The safe swallow; a difficult act to follow. Prevalence, professional practice, and patient perspectives in swallowing disorders (oropharyngeal dysphagia).

Prevalence, professional practice, and patient perspectives in swallowing disorders (oropharyngeal dysphagia)The doctoral candidate defended her thesis in June. Submitted changes in the project have been approved which will allow the completion of study II which was postponed due to difficulties from COVID. This study aims to establish an estimated prevalence of OD in adults admitted to rehabilitation hospitals in South-Eastern Norway.This project has resulted in the completion of a PhD in the field of oropharyngeal dysphagia (OD), the first of it's kind in Norway. OD is difficulty with the mastication and swallowing of food and/or liquids from the mouth to the esophagus. The mouth and pharynx (throat) are not only responsible for the transportation of food and liquids to the esophagus, but also for the production of speech and respiration. Thus, swallowing is a complex neurological process for which small anatomical or physiological changes in swallowing function can result in serious medical and psychosocial problems. These problems, such as, malnutrition, dehydration, aspiration pneumonia, fear for eating, anxiety during mealtimes and sosial isolation have a negative effect quality of life. OD is commonly seen in the elderly and is a result of a number of underlying diseases or injuries, such as stroke, head injury, Parkinson's disease or head and neck cancer. The prevalence of OD may vary depending on several factors such as age, diagnosis, timing and type of screening or assessment. While the majority of prevalence studies in the literature have estimated prevalence of OD in relation to age or diagnosis, the first study of this project, estimated the prevalence of OD in adults admitted to healthcare settings. The main findings of this systematic review and meta-analysis showed a high estimated overall prevalence of OD in all healthcare settings with percentages increasing from the hospital, to rehabilitation, and with the highest prevalence occuring in the nursing home setting. This study was published online in May 2022 and results also highlighted a need for more prevalence research in rehabilitation and palliative healthcare settings. The second study of this project aims to estimate the prevalence of OD in adults admitted to rehabilitation hospitals in South-Eastern Norway. As mentioned in the 2022 e-rapport, this study has beed postponed due to COVID. Time constraints of the allotted PhD period required that the doctoral candidate complete an external study, thus postponing study II. However, approval for changes in the project have been granted and preparations to carry out this study in 2024-2025 have begun. Due to the complexity of OD, it is common for many different healthcare professions to be involved in it's management. The third study of this project contributed to knowledge about the current level of training, skills and service practices provided by healthcare professionals working with adults with OD in the Nordic countries. This study was published in February 2023 and revealed that professionals central in the assessment and treatment of adults with OD, specifically nurses, occupational therapists (OTs) and speech language pathologists (SLPs), had a minimal amount of educational and practical training in OD. In addition, the use of valid tools for the identification and assessment of OD and use of evidence-based rehabilitative treatment methods were limited. Findings indicated a need for guidelines that help improve the educationl and practical requirements needed for healthcare professionals responsible in the management of OD. The fourth study of this project - was a validation study of the Norwegian version of the Swallowing Quality of Life (Nor-SWAL-QOL) was published in 2019. Access to this tool will help shed light on the perspectives of people with OD and how it effects thier quality of life.

Prevalence, professional practice, and patient perspectives in swallowing disorders (oropharyngeal dysphagia)Study I- a systematic review and meta-analysis on the prevalence of OD in adults in different health care settings was published April 2022. A manuscript for Study III was submitted for publication in August, and has been accepted for publication in January 2023.This is a PhD project in the field of oropharyngeal dysphagia (OD) or swallowing disorders. OD is a symptom or group of symptoms caused by an underlying disease or injury involving the brain, mouth and/or throat. Symptoms such as slowed chewing, food sticking in the throat and coughing may be signs of weakness in the muscles in the mouth and/or throat that are responsible for safe and effective swallowing. Unsafe swallowing is when food or liquid enters the airway which can lead to serious respiratory problems. Ineffective swallowing often requires repeated swallowing attempts to empty the throat and increases the risk that food or liquid enters the airway. People with OD report that they become anxious, embarrassed and fatigued during meals. As a result, people with OD no longer look forward to or enjoy eating or mealtimes, and risk becoming socially isolated from family and friends. When asked, people with OD report a reduction in their quality of life. This project aims to fill knowledge gaps in the field of OD, specifically in the areas concerning the frequency (prevalence) of OD, current skill levels and practices of healthcare professionals in the management of OD, and access to validated patient-report questionnaire for dysphagia quality of life. This project includes four sub-studies: I) a systematic review, assessment and summary of the research literature providing an estimate of the current prevalence of OD in different healthcare settings has been completed and a paper published in May 2022 II) a study to establish an estimated prevalence of OD in adults admitted to rehabilitation hospitals in South-Eastern Norway has been postponed due to circumstances caused by the pandemic III) a survey to contribute knowledge about current level of skills, practices of healthcare professionals working with adults with OD is completed and a revised manuscript was submitted January 2023 V) a validation study of the Norwegian version of the Swallowing Quality of Life (Nor-SWAL-QOL) was completed and a paper published 2019 Main results from Study I were reported in the e-Rapport in 2021, where the main findings showed a high estimated overall prevalence of OD in all health care settings, and that there is need for more prevalence data, particularly in the rehabilitation and palliative settings. Study III revealed that there is a minimal amount of time allotted to the education and training of professionals responsible for assessing and treating adults with OD in the Nordic countries. In addition, there was limited availability and use of valid and reliable assessment instruments for the identification and evaluation of OD. Furthermore, the use of rehabilitative treatment methods to improve swallowing function was scarce. Findings identified the need for improved interdisciplinary collaboration between educational and healthcare institutions, in addition to the use of guidelines to improve the quality of care for people with OD. Study II has so far been postponed due to Covid-related challenges, and will be considered carried out in 2023-2025. We will get back to HSØ in this regard.

Prevalence of swallowing disorders and healthcare professional service practices for OD the Nordic countriesAn estimation of the prevalence of swallowing disorders in adults admitted to different healthcare settings with a systematic review and meta-analysis has been conducted. Data from a study on professional roles and service practices are being analysed.This is a PhD project concerning a relatively new field of medicine - oropharyngeal dysphagia (OD) or swallowing disorders. Swallowing disorders can result in difficulties staying properly nourished, hydrated, and taking medications. Serious swallowing disorders can put a person at risk of aspiration; getting food or water into the airway, which can lead to serious health problems. Difficulty with swallowing can occur at any age and is often caused by disease or injury to the brain or mouth and throat. Swallowing disorders are common in the elderly and oropharyngeal dysphagia has been identified as a geriatric syndrome. This PhD project aims to fill in some knowledge gaps in the field of swallowing disorders, particularly regarding the prevalence of OD, the status of professional skills and experience needed for management of OD and access to validated assessment tools. The project includes four sub-studies; I) a systematic review of the literature to establish the current knowledge base regarding prevalence of OD within different parts of the health care system, II) a study to establish the prevalence of OD in rehabilitation hospitals in South-Eastern Norway and provide access to a validated screening tool, III) a survey study to establish knowledge about current practices and future needs in training of transdisciplinary teams within the field of OD, and IV) a validation study of the Norwegian version of the Swallowing Quality of Life questionnaire (Nor-SWAL-QOL) has already been performed. The first study, a systematic review of the literature and meta-analysis has been completed. Forty-four prevalence studies were identified from the literature search, of which 22 studies provided data for meta-analysis. Findings revealed a high estimated overall prevalence for hospital, rehabilitation and nursing home populations. There is a need for more data on OD prevalence for palliative care and rehabilitation settings. A manuscript was submitted in July 2021 and returned for revisions February 2022. The second study has been put on hold due to the pandemic, as it involves swallowing testing of patients admitted to rehabilitation hospitals in South-Eastern Norway. Data for study III has been analyzed, a manuscript is currently in progress and expected to be submitted for publication by May 2022.