Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice

@article{McCurtin2017WhyDC,
  title={Why do clinicians choose the therapies and techniques they do? Exploring clinical decision-making via treatment selections in dysphagia practice},
  author={Arlene McCurtin and Chiara Healy},
  journal={International Journal of Speech-Language Pathology},
  year={2017},
  volume={19},
  pages={69 - 76}
}
  • A. McCurtin, Chiara Healy
  • Published 2 January 2017
  • Medicine, Psychology
  • International Journal of Speech-Language Pathology
Abstract Purpose: Speech-language pathologists (SLPs) are assumed to use evidence-based practice to inform treatment decisions. However, the reasoning underpinning treatment selections is not well known. Understanding why SLPs choose the treatments they do may be clarified by exploring the reasoning tied to specific treatments such as dysphagia interventions. Method: An electronic survey methodology was utilised. Participants were accessed via the gatekeepers of two national dysphagia special… 

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References

SHOWING 1-10 OF 43 REFERENCES

What are the primary influences on treatment decisions? How does this reflect on evidence-based practice? Indications from the discipline of speech and language therapy.

TLDR
Factors influencing decision making did not clearly align with the four pillars of EBP, the principal influences being practice evidence and pragmatic constraints.

'We don't have recipes; we just have loads of ingredients': explanations of evidence and clinical decision making by speech and language therapists.

TLDR
The findings emerging from the data reflect the complexities and paradoxes of clinical practice as described by SLTs, and show that treatment decisions are scaffolded primarily on practice evidence.

Dysphagia Evaluation Practices of Speech and Language Therapists in Ireland: Clinical Assessment and Instrumental Examination Decision-Making

TLDR
The results showed clinician variability regarding which components are included in a bedside clinical examination of swallowing, with a high degree of consistency for only 11 of the 20 components.

Accessing the evidence to treat the dysphagic patient: Can we get it? Is there time?

TLDR
Questions about the speech pathologist's exposure to and attitudes towards evidence-based healthcare in the management of patients with dysphagia are explored and suggestions for strategies that may assist the profession in ensuring anevidence-based practice are outlined.

Dysphagia Evaluation Practices: Inconsistencies in Clinical Assessment and Instrumental Examination Decision-Making

TLDR
The results revealed that clinicians who responded to the survey differ somewhat regarding which components they include in a clinical examination of swallowing, and consistency of clinical decision-making (instrumental vs. non instrumental) given specific patient scenarios.

Dysphagia therapy in stroke: a survey of speech and language therapists.

TLDR
This survey gives valuable insight into the direct dysphagia therapy practices of speech and language therapists based in the UK and Ireland working in stroke and highlights discrepancies between reported approaches and recommendations from existing evidence and clinical guidelines.

Effects of Therapy in Oropharyngeal Dysphagia by Speech and Language Therapists: A Systematic Review

TLDR
A systematic review is given of the literature on the effects of therapy in oropharyngeal dysphagia carried out by speech therapists, and statistically significant positive therapy effects were found.

Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part II--impact of dysphagia treatment on normal swallow function.

TLDR
The behavioral treatments investigated were three postural interventions--side lying, chin tuck, and head rotation--and four swallowing maneuvers--effortful swallow, the Mendelsohn maneuver, supraglottic swallow, and super-supraglotti swallow.

Dysphagia treatment post stroke: a systematic review of randomised controlled trials.

TLDR
Emerging evidence is presented that nasogastric tube feeding is not associated with a higher risk of death compared to percutaneous feeding tubes; and general dysphagia therapy programmes are related with a reduced risk of pneumonia in the acute stage of stroke.

Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part III--impact of dysphagia treatments on populations with neurological disorders.

TLDR
Limited evidence from seven studies shows the potential effects of dysphagia behavioral interventions for select groups of individuals with neurologically induced dysphagias, but further research is needed to evaluate the effectiveness of these and the remaining interventions with various populations with neurological disorders.