题名

台灣語言治療師執行成人吞嚥障礙評估的現況調查:臨床評估項目之決策考量與儀器檢查使用狀況

并列篇名

Adult Dysphagia Evaluation Practices of Speech and Language Therapists in Taiwan: Clinical Swallowing Examination Decision-Making and Instrumental Examination

DOI

10.6143/JSLHAT.202306_(48).0001

作者

陳如筠(Ru-Yun Chen);池育君(Yu-Chun Chih)

关键词

成人吞嚥障礙評估 ; 臨床評估 ; 決策考量 ; 儀器檢查 ; 問卷調查 ; Adult dysphagia evaluation ; Clinical swallowing examination (CSE) ; Decision-making ; Instrumental examination ; Survey study

期刊名称

台灣聽力語言學會雜誌

卷期/出版年月

48期(2023 / 06 / 01)

页次

1 - 26

内容语文

繁體中文;英文

中文摘要

本研究探討台灣語言治療師執行成人吞嚥障礙評估的現況,包括:一、臨床評估的核心項目為何、決策考量與其實證支持率,以及二、吞嚥儀器檢查的取得率、執行狀況與影響因素。本研究採用問卷調查法,招募具有台灣語言治療師證照、於台灣累積一年以上的臨床經驗,過去一年內曾於台灣執行成人吞嚥障礙業務的語言治療師填寫問卷,共收回155份有效問卷進行分析。研究結果顯示,台灣語言治療師使用的臨床評估核心項目共13項,其中69.2%經實證顯示具良好診斷性效能。選擇臨床評估項目的原因依序為臨床經驗(82.4%)、教育訓練(78.1%)、讀過相關文獻(58.1%)。儀器檢查取得狀況的部分,吞嚥儀器檢查取得率為49.7%。影響因素的部分,達顯著差異且具有中度以上效果量或關聯性程度的背景變項與吞嚥障礙評估變項共6組,例如:「工作場域」與「可否取得儀器」。本研究所蒐集的台灣語言治療師執行成人吞嚥障礙評估的現況資料,可供醫療端以及教育訓練單位作為參考。

英文摘要

The purpose of this survey study was to obtain a comprehensive view of the adult dysphagia evaluation practice patterns of speech-language pathologists (SLPs) in Taiwan, specifically in terms of (1) core components, decision-making on certain components of clinical swallowing examination (CSE), and the condition of data-based support, and (2) availability, execution and factors of utilization of swallowing instrumental examination. SLPs who were certified SLPs in Taiwan, had more than one year of clinical experience, and had been providing services to individuals with dysphagia in the past year in Taiwan were recruited to fill out a self-administered survey. A total of 155 questionnaires were returned. Results indicated that there were 13 core components of CSE, and 69.2% of them had valid diagnostic performance. Reasons of using components of CSE were clinical experiences (82.4%), education and training (78.1%), and evidence support (58.1%). As for the instrumental examination, 49.7% of SLPs had access to swallowing instrumental examination. There were six pairs of background and practice patterns variables with significant correlation and valid effect size, such as workplace versus access to swallowing instrumental examination. The study obtained a comprehensive view of adult dysphagia evaluation practice patterns of SLPs in Taiwan which can be used as a reference for medical and educational training institutions.

主题分类 醫藥衛生 > 外科
参考文献
  1. 戴千淑,鄭朝惠,黃千恩,林少瑜,劉子菁,梁穎(2020)。提升腦中風病人急性後期照護下轉率。榮總護理,37,360-368。
    連結:
  2. 語言治療師法(民109年01月15日)。
  3. Akoglu, H.(2018).User’s guide to correlation coefficients.Turkish Journal of Emergency Medicine,18,91-93.
  4. American Speech-Language-Hearing Association. (n.d.a). Adult dysphagia. Retrieved May 11, 2021, from https://www.asha.org/Practice-Portal/Clinical-Topics/Adult-Dysphagia/#collapse_5
  5. American Speech-Language-Hearing Association (n.d.b). States with specific instrumental assessment requirements. Retrieved May 11, 2021, from https://www.asha.org/advocacy/state/states-with-specific-instrumental-assessment-requirements/
  6. Andrews, M.,Pillay, M.(2017).Poor consistency in evaluating South African adults with neurogenic dysphagia.South African Journal of Communication Disorders,64,a158.
  7. Bateman, C.,Leslie, P.,Drinnan, M. J.(2007).Adult dysphagia assessment in the UK and Ireland: Are SLTs assessing the same factors?.Dysphagia,22,174-186.
  8. Beavan, J.,Conroy, S. P.,Harwood, R.,Gladman, J. R. F,Leonardi-Bee, J.,Sach, T.,Gaynor, C.(2010).Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial.Age and Ageing,39,624-630.
  9. Cohen, J.(1988).Statistical power analysis for the behavioral sciences.Mahwah, NJ:Lawerence Erlbaum Associates.
  10. Eltringham, S. A.,Smith, C. J.,Pownall, S.,Sage, K.,Bray, B.(2019).Variation in dysphagia assessment and management in acute stroke: An interview study.Geriatrics,4(4),60.
  11. Garand, K. L. F.,McCullough, G.,Crary, M.,Arvedson, J. C.,Dodrill, P.(2020).Assessment across the life span: The clinical swallow evaluation.American Journal of Speech-Language Pathology,29,919-933.
  12. Gillespie, M. B.,Brodsky, M. B.,Day, T. A.,Lee, F. S.,Martin-Harris, B.(2004).Swallowing-related quality of life after head and neck cancer treatment.The Laryngoscope,114,1362-1367.
  13. González-Fernández, M.,Sein, M. T.,Palmer, J. B.(2011).Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population.American Journal of Speech-Language Pathology,20,331-336.
  14. Hassan, H. E.,Aboloyoun, A. I.(2014).The value of bedside tests in dysphagia evaluation.Egyptian Journal of Ear, Nose, Throat and Allied Sciences,15,197-203.
  15. Kirk, R. E.(1996).Practical significance: A concept whose time has come.Educational and Psychological Measurement,56,746-759.
  16. Langmore, S. E.,Logemann, J. A.(1991).After the clinical bedside swallowing examination: What next?.American Journal of Speech-Language Pathology,1,13-20.
  17. Logemann, J. A.,Veis, S.,Colangelo, L.(1999).A screening procedure for oropharyngeal dysphagia.Dysphagia,14,44-51.
  18. Mann, G.,Hankey, G. J.,Cameron, D.(2000).Swallowing disorders following acute stroke: Prevalence and diagnostic accuracy.Cerebrovascular Diseases,10,380-386.
  19. Martino, R.,Pron, G.,Diamant, N. E.(2004).Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist.Dysphagia,19,165-176.
  20. Mathers-Schmidt, B. A.,Kurlinski, M.(2003).Dysphagia evaluation practices: Inconsistencies in clinical assessment and instrumental examination decision-making.Dysphagia,18,114-125.
  21. McAllister, S.,Kruger, S.,Doeltgen, S.,Tyler-Boltrek, E.(2016).Implications of variability in clinical bedside swallowing assessment practices by speech language pathologists.Dysphagia,31,650-662.
  22. McCullough, G. H.,Rosenbek, J. C.,Wertz, R. T.,McCoy, S.,Mann, G.,McCullough, K.(2005).Utility of clinical swallowing examination measures for detecting aspiration post-stroke.Journal of speech, language, and hearing research,48,1280-1293.
  23. McCullough, G. H.,Wertz, R. T.,Rosenbek, J. C.(2001).Sensitivity and specificity of clinical/bedside examination signs for detecting aspiration in adults subsequent to stroke.Journal of Communication Disorders,34,55-72.
  24. McCullough, G. H.,Wertz, R. T.,Rosenbek, J. C.,Dinneen, C.(1999).Clinicians’ preferences and practices in conducting clinical/bedside and videofluoroscopic swallowing examinations in an adult, neurogenic population.American Journal of Speech-Language Pathology,8,149-163.
  25. Morton, R. P.,Crowder, V. L.,Mawdsley, R.,Ong, E.,Izzard, M.(2009).Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy.ANZ Journal of Surgery,79,713-718.
  26. O’Horo, J. C.,Rogus‐Pulia, N.,Garcia‐Arguello, L.,Robbins, J.,Safdar, N.(2015).Bedside diagnosis of dysphagia: A systematic review.Journal of Hospital Medicine,10,256-265.
  27. Ohira, M.,Ishida, R.,Maki, Y.,Ohkubo, M.,Sugiyama, T.,Sakayori, T.,Sato, T.(2017).Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults.Geriatrics & Gerontology International,17,561-567.
  28. Pettigrew, C. M.,O’Toole, C.(2007).Dysphagia evaluation practices of speech and language therapists in Ireland: Clinical assessment and instrumental examination decision-making.Dysphagia,22,235-244.
  29. Polit, D. F.,Beck, C. T.(2006).The content validity index: Are you sure you know what’s being reported? Critique and recommendations.Research in Nursing & Health,29,489-497.
  30. Polit, D. F.,Beck, C. T.,Owen, S. V.(2007).Is the CVI an acceptable indicator of content validity? Appraisal and recommendations.Research in Nursing & Health,30,459-467.
  31. Rumbach, A.,Coombes, C.,Doeltgen, S.(2018).A survey of Australian dysphagia practice patterns.Dysphagia,33,216-226.
  32. Smith Hammond, C. A.,Goldstein, L. B.,Horner, R. D.,Ying, J.,Gray, L.,Gonzalez-Rothi, L.,Bolser, D. C.(2009).Predicting aspiration in patients with ischemic stroke: Comparison of clinical signs and aerodynamic measures of voluntary cough.Chest,135,769-777.
  33. Speyer, R.(2013).Oropharyngeal dysphagia: screening and assessment.Otolaryngologic Clinics of North America,46,989-1008.
  34. Speyer, R.,Cordier, R.,Farneti, D.,Nascimento, W.,Pilz, W.,Verin, E.,Walshe, M.,Woisard, V.(2022).White paper by the European Society for Swallowing Disorders: Screening and non-instrumental assessment for dysphagia in adults.Dysphagia,37,333-349.
  35. Vogels, B.,Cartwright, J.,Cocks, N.(2015).The bedside assessment practices of speech-language pathologists in adult dysphagia.International Journal of Speech-Language Pathology,17,390-400.
  36. Yusoff, M. S. B.(2019).ABC of content validation and content validity index calculation.Education in Medicine Journal,11(2),49-54.
  37. 許原豪(2021)。看見吞嚥肯定專業。台灣聽力語言學會電子學報,98。取自https://www.slh.org.tw/upload/files/%E7%AC%AC98%E6%9C%9F_%E7%9C%8B%E8%A6%8B%E5%90%9E%E5%9A%A5%20%E8%82%AF%E5%AE%9A%E5%B0%88%E6%A5%AD.pdf
  38. 衛生福利部中央健康保險署(2020)。急性後期整合照護計畫。取自https://www.nhi.gov.tw/Content_List.aspx?n=5A0BB383D955741C&topn=5FE8C9FEAE863B46