice patterns vary considerably across patient populations, work settings, and clinicians. Understanding the SLP assessment and treatment practices across settings and factors that may influence their decisions will help inform future directions in dysphagia education, training, and clinical practice components. These findings will enable the provision of quality care that will ultimately lead to positive patient health outcomes. Thus, this survey study was designed to obtain a comprehensive view of the dysphagia assessment and treatment practice patterns of speech–language pathologists in Virginia. The aim was to better understand the uses, availability, and perspectives as they relate to the clinician, patient, and practice-setting variables as well. A purposive sampling was employed to reach SLPs working in a variety of health care setting throughout the state through a single email blast sent to state organization, conferences, medical facilities, online-platforms (e.g. Facebook groups), and snowball recruitment. A total of 110 surveys were completed with 90 chosen for analysis after meeting the following inclusion criteria: 1) hold a speech-language pathology license from the Virginia Board of Audiology and Speech-Language Pathology; 2) hold Certificate of Clinical Competence from ASHA; and 3) have experience working with persons with dysphagia. The researcher developed and modified the survey based on the questionnaire used by Rumbach, Coombes, and Doeltgen (2017) in the study of Australian dysphagia practice patterns. Participants were provided a link for a survey via SurveyMonkey® from May to August 2018. The survey took approximately 11 minutes to complete. Results were analyzed descriptively and select questions were statistically analyzed using the Kruskal-Wallis and Mann-Whitney non-parametric tests. Individuals with less than 1-5 years of experience reported a significantly higher preference for using the Modified Barium Swallow Study (MBSS) to inform their overall treatment planning. Similarly, SLPs with advanced, specialty training showed a similar preference for using the MBSS to make initial and ongoing treatment planning decisions. With these exceptions, no other significant patterns were seen for treatment planning. Interestingly, this group reported that the CSE, however, was still their primary assessment tool used for assessing and treating clients with dysphagia. These findings suggest that although SLPs with less than 1-5 years of experience or specialty certifications and/trainings prefer the MBSS for treatment, their preferences for these assessment tools have yet to be implemented into their actual practices when assessing clients with dysphagia. This may also reflect availability of instrumental assessment tools. The majority of respondents (62%) reported that their choice of assessment tools was impacted by availability, time, and location. Regarding therapeutic interventions, diet modification and caregiver training were reported as the top treatment techniques used for managing clients with dysphagia, while neuromuscular electrical stimulation, sEMG biofeedback, and non-invasive brain stimulation was the least used therapy techniques. Results across all areas were indicated with high variable practice patterns for assessment and treatment of dysphagia in Virginia. Variability may be contributed to the needs of the patient, experience, location, and accessibility to assessment and treatment materials when providing dysphagia services