Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus

Abstract

Purpose

International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool.

Materials and Methods

A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round.

Results

Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool.

Conclusions

Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed.

Implications for Rehabilitation

• Dysphagia is an added complication following cervical spinal cord injury (cSCI) affecting morbidity, mortality and quality of life.

• Early identification of dysphagia risk allows focused interventions that reduce associated nutritional and respiratory impairments.

• Best practice recommendations based on expert consensus provide a baseline of appropriate interventions, in the absence of empirical evidence.

• A multi-professional approach to rehabilitation encourages a consistent and coordinated approach to care across acute and rehabilitation settings.

Keywords:

• Deglutition disorders
• spinal cord injuries
• rehabilitation
• tracheostomy
• ventilator weaning
• communication disorders

Acknowledgements

This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors wish to thank Dr Hugh Boardman and Ian Redsell of the Delphi Process Research Unit for their support and expertise, and members of the Delphi steering group and expert panel for their time and willingness to participate and contribute to this study: Kathy Castillo, Rees Collins, Cecilia Daly, Brooke Duggan, Anton Emmanuel, Aram Farad, Rik Fox, Maggie Garvey, Ram Hariharan, Matt Henley, Louise Kelly, Anna Miles, Sarah Morgan, Rachael Moses, Vivien Mulgrew, Sophie Nawarski, Clare Park, Lee Pryor, Pauline Robertson, Helena Rodi, Jack Ross, Jacqui Ross, Claire Salisbury, Fiona Stephenson.

Disclosure statement

Jackie McRae was funded for a Clinical Doctoral Research Fellowship award by the National Institute for Health Research (NIHR) and Health Education England (HEE) (Grant Reference Number CDRF 2013–04-024). Anton Emmanuel was supported by grants through the UCL Biomedical Research Centre.

Data availability statement

All research data are stored securely in the Research Innovation Centre at the Royal National Orthopaedic Hospital ([email protected]).

Additional information

Funding

This work was supported by National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship (Grant Reference Number CDRF 2013–04-024), part of the Health Education England and NIHR Integrate Clinical Academic Programme.