Use of Standardized Dysphagia Protocols in Clinical Practice: A Survey of U.S. Speech-Language Pathologists

Objective: This study aims to examine the practice and adoption of standardized dysphagia evaluation protocols among speech-language pathologists (SLPs) in the United States. Design: We used online web-based quantitative survey. Method: The survey was developed and distributed between April 12, 2022, and June 16, 2022. It was open to SLPs working with individuals with dysphagia across settings and populations. It consisted of 40 questions designed to capture the timing of assessments, swallowing components used, use of imaging protocols, characteristics of imaging protocols, and implementation of research-supported protocols in clinical practice. Results: In total, 520 practicing SLPs completed the survey. Most respondents were master’s-level clinicians working in adult inpatient care settings with > 15 years of experience in dysphagia management. Analyses revealed significant differences in practice patterns by age and dysphagia experience of the SLP but not by education level. Younger clinicians (45 years) infrequently reported using clinical/ bedside evaluations, F(3, 450) = 3.1, p .03, and relied heavily upon imaging assessments. Although imaging assessments were commonly accessed (81.4%), younger clinicians rarely utilized measured bolus amounts, and they more often applied numerous bolus trials (4+) during imaging, F(4, 327) = 3.7, p .006. When aspiration was observed, clinicians were more likely to change patient positioning and offer maneuvers rather than modify bolus type or amounts (Χ2 = 30.2, p .017). Using bolus/texture modification guidelines (i.e., International Dysphagia Diet Standardization Initiative Framework) is uncommon. Conclusions: Although commonly applied, oropharyngeal dysphagia assessment techniques vary considerably, highlighting the need for greater consistency in clinical practice. The practice patterns of younger clinicians may reflect possible limitations in educational practices or an increased workplace burden in managing dysphagia. These data establish the need to develop and disseminate professionally endorsed guidelines for the assessment of dysphagia. Supplemental Material: https://doi.org/10.23641/asha.30593810