Advertisement

Dysphagia

, Volume 23, Issue 4, pp 378–384 | Cite as

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

  • Jeri A. LogemannEmail author
  • Alfred Rademaker
  • Barbara Roa Pauloski
  • Jodi Antinoja
  • Mary Bacon
  • Michelle Bernstein
  • Joy Gaziano
  • Barbara Grande
  • Lisa Kelchner
  • Amy Kelly
  • Bernice Klaben
  • Donna Lundy
  • Lisa Newman
  • Daphne Santa
  • Linda Stachowiak
  • Carrie Stangl-McBreen
  • Cory Atkinson
  • Heidi Bassani
  • Melissa Czapla
  • Julie Farquharson
  • Kristin Larsen
  • Vicki Lewis
  • Heather Logan
  • Teri Nitschke
  • Sharon Veis
Original Article

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.

Keywords

Oral feeding Nonoral feeding Videofluoroscopy Oropharyngeal dysphagia Deglutition Deglutition disorders 

References

  1. 1.
    Logemann JA. Evaluation and treatment of swallowing disorders, 2nd ed. Austin, TX: Pro-Ed, 1998.Google Scholar
  2. 2.
    Bateman C, Leslie P, Drinnan MJ. Adult dysphagia assessment in the UK and Ireland: Are SLTs assessing the same factors? Dysphagia 2007;22:174–86.CrossRefPubMedGoogle Scholar
  3. 3.
    Cameron JL, Mitchell WH, Zuidema GD. Aspiration pneumonia: clinical outcome following documented aspiration. Arch Surg 1973;106:49–52.PubMedGoogle Scholar
  4. 4.
    Holas MA, DePippo KL, Reding MJ. Aspiration and relative risk of medical complications following stroke. Arch Neurol 1994;51:1051–3.PubMedGoogle Scholar
  5. 5.
    Linden P, Siebens AA. Dysphagia: predicting laryngeal penetration. Arch Phys Med Rehabil 1983;64:281–4.PubMedGoogle Scholar
  6. 6.
    Pikus L, Levine MS, Yang YX, Rubesin SE, Katzka DA, Laufer I, Gefter WB. Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. AJR Am J Roentgenol 2003;180:1613–6.PubMedGoogle Scholar
  7. 7.
    Schmidt J, Holas M, Halvorson K, Reding M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia 1994;9:7–11.CrossRefPubMedGoogle Scholar
  8. 8.
    Teasell RW, McRae M, Heitzner J, Bhardwaj A, Finestone H. Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study. Arch Phys Med Rehabil 1999;80:294–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Fleiss JL. Statistical Methods for Rates and Proportions, 3rd ed. New York: Wiley, 2003.Google Scholar
  10. 10.
    Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;3:159–74.CrossRefGoogle Scholar
  11. 11.
    Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–48.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jeri A. Logemann
    • 1
    • 15
    Email author
  • Alfred Rademaker
    • 2
  • Barbara Roa Pauloski
    • 1
  • Jodi Antinoja
    • 3
  • Mary Bacon
    • 4
  • Michelle Bernstein
    • 5
  • Joy Gaziano
    • 6
  • Barbara Grande
    • 7
  • Lisa Kelchner
    • 8
  • Amy Kelly
    • 9
  • Bernice Klaben
    • 10
  • Donna Lundy
    • 5
  • Lisa Newman
    • 11
  • Daphne Santa
    • 12
  • Linda Stachowiak
    • 6
  • Carrie Stangl-McBreen
    • 13
  • Cory Atkinson
    • 13
  • Heidi Bassani
    • 11
  • Melissa Czapla
    • 6
  • Julie Farquharson
    • 13
  • Kristin Larsen
    • 13
  • Vicki Lewis
    • 6
  • Heather Logan
    • 13
  • Teri Nitschke
    • 14
  • Sharon Veis
    • 13
  1. 1.Department of Communication Sciences and DisordersNorthwestern UniversityEvanstonUSA
  2. 2.Department of Preventive MedicineRobert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicagoUSA
  3. 3.Froedtert Memorial HospitalMilwaukeeUSA
  4. 4.Audiology and Speech Pathology (126), Hines VA Medical CenterHinesUSA
  5. 5.Department of OtolaryngologyUniversity of Miami Hospital Medical CenterMiamiUSA
  6. 6.H. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  7. 7.St. Joseph Regional Medical CenterMilwaukeeUSA
  8. 8.CAHS-Communication Sciences and DisordersUniversity of CincinnatiCincinnatiUSA
  9. 9.Speech Pathology DepartmentEvanston Northwestern HealthcareEvanstonUSA
  10. 10.Blaine Block Institute for Voice Analysis and RehabilitationDaytonUSA
  11. 11.Army Audiology & Speech CenterWalter Reed Army Medical CenterWashingtonUSA
  12. 12.Audiology and Speech (126)Miami VA Medical CenterMiamiUSA
  13. 13.Northwestern Memorial HospitalChicagoUSA
  14. 14.Zablocki VA Medical CenterMilwaukeeUSA
  15. 15.Northwestern UniversityEvanstonUSA

Personalised recommendations