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Molokwu, Anuri Joy (2015) Assessment of dysphagia in people with Parkinson’s disease, multiple sclerosis and muscular dystrophy. PhD thesis, University of Nottingham.

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Abstract

Introduction

Previous research has shown that patients with Parkinson’s disease (PD), multiple sclerosis (MS) and muscular dystrophy (MD) are known to be at risk of dysphagia and could benefit from dysphagia screening. The aim of this study was to describe the use of dysphagia screening and assessment procedures amongst patients with neurological conditions when they have an unplanned admission to hospital.

Methods

Two methods of data collection were used in this study. The first method was a prospective observational study to determine the use of dysphagia screening and assessment procedures amongst patients with Parkinson’s disease, multiple sclerosis and muscular dystrophy. The second, qualitative study examined clinicians’ perceptions of the factors that influenced the decision to screen for dysphagia in people with neurological conditions and the difficulties experienced. Data were collected from clinicians using semi-structured in-depth interviews. Potential interventions to improve the management of dysphagia in these conditions were identified.

Results

Two hundred patients were recruited to the observational study. Thirty four percent (n=68) of this group underwent a swallow screening assessment (SSA) during the first week of admission and 93% (n=63) of these were judged to have dysphagia. Amongst those who were not assessed initially (n=132), a further 77% (n=101) were found to have dysphagia.

Twenty people took part in the interview study including doctors, health care assistants, nurses and therapists. Clinicians reported that the factors which underpinned their decision to screen for dysphagia included pre-existing swallowing difficulties, recognition of symptoms, staff/relative anxiety, communication difficulties and the presenting complaint and diagnosis. However, clinicians reported that their limited knowledge, clinical competencies in swallow screening, a lack of confidence and resources, affected their practice and use of dysphagia screening and assessments. Clinicians noted a number of interventions that could improve the management of dysphagia when patients are admitted to hospital and these included: training in dysphagia screening; development of dysphagia pathways or guidelines; provision of an alert system, introduction of on-call speech and language therapy services; and research funding.

Discussions and Conclusions

The findings of this study suggest that screening for dysphagia does not occur routinely when patients with neurological conditions are admitted to hospital for an acute condition. This means that opportunities to detect treatable causes of potentially life-threatening complications are being missed.

Many inter-related factors were reported to account for this practice and these related primarily to limited knowledge and confidence and the limited accessibility of speech and language therapists outside usual working hours. Interventions to improve routine dysphagia screening should help to reduce the incidence of avoidable complications and perhaps shorten length of stay. Dysphagia pathways or guidelines are needed to support effective management in acute hospital settings.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Pinnington, L.L. Phillips, M.F.
Keywords:	Neurodegenerative disorder, Function and impairment-dependent, Clinical practice
Subjects:	W Medicine and related subjects (NLM Classification) > WI Digestive system
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	29048
Depositing User:	MOLOKWU, ANURI
Date Deposited:	01 Sep 2015 10:58
Last Modified:	15 Dec 2017 05:53
URI:	https://eprints.nottingham.ac.uk/id/eprint/29048

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