Introduction
Swallowing is a complex process and individuals can present with breakdown at various levels, which can affect control, coordination or strength of swallowing 1. Swallowing difficulties (dysphagia) can affect health in a variety of ways, including malnutrition and dehydration 2 and life-threatening illnesses such as aspiration pneumonia 3. Safe swallowing is essential both to maintain life and also to maintain quality of life 4.
The complexity of swallowing and its heterogeneity in presentation can make evaluating the true effect of treatment methods challenging; there is limited evidence on the effectiveness of the range of therapy approaches available 5,6. Alongside this, there is poor uptake of interventions which demonstrate a good evidence-base, with Speech and Language Therapists (SLTs) relying heavily on clinical experience and anecdotal evidence 6–8.
The following study aims to investigate the use of ‘oral trials’, a commonly used dysphagia management approach. Although this initiative has been documented in research and practice 6,9–12, the terminology has not been officially defined. For the purpose of this study it has been defined as: a dysphagia management approach whereby specified, limited amounts of oral diet or fluids are recommended for those at risk of aspiration or choking if full amounts are taken orally. Oral trials are recommended for a specified reason, such as rehabilitation or quality of life.
A recent survey of SLTs working in stroke rehabilitation identified that supervised ‘swallow trials’ were recommended ‘frequently or always’ by 73% of respondents 6. A further survey in Australia found that swallow trials were the only rehabilitation approach being used in dysphagia management with a high degree of consistency12. The use of oral trials is also included in a range of outcome measurement tools, such as the Functional Oral Intake Scale (FOIS) 9, Dysphagia Severity Rating Scale (DSRS)11 and Therapy Outcome Measures (TOMS)10. A further three conference abstracts identify the use of oral trials within SLT approaches 13–15. However, in spite of its documented use, a search of the literature found no further research into the use or efficacy of oral trials.
This study is part of a mixed methods research project exploring the use of oral trials in hospital. This paper reports on phase one: an observational, cross-sectional study evaluating the dysphagia caseload within one inpatient hospital. Phase two is reported in a separate paper and involves qualitative data collection via focus groups with SLTs, to explore the clinical reasoning behind this quantitative data. Phase one aims to identify where and with which patients oral trials are currently being offered. Given that oral trials have documented use in stroke rehabilitation, it is hypothesised that oral trials are used most commonly within neurological rehabilitation. Data collected will begin to inform how and why oral trials are used widely within dysphagia management, despite their lack of evidence.