SLT experience
Results show that patients in the oral trials group were more likely to be assessed by ‘mixed SLTs’, suggesting a degree of supervision or shared-working between SLTs in the team. When controlled for neurological diagnosis, SLT experience is no longer significant. This suggests that SLT experience is related to types of patients being seen or ward speciality rather than being a predictor for treatment decisions made. SLT experience can influence dysphagia treatment taken and less experienced SLTs may lack the confidence to try novel dysphagia therapies 28,29. A variety of patients and availability of clinical supervision has been recognised as essential for the development of dysphagia skills 30. Results may reflect how supervision is used in the hospital studied to support dysphagia management in more complex cases.
Videofluoroscopy was not a significant factor between treatment groups and had only been carried out on 11.0% of patients on the caseload. This may highlight the clinical decision-making process taking place at bedside assessment or may reflect resource limitations. Over half of SLTs working in stroke rehabilitation report using instrumental assessments ‘rarely or never’ before recommending exercises6. This suggests that decision-making around dysphagia therapies relies on other clinical measures and judgments within practice.