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.