Assessment of swallowing and referral to speech and language therapists in acute stroke.
The best clinical assessment of swallowing following acute stroke, in order to decide whether to refer a patient to a speech and language therapist (SLT), is uncertain. Independently of the managing clinical team, we prospectively investigated 115 patients (51 male) with acute stroke, mean age 75 years (range 24-94) within 72 h of admission, using a questionnaire, structured examination and timed water swallowing test. Outcome variables included referral to and intervention by a speech and language therapist (SLT), dietary modification, respiratory complications and death. Of those patients in whom an SLT recommended intervention, 97% were detected by an abnormal quantitative water swallowing test; specificity was 69%. An SLT was very unlikely to recommend any intervention if the test was normal. Inability to perform a water test and/or abnormality of the test was associated with significantly increased relative risks of death, chest infection and dietary modification. A timed water swallowing test can be a useful test of swallowing and may be used to screen patients for referral to a speech and language therapist after acute stroke. (+info)
Therapy outcome measures for allied health practitioners in Australia: the AusTOMs.
OBJECTIVE: The aim of this study was to develop a valid and reliable measure of therapy outcome for three allied health professions in Australia: speech pathology, occupational therapy, and physiotherapy. The Australian Therapy Outcome Measures (AusTOMs) enable measurement of the differences in client profiles and patterns of services provision across health care settings. In this paper we describe phase 1 of the study: the development and preliminary validation of the AusTOMs. METHOD: The UK TOMs, developed by Enderby, were scrutinized by the research team. A pilot core scale was developed, based on the structure of the TOM. Focus groups of expert clinicians for each profession, across the state of Victoria in Australia, analysed and refined the scales further. A mail-out survey was then sent to therapists across Australia to assess both face and content validity of the AusTOMs. MAIN RESULTS: A new tool, the AusTOM, was developed and tailored to the needs of each profession, with input from specialist clinicians and allied health researchers. The face and content validity of the new scales were assessed, and good consensus was obtained for the wording and content validity of the scales. The discriminative validity, concurrent validity, and reliability of the tool are now being evaluated. CONCLUSION: We have produced an outcome measure in the Australian context for speech pathology, physiotherapy, and occupational therapy. There are six speech pathology scales, nine physiotherapy scales, and 11 occupational therapy scales in the AusTOMs. A clinician chooses the relevant scale(s) for the client (based on the goals of therapy) and makes a rating across all domains for each scale. Further papers will report on the reliability, validity, and clinical usefulness of the AusTOMs. (+info)
Validity of the AusTOM scales: a comparison of the AusTOMs and EuroQol-5D.
BACKGROUND: Clinicians require brief outcome measures in their busy daily practice to document global client outcomes. Based on the UK Therapy Outcome Measure, the Australian Therapy Outcome Measures were designed to capture global therapy outcomes of occupational therapy, physiotherapy and speech pathology in the Australian clinical context. The aim of this study was to investigate the construct (convergent) validity of the Australian Therapy Outcome Measures (AusTOMs) by comparing it with the EuroQuol-5D (EQ-5D). METHODS: The research was a prospective, longitudinal cohort study, with data collected over a seven month time period. The study was conducted at a total of 13 metropolitan and rural health-care sites including acute, sub-acute and community facilities. Two-hundred and five clients were asked to score themselves on the EQ-5D, and the same clients were scored by approximately 115 therapists (physiotherapists, speech pathologists and occupational therapists) using the AusTOMs at admission and discharge. Clients were consecutive admissions who agreed to participate in the study. Clients of all diagnoses, aged 18 years and over (a criteria of the EQ-5D), and able to give informed consent were scored on the measures. Spearman rank order correlation coefficients were used to analyze the relationships between scores from the two tools. The clients were scored on the AusTOMs and EQ-5D. RESULTS: There were many health care areas where correlations were expected and found between scores on the AusTOMs and the EQ-5D. CONCLUSION: In the quest to measure the effectiveness of therapy services, managers, health care founders and clinicians are urgently seeking to undertake the first step by identifying tools that can measure therapy outcome. AusTOMs is one tool that can measure global client outcomes following therapy. In this study, it was found that on the whole, the AusTOMs and the EQ-5D measure similar constructs. Hence, although the validity of a tool is never 'proven', this study offers preliminary support for the construct validity of AusTOMs. (+info)
Role of videoendoscopy in phoniatrics: data from three years of daily practice.
Phoniatrics is the medical specialty involved in the management of communication and swallowing disorders. Videoendoscopy plays an important role in the assessment of various disorders in the clinical practice of phoniatrics: the voice as well as the speech and swallowing mechanisms can be analysed through this procedure. Aim of the study is to describe videoendoscopic application in daily phoniatric practice: data on 1627 participants, consecutively examined, are reported. A total of 2004 videoendoscopy examinations were performed between March 1999 and December 2002. Study population comprising 1627 patients (716 male, 911 female); age ranged from 0.6 to 97 years. The following parameters were considered: a) function to be assessed through videoendoscopy (voice, speech, swallowing, other); b) phoniatric nosological chapter in participants with a recognized disease; c) age of participant; d) occupation of participant; d) medical discipline related to disease identified. Three populations were analysed: study population (1627 subjects), subjects requiring phoniatric consultation for voice and swallowing assessment. The participants examined endoscopically required a phoniatric consultation in order to have a voice or a swallowing assessment, respectively, in 67% and 20% of the cases. In 411 out of 1095 (37.5%) voice evaluations, no disorder was identified, while in most of the swallowing assessments (93.1%), a clear dysphagic disorder was detected. A bimodal distribution appeared in the 1627 participants and in the voice population with a first peak at age 20-40 years and a second peak at age 50-70. In the swallowing population, the number of participants examined appeared to increase with age. In the swallowing population, pensioners and clerks represent almost 80% of the population; in the total population, as well as in the voice populations, pensioners as well as teachers, singers and students are well represented. In most cases (52.5%), no clear disease was present. The two areas of disease most represented were otorhinolaryngology and neurology. (+info)
Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint.
As a result of technology evolution and development, methods of voice evaluation have changed both in medical and speech and language pathology practice. AIM: To relate the results of perceptual evaluation, acoustic analysis and medical evaluation in the diagnosis of vocal and/or laryngeal affections of the population with vocal complaint. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: 29 people that attended vocal health protection campaign were evaluated. They were submitted to perceptual evaluation (AFPA), acoustic analysis (AA), indirect laryngoscopy (LI) and telelaryngoscopy (TL). RESULTS: Correlations between medical and speech language pathology evaluation methods were established, verifying possible statistical signification with the application of Fischer Exact Test. There were statistically significant results in the correlation between AFPA and LI, AFPA and TL, LI and TL. CONCLUSION: This research study conducted in a vocal health protection campaign presented correlations between speech language pathology evaluation and perceptual evaluation and clinical evaluation, as well as between vocal affection and/or laryngeal medical exams. (+info)
Measuring communicative participation: a review of self-report instruments in speech-language pathology.
PURPOSE: To assess the adequacy of self-report instruments in speech-language pathology for measuring a construct called communicative participation. METHOD: Six instruments were evaluated relative to (a) the construct measured, (b) the relevance of individual items to communicative participation, and (c) their psychometric properties. RESULTS: No instrument exclusively measured communicative participation. Twenty-six percent (n = 34) of all items (N = 132) across the reviewed instruments were consistent with communicative participation. The majority (76%) of the 34 items were associated with general communication, while the remaining 24% of the items were associated with communication at work, during leisure, or for establishing relationships. Instruments varied relative to psychometric properties. CONCLUSIONS: No existing self-report instruments in speech-language pathology were found to be solely dedicated to measuring communicative participation. Developing an instrument for measuring communicative participation is essential for meeting the requirements of our scope of practice. (+info)
The efficacy of interactive lecturing for students with diverse science backgrounds.
Learning is an active process, and, as such, interactive lectures are considered as the educational best practice. This study investigated the efficacy of interactive lecturing in a module of eight respiratory physiology lectures in a second-year Physiology course with two distinct subcohorts: students with strong science backgrounds and those without. The comparison of student performance in the summative examinations of respiratory physiology allowed us to evaluate the efficacy of interactive lecturing for each subcohort. Formal teaching evaluations were used to gauge the students' perception of interactive lectures. To further validate our findings, we repeated the study in the following year. The introduction of interactive lecturing significantly improved learning outcomes, with this improvement being maintained for the period of this study. Furthermore, students with limited prior knowledge, who had typically performed very poorly in this module, achieved a similar learning outcome to those students with a good science background. From these summative results and the students' perceptions, we concluded that students that are alert, motivated and interested in the subject, and engaged in learning activities and that are being encouraged to think and receive constant feedback on their progress will become confident in their learning abilities and have improved learning outcomes. (+info)
An assessment of the information-seeking abilities and needs of practicing speech-language pathologists.
OBJECTIVES: This study assessed the information-seeking practices and needs of speech-language pathologists (SLPs). Improved understanding of these needs can inform librarians and educators to better prepare students in principles and methods of evidence-based practice (EBP) and, through continuing education (CE), promote the integration of EBP into clinical practice of SLPs. METHODS: A 16-question survey was mailed to 1,000 certified speech-language pathologists in the United States. RESULTS: Two hundred and eight usable surveys were returned for a response rate of 21%. For clinical questions, SLPs most often consulted with a colleague, participated in CE activities, and searched the open Internet. Few respondents relied on scholarly journal articles for assistance with clinical cases. The most prominent barriers to finding appropriate information were time and knowledge of where and how to find relevant information. Few reported having information literacy instruction by a librarian. DISCUSSION: If EBP is to become a viable practice in clinical decision making, there appears to be a tremendous need for information literacy instruction in the university curriculum, as well as through CE activities for currently practicing SLPs. Given respondents' reported lack of time and limited access to full-text journals containing evidence relevant to clinical practice, the field of speech-language pathology will need to generate readily accessible clinical summaries of research evidence through meta-analyses, systematic reviews, and clinical practice guidelines. (+info)