Purpose Oral trials, otherwise known as swallow trials or tasters, are widely used in dysphagia management. However, to date, no studies have investigated the effectiveness of oral trials or outlined how the approach is utilized in everyday practice. This article aims to start a dialogue regarding this much-used but little-evidenced dysphagia intervention by exploring three main aspects to (a) identify the patient demographics and environments in which oral trials are used in hospital, (b) explore clinical decision making around the approach, and (c) consider clinical implications around current findings and future areas for research. Method A cross-sectional examination of 118 patients on the dysphagia caseload of a United Kingdom–based inpatient speech and language therapy team was conducted. Statistical analysis explored demographic differences between oral trials groups and the rest of the dysphagia caseload. Results Twenty-three of 118 (19.5%) individuals on the caseload were or had been on oral trials during admission. Individuals in the oral trials group were significantly more likely to have a neurological diagnosis than the full oral intake group (78.3% vs. 30.5%, p < .001). There was a lack of uniformity in oral trials recommendations, and the rationale behind quantity and types of diet or fluids offered was unclear. Conclusions This study begins to evidence the use of a dysphagia therapy not previously explored within existing literature. It highlights the wide use of oral trials within the hospital trust observed. Based on current evidence, it would be difficult for clinicians to know how to implement oral trials as an intervention. Further research is required both to explore the effectiveness of this approach and also to develop a consensus within practice around how, why, and when oral trials are offered. This would ensure an equitable and effective service is offered and would ensure a high standard of evidence-based practice within dysphagia management.
Background:The lack of high-quality evidence to support specific treatment approaches has been widely documented in the existing literature, with evidence suggesting speech and language therapists (SLTs) frequently rely on experience and expert opinion to inform treatment. One approach that is commonly used within dysphagia management, in spite of a lack of existing evidence to support its efficacy, is the use of oral trials, otherwise known as swallow trials or tasters. This approach involves offering specified, limited amounts of oral diet or fluids for those at risk of aspiration or choking if full amounts are taken orally and may be recommended for rehabilitation or quality of life. Methods & Procedures: A total of nine SLTs working in one acute hospital volunteered to participate in focus groups in order to discuss their experience and clinical reasoning for using oral trials within one inpatient hospital setting in the UK. The objectives of this study were (1) to explore how oral trials are used within one inpatient hospital; (2) to consider the barriers and facilitators to the approach; and (3) to consider why this approach may be favoured over other evidenced dysphagia therapies. A grounded theory approach was used to guide data analysis, using two independent coders to identify themes within the focus groups.Outcomes & Results: Analysis of data revealed the following themes: (1) delivering oral trials requires 'a whole team approach'; (2) SLTs vary recommendations based on patient and environmental factors; and (3) oral trials as a holistic approach.Conclusions & Implications: The use of oral trials was considered by SLTs to be a holistic and flexible approach which can be adapted to a range of patient and environmental factors. Although clinical experience guided rationale, an understanding of the principles of neuroplasticity and swallow physiology was also integral to the approach. Further research is warranted to investigate the use and efficacy of oral trials across the SLT community and within specific patient groups and different environments.
Rationale, aims and objectives: Oral trials, otherwise known as swallow trials or tasters, are widely used in dysphagia management. However, to date, no studies have investigated the effectiveness of oral trials or outlined how the approach is utilised in everyday practice. This paper aims to (1) Identify the patient demographics and environments in which oral trials are used in hospital. (2) Explore clinical decision-making around the approach. Method: A cross-sectional examination of 118 patients on the dysphagia caseload of a UK-based inpatient Speech and Language Therapy team was conducted. Statistical analysis explored demographic differences between oral trials groups and the rest of the dysphagia caseload. Results: 19.5% (23/118) of individuals on the caseload were or had been on oral trials during admission. Individuals in the oral trials group were significantly more likely to have a neurological diagnosis than the full oral intake group (78.3% vs 30.5%, p<0.001). There was a lack of uniformity in oral trials recommendations and the rationale behind quantity and types of diet or fluids offered was unclear. Conclusions: This study begins to evidence the use of a dysphagia therapy not previously explored within existing literature. It highlights the wide use of oral trials within the hospital observed. Neurological diagnosis was a key predictor of belonging to the oral trials group. Further research into the effectiveness and implementation of oral trials is warranted.
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