Speech-language pathologists’ perspectives of dysphagia following reperfusion therapies: An Australian mixed-methods study

Minchell, Ellie; Rumbach, Anna F.; Finch, Emma

doi:10.1080/17549507.2022.2140830

Cited by 3 publications

(8 citation statements)

References 43 publications

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“…The goal of this study was not to analyse different dysphagia screening methods, and we cannot exclude the possibility that other screening methods have better screening performance than SSA for this specific population of patients. In a recent study of stroke patients undergoing MT and/or thrombolysis, the Gugging Swallowing Screen (GUSS) identified dysphagia in about 90% of patients in the first 72 h after reperfusion therapy, 9 which could suggest a better sensitivity for this screening method. However, this study had a small study population ( n = 26), and no comprehensive clinical or instrumental swallowing assessment which could serve as a reference for the analysis of the screening performance of GUSS was available.…”

Section: Discussionmentioning

confidence: 99%

“…7 There are few studies addressing the frequency and characteristics of dysphagia and the performance of dysphagia screening tests in this group of patients, and there are still open questions related to the optimal strategy of swallowing assessment. 8,9 Current international guidelines for the diagnosis of post-stroke dysphagia recommend a detailed dysphagia assessment for stroke patients who fail a dysphagia screen and for patients who present risk factors for post-stroke dysphagia. 10 A detailed dysphagia assessment, including comprehensive clinical swallowing assessment and instrumental swallowing assessment, allows not only to identify the presence of dysphagia and the risk of aspiration, but is also able to further characterize the type and severity of dysphagia and to provide dietary recommendations.…”

Section: Introductionmentioning

confidence: 99%

“…Mechanical thrombectomy (MT), with or without intravenous thrombolysis, has become the standard of care for acute stroke patients with large vessel occlusion in the last decade 7 . There are few studies addressing the frequency and characteristics of dysphagia and the performance of dysphagia screening tests in this group of patients, and there are still open questions related to the optimal strategy of swallowing assessment 8,9 . Current international guidelines for the diagnosis of post‐stroke dysphagia recommend a detailed dysphagia assessment for stroke patients who fail a dysphagia screen and for patients who present risk factors for post‐stroke dysphagia 10 .…”

Section: Introductionmentioning

confidence: 99%

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Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

Pinho,

Meyer,

Mall

et al. 2024

Ann Clin Transl Neurol

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ObjectiveThe aims of the study were to (1) characterize the findings of flexible endoscopic evaluation of swallowing (FEES) in stroke patients undergoing mechanical thrombectomy (MT); (2) analyse the screening performance of the Standardized Swallowing Assessment (SSA); and (3) study the impact of FEES‐defined dysphagia on 3‐month outcomes.MethodsThis single‐centre study was based on a local registry of consecutive acute ischaemic stroke patients undergoing MT during a 1‐year period. Patients received FEES within 5 days of admission regardless of the result of dysphagia screening. We compared baseline demographic and clinical characteristics of patients with and without FEES‐defined dysphagia. We collected 3‐month modified Rankin Scale (mRS) and individual index values of the European Quality of Life 5 Dimensions (EQ‐5D‐iv). Using univariable and multivariable regression analyses we predicted 3‐month outcomes for presence of dysphagia and for FEES‐defined dysphagia severity.ResultsWe included 137 patients with a median age of 74 years, 43.1% were female, median NIHSS was 12 and successful recanalization was achieved in 92.7%. Stroke‐associated pneumonia occurred in 8% of patients. FEES‐defined dysphagia occurred in 81% of patients. Sensitivity of the SSA as a dysphagia screening was 67%. Presence of dysphagia and increasing severity of dysphagia were independently associated with increasing 3‐month mRS score. Increasing dysphagia severity dysphagia was independently associated with lower EQ‐5D‐iv.InterpretationEarly FEES‐defined dysphagia occurs in four in every five patients undergoing MT. SSA has a suboptimal dysphagia screening performance. Presence of dysphagia and increasing dysphagia severity predict worse functional outcome and worse health‐related quality‐of‐life.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

Pinho,

Meyer,

Mall

et al. 2024

Ann Clin Transl Neurol

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“…Due to the limited understanding of the continuum of dysphagia recovery following EVT and thrombolysis, management pathways for dysphagia are unclear for SLPs and the wider medical team. A 2022 mixed-methods survey of 62 Australian SLPs found inconsistencies in the management of dysphagia following reperfusion therapies across Australia, with SLPs also reporting various changes in dysphagia presentation in the acute stage post-stroke [ 12 ]. Dysphagia was reported to be more fluctuant following EVT and/or thrombolysis, resulting in increased need for repeat clinical swallowing assessment, as well as a reduced incidence rates of dysphagia of a moderate severity [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…A 2022 mixed-methods survey of 62 Australian SLPs found inconsistencies in the management of dysphagia following reperfusion therapies across Australia, with SLPs also reporting various changes in dysphagia presentation in the acute stage post-stroke [ 12 ]. Dysphagia was reported to be more fluctuant following EVT and/or thrombolysis, resulting in increased need for repeat clinical swallowing assessment, as well as a reduced incidence rates of dysphagia of a moderate severity [ 12 ]. Dysphagia was reported to be severe in cases of unsuccessful reperfusion therapies.…”

Section: Introductionmentioning

confidence: 99%

Acute Dysphagia Following Reperfusion Therapies: A Prospective Pilot Cohort Study

et al. 2023

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Dysphagia is a well-documented sequela of stroke. Recent advancements in medical treatments for stroke include reperfusion therapies (endovascular thrombectomy (EVT) and thrombolysis). As outcomes following reperfusion therapies are typically measured via general functional scales, the pattern and progression of acute dysphagia following reperfusion therapies is less known. To determine the progression of acute dysphagia (0–72 h) following reperfusion therapies and relationships between various stroke parameters and dysphagia, twenty-six patients were prospectively recruited across two EVT and thrombolysis centres in Brisbane, Australia. Dysphagia was screened via the Gugging Swallowing Screen (GUSS) at the bedside at three timepoints: 0–24 h, 24–48 h, and 48–72 h post-reperfusion therapies. Across three groups (EVT only, thrombolysis only, or both), the incidence of any dysphagia within the first 24 h of reperfusion therapy was 92.31% (n = 24/26), 91.30% (n = 21/23) by 48 h, and 90.91% (n = 20/22) by 72 h. Fifteen patients presented with severe dysphagia at 0–24 h, 10 at 24–48 h, and 10 at 48–72 h. Whilst dysphagia was not significantly correlated to infarct penumbra/core size, dysphagia severity was significantly related to the number of passes required during EVT (p = 0.009).Dysphagia continues to persist in the acute stroke population despite recent advancements in technology aimed to reduce morbidity and mortality post-stroke. Further research is required to establish protocols for management of dysphagia post-reperfusion therapies.

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Growing our evidence: Development, direction, and dissemination

Cardell,

Munro

2023

International Journal of Speech-Language Pathology

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Speech-language pathologists’ perspectives of dysphagia following reperfusion therapies: An Australian mixed-methods study

Cited by 3 publications

References 43 publications

Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

Early flexible endoscopic evaluation of swallowing after mechanical thrombectomy in stroke patients

Acute Dysphagia Following Reperfusion Therapies: A Prospective Pilot Cohort Study

Growing our evidence: Development, direction, and dissemination

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