“One of the biggest grey areas”: A focus group study exploring dosage of swallowing exercises from speech-language pathologist perspectives

Figures & data

Table I. Focus group participant characteristics (n = 20).

Focus group and length (h:min)	Participant code	Age range (years)	Sex	Years of practice	Years of practice in stroke rehabilitation	Work settings	Geographic area	State/territory
1 (1:03)	FG1P1	21–30	Female	6–10	6–10	Private practice	Rural	NT
	FG1P2	31–40	Female	6–10	6–10	Community	Metropolitan	NSW
	FG1P3	31–40	Female	10–20	10–20	Subacute and outpatient	Rural	NSW
	FG1P4	41–50	Female	10–20	10–20	Community and disability	Metropolitan	QLD
2 (1:08)	FG2P1	21–30	Female	2–5	<2	Acute and subacute	Metropolitan	NSW
	FG2P2	21–30	Female	2–5	2–5	Subacute	Metropolitan	NSW
	FG2P3	31–40	Female	2–5	<2	Acute and private practice	Rural	NSW
	FG2P4	31–40	Female	6–10	6–10	Acute and subacute	Metropolitan	VIC
	FG2P5	41–50	Male	10–20	10–20	Acute, subacute, and outpatient	Metropolitan	VIC
3 (1:25)	FG3P1	21–30	Female	6–10	2–5	Subacute	Metropolitan	NSW
	FG3P2	21–30	Female	6–10	2–5	Subacute and outpatient, community, disability, and private practice	Metropolitan	NSW
	FG3P3	21–30	Female	6–10	6–10	Acute and subacute	Rural	QLD
	FG3P4	31–40	Female	6–10	6–10	Subacute and outpatient, community, and RACF	Rural	NSW
	FG3P5	51–60	Female	>20	>20	Community and private practice	Metropolitan	VIC
4 (1:15)	FG4P1	21–30	Female	6–10	2–5	Outpatient, community, RACF, and disability	Rural	QLD
	FG4P2	31–40	Female	10–20	10–20	Acute and subacute	Metropolitan	VIC
	FG4P3	41–50	Female	>20	>20	Acute, outpatient, and community	Rural	NSW
5 (1:14)	FG5P1	21–30	Female	2–5	<2	Community and private practice	Metropolitan	NSW
	FG5P2	21–30	Female	2–5	2–5	Acute and subacute	Metropolitan	NSW
	FG5P3	31–40	Female	6–10	6–10	Private practice and disability	Metropolitan	NSW

Note. NSW = New South Wales; NT = Northern Territory; RACF = residential aged care facility; QLD = Queensland; VIC = Victoria.

Table II. Main themes and subthemes from focus groups.

Main themes	Subthemes	Exemplar quote
“Getting the most bang for your buck”: Importance of dosage in swallowing	N/A	“Dosage is an essential component when we’re prescribing those exercises. We can’t just say, do this exercise, and not give an amount, a repetition, sets per day” (FG2P2).
“No patient is identical”: Personalising swallowing exercise dosage to the patient	Patient goals and perception of swallowing exercises influence buy-in	“There’s so much around the patient’s buy-in…if you’ve got someone who’s really engaged and committed and kind of with you in what you’re trying to do, I think their chances of having any success are much higher” (FG3P2).
	Swallowing exercise dosage depends on patient capacity	“Have a look at the patient and see what they can tolerate, and what they’re willing to put up with. Some patients are willing to do a full set… whereas some are, just no, I’m too tired” (FG3P3).
“You’ve got what you should do, and then what you can do”: Gap between recommendations and practical application	Instrumental assessment is necessary but difficult to access	“I definitely feel more confident if I do have instrumental to back me up. But I’ve got provide a service either way” (FG3P3).
	Dosage prescription depends on availability of resources	“In a perfect world every workplace would have enough resources and staffing to know that we can confidently implement it at the required dosage” (FG4P1).
	Speech-language pathologist efforts to bridge the gap	“There’s some inherent personality trait within our profession which assists. So we want our patients to do well… our sort of intrinsic motivation to do well and help patients and care for patients” (FG2P5).
“Not much guidance out there about dosage”: More research needed to guide dosage	Limited research leads to uncertainty	“I feel like there’s not this rule or model that I can follow, and also there’s not a great deal of evidence that helps you make these decisions. Because sometimes you just kind of wing it” (FG4P2).
	Learning from other disciplines	“Working as a paediatric therapist I always felt more confident in delivering because the evidence is there… But I think in the adult speechie world…it’s an area that is just lacking in the research evidence” (FG4P1).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.