What is "Usual Care" in Dysphagia Rehabilitation: A Survey of USA Dysphagia Practice Patterns

The scope of dysphagia rehabilitation has been expanding. Therapeutic approaches have begun to move away from the use of behavioral compensations and maneuvers only, toward a greater emphasis on research-supported exercise-based therapies. Given the change in focus and demand for evidence-based practice, this study surveyed licensed speech language pathologists who treat dysphagic adults to ascertain the utilization of exercise-based techniques and supportive research in treatment decision-making. A web-based survey was created using Qualtrics online software. The survey consisted of 29 questions on demographics and treatment options for a deidentified patient in a video-supported fictional scenario. Initially, a field test was conducted by sending the survey to a sample population of 12 local speech pathologists working in adult dysphagia rehabilitation. Responses were collated and analyzed for item agreement and internal consistency. A blast e-mail containing a link to the modified survey was then sent out to members of the American Speech Language Hearing Association Special Interest Group 13. Participants were given 2 months to complete the survey. A total of 254 responses were analyzed using descriptive, correlative, and associative methods. Respondents were experienced speech-language pathologists (SLP) working in primarily acute and rehabilitation settings and treating more than 50 dysphagic cases in a 6-month period. They reported treating dysphagic patients daily for an average of 30 min a session. Follow-up of treated patients was infrequent. Most respondents reported using self-developed assessment techniques, and as a group they recommended 47 different treatment techniques and more than 90 different treatment combinations for the same hypothetical patient case. The majority of respondents also described the common outcome of dysphagia treatment as returning a patient to a safe and functional oral diet, but not preinjury status. Results demonstrate a lack of uniformity in the treatment schemes and strategies used by SLP to treat dysphagic patients. The concept of "usual care practice" for dysphagia is not supported. Utilization of research-supported assessment techniques and exercise-based approaches was also sparse. These data clearly highlight ongoing challenges to professional education and growth in the area of dysphagia management.