Telemed J E Health - Impact of dysphagia severity on clinical decision making via telerehabilitation.

Tópicos

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Resumo

JECTIVE: Recent research supports the proposal that valid and reliable clinical swallow examinations (CSEs) can be conducted via telerehabilitation. However, no studies have explored whether dysphagia severity has an impact on the success of the session or its outcomes. The current study examined how dysphagia severity impacted on either (a) clinical decision making for safety of oral intake or (b) clinician perceptions of CSEs conducted via telerehabilitation.SUBJECTS AND METHODS: One hundred patients (25 nondysphagics and 25 mild, 25 moderate, and 25 severe dysphagics) were assessed using a telehealth system and methodology reported in prior research. For each assessment, the online and face-to-face (FTF) clinicians simultaneously completed a structured CSE. On session completion, the online clinician indicated level of agreement with two statements regarding the level of rapport and ability to competently assess the patient.RESULTS: In each of the four groups, acceptable levels of agreement were observed between raters for the three primary outcomes (decisions regarding oral/nonoral intake and safe food and fluids) as well as over 90% of the CSE items. Clinicians agreed they could develop good rapport with the majority of patients in all groups. However, for a small but significant (p<0.5) proportion of patents in the severe dysphagic group, clinicians disagreed they were able to satisfactorily and competently assess to the best of their abilities using the telerehabilitation system.CONCLUSIONS: Clinical decisions made during and as an outcome of the total CSE were found to be comparable to those made in the FTF environment regardless of dysphagia severity. Clinicians noted some difficulty assessing patients with greater complexity, which occurred in greater numbers in the group with severe dysphagia.

Resumo Limpo

jectiv recent research support propos valid reliabl clinic swallow examin cses can conduct via telerehabilit howev studi explor whether dysphagia sever impact success session outcom current studi examin dysphagia sever impact either clinic decis make safeti oral intak b clinician percept cses conduct via telerehabilitationsubject method one hundr patient nondysphag mild moder sever dysphag assess use telehealth system methodolog report prior research assess onlin facetofac ftf clinician simultan complet structur cse session complet onlin clinician indic level agreement two statement regard level rapport abil compet assess patientresult four group accept level agreement observ rater three primari outcom decis regard oralnonor intak safe food fluid well cse item clinician agre develop good rapport major patient group howev small signific p proport patent sever dysphag group clinician disagre abl satisfactorili compet assess best abil use telerehabilit systemconclus clinic decis made outcom total cse found compar made ftf environ regardless dysphagia sever clinician note difficulti assess patient greater complex occur greater number group sever dysphagia

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