, Volume 19, Issue 3, pp 165–176 | Cite as

Oropharyngeal Dysphagia: Surveying Practice Patterns of the Speech–Language Pathologist

  • Rosemary Martino
  • Gaylene Pron
  • Nicholas E. Diamant


The present study was designed to obtain a comprehensive view of the dysphagia assessment practice patterns of speech–language pathologists and their opinion on the importance of these practices using survey methods and taking into consideration clinician, patient, and practice-setting variables. A self-administered mail questionnaire was developed following established methodology to maximize response rates. Eight dysphagia experts independently rated the new survey for content validity. Test–retest reliability was assessed with a random sample of 23 participants. The survey was sent to 50 speech–language pathologists randomly selected from the Canadian professional association database of members who practice in dysphagia. Surveys were mailed according to the Dillman Total Design Method and included an incentive offer. High survey (64%) and item response (95%) rates were achieved and clinicians were reliable reporters of their practice behaviors (ICC>0.60). Of all the clinical assessment items, 36% were reported with high (>80%) utilization and 24% with low (<20%) utilization, the former pertaining to tongue motion and vocal quality after food/fluid intake and the latter to testing of oral sensation without food. One-third (33%) of instrumental assessment items were highly utilized and included assessment of bolus movement and laryngeal response to bolus misdirection. Overall, clinician experience and teaching institutions influenced greater utilization. Opinions of importance were similar to utilization behaviors (r = 0.947, p = 0.01). Of all patients referred for dysphagia assessment, full clinical assessments were administered to 71% of patients but instrumental assessments to only 36%. A hierarchical model of practice behavior is proposed to explain this pattern of progressively decreasing item utilization.


Dysphagia Practice patterns Survey Clinical Instrumental Deglutition Deglutition disorders 



The authors thank the following dysphagia experts for their involvement in item generation: Cathy Lazarus, Jeri A. Logemann, JoAnne Robbins, Barbara C. Sonies, and Jonathan Aviv.


  1. 1.
    Association American Speech-Language-Hearing1999Omnibus Survey: Caseload Report: SLPASLHARockville, MDGoogle Scholar
  2. 2.
    Ontario Speech-Language-Hearing Association1999Average for Communication versus Swallowing in Adults. Health Care Professional Interest GroupOSLHATorontoGoogle Scholar
  3. 3.
    McCullough, GH, Wert, RT, Rosenbak, JC, Dinneen, C 1999Clinicians’ preferences and practices in conducting clinical/bedside and videofluoroscopic swallowing examinations in an adult, neurogenic populationAm J Speech Lang Pathol8149163Google Scholar
  4. 4.
    Mangione, TW 1995Mail Surveys: Improving the Quality. Sage Publications IncThousand Oaks, CAGoogle Scholar
  5. 5.
    Health Services, Group 1992Small-area variations: What are they and what do they mean?Can Med Assoc J146467470Google Scholar
  6. 6.
    Feinstein, AR 1987Chapter 2: Nomenclature and functional classification of clinimetric indexes.,  eds. ClinemetricsYale University PressNew Haven, CT621Google Scholar
  7. 7.
    Donner, A, Eliasziw, M 1987Sample size requirements for reliability studiesStat Med6441448PubMedGoogle Scholar
  8. 8.
    Aday, LA 1996Designing and Conducting Health Surveys: A Comprehensive Guide, Vol. 2Jossey-Bass IncSan Francisco, CAGoogle Scholar
  9. 9.
    Dillman, DA 2000Mail and Internet Surveys: The Tailored Design Method2WileyNew YorkGoogle Scholar
  10. 10.
    Streiner, DL, Norman, GR 1995Health Measurement Scales: A Practical Guide to Their Development and UseOxford University PressNew YorkGoogle Scholar
  11. 11.
    Rosenbek, JC, Robbins, JA, Roecker, EB, Coyle, JL, Wood, JL 1996A penetration-aspiration scaleDysphagia119398PubMedGoogle Scholar
  12. 12.
    Roos, NP, Roos, LL 1991Small area variations, practice style, and quality of careWenzel, RP eds. Assessing Quality of Care: Prospectives for CliniciansWilliams & WilliamsBaltimore223238Google Scholar
  13. 13.
    Martino, R, Pron, G, Diamant, NE 2000Screening for oropharyngeal dysphagia in stroke: Insufficient evidence for guidelinesDysphagia151930PubMedGoogle Scholar
  14. 14.
    Kidd, D, Lawson, J, Nesbitt, R, MacMahan, J 1993Aspiration in acute stroke: A clinical study with videofluoroscopyQ J M86825829Google Scholar
  15. 15.
    Holas, MA, DePipp, KL, Reding, MJ 1994Aspiration and relative risk of medical complications following strokeArch Neurol5110511053PubMedGoogle Scholar
  16. 16.
    Association American Speech-Language-Hearing1998Clinical indicators for instrumentation assessment of dysphagiaASLHARockville, MDGoogle Scholar
  17. 17.
    Martino R, Meisssner–Fishbein B, Saville D, Barton D, Kerry V, Kodama S, Lbas–Weber M, McVilltie A, Mintz T, Tamas I: Preferred Practice Guidelines for dysphagia. College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO), 2000 (
  18. 18.
    Logemann, JA 1993Manual for the Videofluorographic Study of Swallowing, Vol 2Pro-EdAustin, TXGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Rosemary Martino
    • 1
  • Gaylene Pron
    • 2
  • Nicholas E. Diamant
    • 3
  1. 1.Departments of Speech Language Pathology and the Toronto Western Research Institute, University of Toronto and Department of Speech Language PathologyUniversity Health NetworkTorontoCanada
  2. 2.Departments of Public Health Service, Clinical Epidemiology and Health Care Research ProgramUniversity of TorontoTorontoCanada
  3. 3.Departments of Speech Language Pathology, Gastroenterology Medicine, Physiology, and the Toronto Western Research InstituteUniversity of Toronto, Department of Speech Language Pathology and Gastroenterology Medicine, University Health NetworkTorontoCanada

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