| Teleeducation (n = 4) |
Davis and Copeland, 20053131. Davis L, Copeland K. Effectiveness of computer-based dysphagia training for direct patient care staff. Dysphagia. 2005;20(2):141-8. https://doi.org/10.1007/s00455-005-0007-z PMID: 16172824.
https://doi.org/10.1007/s00455-005-0007-...
|
To determine if there are changes in knowledge levels after swallowing safety training and to explore the effects of training on nurses who assist individuals with swallowing disorders. |
- Experimental study involving 123 nurses and nursing assistants, divided into experimental group (EG) (n=60) and control group (CG) (n=63).
- EG: implemented a training program in swallowing safety, using an interactive lecture developed by a team of speech-language pathologists, and applying a pre- and post-training knowledge test;
- CG: application of the same knowledge test in two moments, without training. |
- 82% of individuals in EG improved their scores in the post-training test compared to 49% in the CG;
- Pre x post: statistically significant difference was found in EG, while the CG score did not change significantly. |
Brady et al., 20182323. Brady S, Rao N, Gibbons P, Williams L, Hakel M, Pape T. Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure. Adv Med Educ Pract. 2018;9:433-41. https://doi.org/10.2147/AMEP.S142947 PMID: 29928150.
https://doi.org/10.2147/AMEP.S142947...
|
To evaluate the effectiveness of an online course designed to increase the ability to accurately interpret the fiberoptic endoscopic evaluation of swallowing (FEES) and compare it to the traditional (in-person) procedure. |
- Experimental study involving 108 postgraduate Medicine and Speech-Language Pathology students divided into: group 1 - online course (n=57) and group 2 - in-person course (n=51).
- Both groups underwent three stages: pre-knowledge test, FEES training program and post-knowledge test. |
- The change in knowledge observed in both groups was significant in the pre- and post-training test comparison, without difference between them;
- The positive points of the online course were the flexibility of schedule and the control of pace for content access. |
Ferguson and Estis, 20183232. Ferguson NF, Estis JM. Training students to evaluate preterm infant feeding safety using a video-recorded patient simulation approach. Am J Speech-Language Pathol. 2018;27(2):566-73. https://doi.org/10.1044/2017_AJSLP-16-0107 PMID: 29536107.
https://doi.org/10.1044/2017_AJSLP-16-01...
|
To test video simulation as a method to meet the training needs to develop clinical expertise and skills to safely assess the feeding of premature infants. |
- Experimental study involving 108 Nursing students and Speech-Language Pathology postgraduate students, divided into two groups: didactic training (DT) (n=51) and didactic training with video simulation (DTVS) (n=43);
- The groups underwent training by an online research platform and the DTVS received a simulated video recording of behavioral signs of disorganization;
- Students were evaluated before and after training. |
- The knowledge of students increased in the post-training test, without differences in scores between the two types of training;
- The DTVS group interpreted simulated feeding behaviors of premature babies more accurately than the DT group. |
Catalini et al., 20202525. Catalani B, Luccas GR de, Berretin-Felix G. Educação mediada por tecnologia em disfagia orofaríngea: proposta de ensino na graduação. Rev Grad USP. 2020;4(1):71-83. https://doi.org/10.11606/issn.2525-376X.v4i1p71-83
https://doi.org/10.11606/issn.2525-376X....
|
To verify the effectiveness of using distance learning, combined with in-person learning, in the dysphagia learning process of undergraduate Speech-Language Pathology students. |
- Experimental study involving 15 undergraduate Speech-Language Pathology students, divided into group 1 (n=8) - who attended the course in person, and group 2 (n=7), who attended the course in a hybrid form;
- Participants answered a questionnaire with questions about the content addressed, and an assessment protocol on skills and competences was applied. |
- There was statistically significant difference between scores obtained by students in the questionnaire on the content addressed in the pre- and post-moments only for students in group 2;
- Regarding the skills and competences protocol, the scores were similar for students in both groups. |
| Telediagnosis (n=7) |
Perlman and Witthawaskul, 20024242. Perlman AL, Witthawaskul W. Real-time remote telefluoroscopic assessment of patients with dysphagia. Dysphagia. 2002;17(2):162-7. https://doi.org/10.1007/s00455-001-0116-2 PMID: 11956842.
https://doi.org/10.1007/s00455-001-0116-...
|
To develop an internet system to allow the evaluation of oral and pharyngeal phases of swallowing in real time and interactively - TESS. |
- Descriptive study presenting an equipment with two components: 1) a computer connected to the videofluoroscopy service in a hospital - image capture + transmission + storage; 2) a computer for control and analysis in a location with capacity for remote management and analysis of exams. |
- A delay was identified between the two images - image captured in the hospital and the controller (3 to 5 seconds). - The image was subjected to analysis, allowing to use the equipment in future studies. |
Malandraki et al., 20112626. Malandraki GA, McCullough G, He X, McWeeny E, Perlman AL. Teledynamic evaluation of oropharyngeal swallowing. J Speech, Lang Hear Res. 2011;54(6):1497-505. https://doi.org/10.1044/1092-4388(2011/10-0284) PMID: 22052284.
https://doi.org/10.1044/1092-4388(2011/1...
|
To test the feasibility and clinical usefulness of a telefluoroscopy protocol - by an internet system, remote and in real time - for swallowing assessment. |
- Analytical cohort study involving 32 patients diagnosed with stroke or head and neck cancer, between 50 and 75 years of age;
- Participants underwent two fluoroscopic assessments - traditional and by the Teledynamic Assessment Software System (TESS). |
- The results demonstrated good general agreement in the subjective severity ratings (k = 0.636) and in the penetration-aspiration scale ratings between the assessment modes;
- Agreement on treatment recommendations was moderate to high, ranging from 69.3% to 100%. |
Sharma et al, 20113636. Sharma S, Ward EC, Burns C, Theodoros D, Russell T. Assessing swallowing disorders online: a pilot telerehabilitation study. Telemed e-Health. 2011;17(9):688-95. https://doi.org/10.1089/tmj.2011.0034 PMID: 21882996.
https://doi.org/10.1089/tmj.2011.0034...
|
To provide initial information (pilot study) on the feasibility and validity of performing clinical assessments of dysphagia by telerehabilitation. |
- Ten actors portraying patients with a variety of swallowing difficulties were involved in the study;
- Dysphagia was assessed simultaneously by a speech-language pathologist by clinical examination and telerehabilitation;
- Each simulated patient was evaluated using a clinical swallowing examination protocol. For telerehabilitation, the protocol was adapted and administered with the support of an assistant. |
- The results revealed that telerehabilitation allowed the clinical assessment of swallowing in a manner not much different from the traditional assessment;
- There was high agreement between the results of remote and traditional assessments. |
Ward and Sharma et al, 20123939. Ward EC, Sharma S, Burns C, Theodoros D, Russell T. Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation. Dysphagia. 2012;27(4):460-72. https://doi.org/10.1007/s00455-011-9390-9 PMID: 22271284.
https://doi.org/10.1007/s00455-011-9390-...
|
To evaluate the validity of performing clinical assessments of dysphagia by telerehabilitation. To determine the agreement level between online and in-person assessment regarding food safety. |
- Forty dysphagic patients, with mean age 66 years;
- Simultaneous clinical assessments by a speech-language pathologist in person and a speech-language pathologist remotely;
- Dysphagia was assessed using a clinical examination protocol in both cases, involving the use of an assistant for remote assessment. |
- The agreement levels between in-person and remote assessment revealed that most parameters reached clinically acceptable levels: aspects of oral, oromotor and laryngeal function revealed levels that varied between 75 and 100% (kappa = 0.36-1.0); parameters related to food varied between 79 and 100% (kappa = 0.61-1.0); and parameters related to the risk of aspiration and swallowing management varied between 79 and 100% (kappa = 0.49-1.0). |
Morrell et al., 20173535. Morrell K, Hyers M, Stuchiner T, Lucas L, Schwartz K, Mako J et al. Telehealth stroke dysphagia evaluation is safe and effective. Cerebrovasc Dis. 2017;44(3-4):225-31. https://doi.org/10.1159/000478107 PMID: 28848110.
https://doi.org/10.1159/000478107...
|
To report the development, implementation and reliability testing of a hospital telehealth assessment for patients with acute stroke. |
- Prospective study with participation of 100 volunteers. Each patient was evaluated sequentially by an audiologist at bedside and a telehealth audiologist;
- Telehealth assessments used the RP-7i remote presence system (InTouch Health);
- Both speech-language pathologists completed a data form documenting the patient's clinical factors and recommended diet based on the speech-language pathology assessment. |
- The mean time between telehealth and bedside assessments was 43 minutes;
- Bedside and telehealth speech-language pathologists agreed 91% on liquid diet recommendations and 87% on solid diet recommendations. |
Ward et al., 20143838. Ward EC, Burns CL, Theodoros DG, Russell TG. Impact of dysphagia severity on clinical decision making via telerehabilitation. Telemed e-Health. 2014;20(4):296-303. https://doi.org/10.1089/tmj.2013.0198 PMID: 24443927.
https://doi.org/10.1089/tmj.2013.0198...
|
To examine if the severity of dysphagia impacts: a) clinical decision-making for the safety of oral intake, b) perceptions of clinical swallowing examination conducted by telerehabilitation. |
- Descriptive study involving 100 volunteers, divided into 4 groups - 1) non-dysphagic, 2) mildly dysphagic, 3) moderately dysphagic, 4) severely dysphagic;
- Participants were assessed remotely and in person, simultaneously;
- Dysphagia was classified according to the Dysphagia Outcome and Severity Scale (DOSS). |
- Acceptable agreement levels between examiners were observed for decisions regarding safe levels of oral intake of food and liquids, as well as more than 90% of items in the clinical swallowing assessment;
- Agreement levels were not negatively affected by the severity of dysphagia;
- However, the perceptions from online clinicians indicated that a greater proportion of patients in the severe group had more complex signs and were more difficult to assess. |
Kantarcigil and Malandraki, 20173333. Kantarcigil C, Malandraki GA. First step in telehealth assessment: a randomized controlled trial to investigate the effectiveness of an electronic case history form for dysphagia. Dysphagia. 2017;32(4):548-58. https://doi.org/10.1007/s00455-017-9798-y PMID: 28424897.
https://doi.org/10.1007/s00455-017-9798-...
|
To develop an electronic case history tool/form (e-HiT) for adult patients with oropharyngeal dysphagia and examine its effectiveness compared to its printed version in relation to completion time, integrity level, independence level, and patient satisfaction. |
- Experimental study involving 40 adults with scores above 3 on the EAT-10 instrument, divided into groups A and B, in a randomized manner. The two groups were exposed to the same procedures, in alternate order - filling the e-HiT form and printing the instrument. - A satisfaction survey was completed after the experiment. |
- Participants had mean age of 40 years, with a mean score of 10.27 on the EAT-10;
- There were no statistically significant differences for completion time (p = 0.743), completeness (p = 0.486) and independence (p = 0.738);
- The satisfaction level indicated significantly greater responses in favor of e-HiT. |
| Teleconsulting (n=1) |
Raatz et al., 20202828. Raatz MK, Ward EC, Marshall J. Telepractice for the Delivery of Pediatric Feeding Services: a survey of practice investigating clinician perceptions and current service models in Australia. Dysphagia. 2020;35(2):378-88. https://doi.org/10.1007/s00455-019-10042-9 PMID: 31363846.
https://doi.org/10.1007/s00455-019-10042...
|
To establish the current perceptions of speech-language pathologists on the types of food services by telepractice, their current use of telepractice in providing pediatric food services and explore barriers and facilitators. |
- Analytical study involving 84 speech-language pathologists with experience in pediatric feeding in Australia;
- Participants completed an electronic questionnaire consisting of items such as demographic data, feeding services and experiences, telepractice experience, and perceptions and experiences of providing pediatric feeding services via telepractice. |
- Only 20% were offering pediatric feeding services by telepractice;
- Participants commented that telepractice could help them offer more frequent assessments, provide services to families who would not otherwise have access to services, increase access to specialized services for families, and conduct consultations in the natural environment of the child. |
| Telemonitoring (n=10) |
Cassel and McIlvaine, 20172424. Cassel SG, McIlvaine JA. Patient responses to swallowing safety cues: a comparison of traditional face-to-face and tele-dysphagia instructional methods. Surg Rehabil. 2017;1(5):1-7. https://doi.org/10.15761/SRJ.1000126
https://doi.org/10.15761/SRJ.1000126...
|
To compare the results of traditional dysphagia intervention with teledysphagia intervention, measuring correct and incorrect responses to visual and auditory cues presented by a speech-language pathologist. |
- Thirty participants with stroke and confirmed dysphagia divided into 2 groups, with one group receiving intervention by teledysphagia and the other traditional intervention. |
- Efficacy measurements revealed that 87% of teledysphagia participants achieved their clinical goal compared to 80% of traditional intervention participants. - It can be concluded that the teledysphagia method can produce effective clinical results similar to a traditional in-person method. |
Malandraki et al., 20142727. Malandraki GA, Roth M, Sheppard JJ. Telepractice for pediatric dysphagia: a case study. Int J Telerehabilitation. 2014;6(1):3-16. https://doi.org/10.5195/ijt.2014.6135 PMID: 25945217.
https://doi.org/10.5195/ijt.2014.6135...
|
To examine the feasibility of providing dysphagia treatment by telepractice in a pediatric patient;
and secondarily, to examine if this program was effective. |
- 6-year-old male child, with primary diagnoses of Opitz BBB/G and Asperger Syndrome, post tracheostomy with decannulation ten months before the program onset;
- The intensive treatment program consisted of 8 sessions, each session lasting 1 hour and daily home practice;
- Post-intervention assessment (four weeks) and follow-up family interview four weeks after program completion. |
- After the intervention, the patient was accepting to ingest 5.25 times more food and 11.25 times more food;
- The progress in accepting a variety of foods in pureed consistency was evident after the intervention;
- There was reduction in saliva swallowing time post-treatment;
- The results of the tele satisfaction questionnaire showed that the family seemed very satisfied with this program and mode of delivery and scored the online rehabilitation approach as equal to traditional in-person approaches. |
Burns et al., 20192929. Burns CL, Ward EC, Gray A, Baker L, Cowie B, Winter N et al. Implementation of speech pathology telepractice services for clinical swallowing assessment: an evaluation of service outcomes, costs and consumer satisfaction. J Telemed. 2019;25(9):545-51. https://doi.org/10.1177/1357633X19873248 PMID: 31631757.
https://doi.org/10.1177/1357633X19873248...
|
This study involved the multi-site implementation of a model for conducting adult clinical swallowing assessments by telepractice and examined its service outcomes, costs and consumer satisfaction. |
- Five telepractice services were established, encompassing 18 facilities in a public health service;
- Support for the implementation of services, including the training of speech-language pathologists in telepractice and support health workers at each site, was facilitated by an experienced project manager;
- References of published protocols for dysphagia assessments by telepractice were managed by experienced speech-language pathologists;
- Patient demographics, referral information, outcomes, costs, and satisfaction with telepractice were collected. |
- The first 50 sessions were analyzed;
- Telepractice assessments were completed successfully with only minor technical issues;
- Food/fluid changes were required after assessment to optimize safety or progress of oral intake in 64% of patients;
- Service and cost were achieved with an average 2-day reduction in wait time and a benefit of $218 per session when using the telepractice service;
- High clinician and patient satisfaction were reported. |
Burns et al., 20173030. Burns CL, Ward EC, Hill AJ, Kularatna S, Byrnes J, Kenny LM. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes. Head Neck. 2017;39(5):932-9. https://doi.org/10.1002/hed.24706 PMID: 28225567.
https://doi.org/10.1002/hed.24706...
|
To examine the efficiency of a telepractice service model and the satisfaction of service participants. |
- Patients undergoing treatment for head and neck cancer participated in the study - divided into telepractice and in-person care;
- The Functional Assessment of Satisfaction with Chronic Illness Therapy questionnaire (FACIT-TS, version 1.0) was completed to assess patient satisfaction with speech therapy treatment. |
- There were no significant differences between care models in relation to the time elapsed from referral to the first session;
- Regarding the number and duration of events to manage clinical problems, a significantly smaller number was needed in the telepractice group;
- High satisfaction levels were reported across all evaluation parameters by patients in favor of the telepractice service. |
Mayadevi et al., 20183434. Mayadevi M, Thankappan K, Limbachiya SV, Vidhyadharan S, Villegas B, Ouyoung M et al. Interdisciplinary Telemedicine in the Management of Dysphagia in Head and Neck. Dysphagia. 2018;33(4):474-80. https://doi.org/10.1007/s00455-018-9876-9 PMID: 29404691.
https://doi.org/10.1007/s00455-018-9876-...
|
To verify the effectiveness of interdisciplinary discussions in improving the food intake of dysphagic patients, using the Functional Oral Intake Scale (FOIS) as a parameter for comparing results. |
- Twenty-six patients with persistent dysphagia after treatment for head and neck pathology, from an institute in India;
- The cases were discussed in the telemedicine meeting between the host institute and a second unit in the United States;
- A monthly meeting was organized using a videoconferencing system. Swallowing and management problems were presented and, by discussions, a plan for further management was formulated;
- The Intake Scale (FOIS) was measured before and after implementing the plan. |
- The recommendations coincided with those of the reception unit in 18, differed for three and were reformulated in five patients;
- The mean FOIS was 1.46 (±0.989) pre-treatment and 3.92 (±1.809) post-treatment, with significant improvement (p=0.0001). |
Wall et al., 20173737. Wall LR, Ward EC, Cartmill B, Hill AJ, Porceddu SV. Adherence to a prophylactic swallowing therapy program during (Chemo) radiotherapy: impact of service-delivery model and patient factors. Dysphagia. 2017;32(2):279-92. https://doi.org/10.1007/s00455-016-9757-z PMID: 27844152.
https://doi.org/10.1007/s00455-016-9757-...
|
To examine if adherence to therapy is influenced by the service delivery method. |
- Adult patients diagnosed with oropharyngeal squamous cell carcinoma, with radiotherapy planning with non-surgical curative aim;
- Three service delivery models: (1) traditional therapy, (2) technology-assisted therapy using an asynchronous telepractice app - SwallowIT, and (3) independently self-directed therapy. - The FOIS scale, MD Anderson Dysphagia Inventory (MDADI), Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Inventory (MFI) and multidimensional scale Health Locus of Control (HLC) were used. |
- The overall adherence rates were low (31 and 71%), with most patients completing no more than 25% of their exercises, with a particularly sharp drop in the fourth week. - Although radiotherapy-related toxicities impact adherence, adopting service delivery models with greater structure/support and providing extra assistance to patients with known risk factors can help optimize adherence to therapy. Telepractice may provide an alternative to support adherence where service restrictions limit intensive therapy. |
Bidmead et al., 20154040. Bidmead E, Reid T, Marshall A, Southern V. "Tele Swallowing": a case study of remote swallowing assessment. Clin Gov An Int J. 2015;20(3):155-68. https://doi.org/10.1108/CGIJ-06-2015-0020
https://doi.org/10.1108/CGIJ-06-2015-002...
|
To report a second pilot project on the application of Teleswallowing.
|
- Application of the Teleswallowing program was conducted on 17 patients from 5 nursing homes with a demand to evaluate swallowing, with the participation of 6 speech-language pathologists who conducted the consultations, conducted over three months;
- Training was provided to 10 nursing home nurses, which consisted of anatomy and mechanics of swallowing and use of equipment. The home team was prepared for the assessment before the tele-link;
this included the patient's posture, oral hygiene and the attached pulse oximeter, thus allowing the speech-language pathologist to be in control and focus solely on the assessment, guiding the nurse. |
- Teleswallowing benefited both patients and participating nursing homes. Better use of professional time and cost savings were demonstrated, and evidence showed that the service could be scaled up successfully;
- Improved knowledge increased confidence among nurses and allowed them to provide better quality of care for patients by improved feeding techniques and quicker recognition of signs of dysphagia;
- Notwithstanding, a series of barriers were identified - problems with technology and the attitude of speech-language pathologists towards these barriers. |
Constantinescu et al., 20184141. Constantinescu G, Kuffel K, King B, Hodgetts W, Rieger J. Usability testing of an mHealth device for swallowing therapy in head and neck cancer survivors. Health Informatics J. 2018;25(4):1373-82. https://doi.org/10.1177/1460458218766574 PMID: 29618274.
https://doi.org/10.1177/1460458218766574...
|
To conduct the first usability test of a mobile health device for swallowing therapy at home. |
- Five patients with head and neck cancer participated in the evaluation of the mobile therapy program (Mobili-T);
- Participants were scheduled for individual sessions with a speech-language pathologist, where they were introduced to the study and the system;
- Pairing the device with the app and navigating the tutorial were demonstrated. After that, participants were asked to complete five tasks: pair the device with their smartphone; place the device correctly; perform a set of exercises; interpret progress screens; and close the application. |
- In application efficiency, task 1 required five instances of assistance for three participants. Tasks 2 and 4 required assistance once;
- Regarding satisfaction, participants scored the app favorably for the ease of completing a task, the time for that purpose, and the support information provided. |
Wall et al., 20164343. Wall LR, Ward EC, Cartmill B, Hill AJ, Porceddu SV. Examining user perceptions of SwallowIT : a pilot study of a new telepractice application for delivering intensive swallowing therapy to head and neck cancer patients. J Telemed Telecare. 2016;23(1):53-9. https://doi.org/10.1177/1357633X15617887 PMID: 26670210.
https://doi.org/10.1177/1357633X15617887...
|
To evaluate user perceptions of a new asynchronous telepractice application, 'SwallowIT', designed to support patients to remotely complete intensive swallowing therapy during chemoradiotherapy treatment. |
- Fifteen patients with oropharyngeal cancer used SwallowIT;
- A 12-item questionnaire was administered: (a) immediately after SwallowIT orientation; and (b) at the conclusion of chemotherapy (treatment completion). |
- The majority of patients reported positive initial perceptions regarding SwallowIT for comfort (87%), confidence (87%), motivation (73%) and support (87%);
- No statistically significant changes in perceptions were observed at the two assessment moments. |
Wall et al., 20194444. Wall LR, Kularatna S, Ward EC, Cartmill B, Hill AJ, Isenring E et al. Economic analysis of a three-arm RCT exploring the delivery of intensive, prophylactic swallowing therapy to patients with head and neck cancer during (Chemo) radiotherapy. Dysphagia. 2019;34(5):627-39. https://doi.org/10.1007/s00455-018-9960-1 PMID: 30515560.
https://doi.org/10.1007/s00455-018-9960-...
|
To investigate the costs to the healthcare service and patients associated with the SwallowIT model, compared to two alternative methods of service delivery: (1) traditional and (2) independent patient-directed. |
- 75 patients with oropharyngeal cancer receiving radiotherapy were randomized to receive therapy via: traditional means (n = 24); patient-directed (n = 26) or SwallowIT-assisted (n = 25) care model;
- Data regarding healthcare service costs (service time, consumables, therapy resources), patient-attributable costs (travel and wages) and health-related quality of life were collected. |
- SwallowIT provided a more cost-effective care model than the professional-directed model (equivalent results at reduced cost) and greater cost-effectiveness than the patient-directed model (improved results achieved at an acceptable cost). |
Thumbnail
