Purpose: To evaluate patient characteristics that may lead to inappropriate dietary texture recommendations by Teleswallow evaluation by Speech Language Pathologists (SLPs).
Background: Following stroke, screening for dysphagia using a swallow evaluation is essential for patient safety. Liquid and solid diet recommendations are given per our standardized four-level scale, ranging from nothing by mouth (NPO) to regular for solid and thin for liquid. We have previously shown good agreement between tele- and bedside swallow evaluation by SLPs, for both liquid and solid dietary textures. In this study, we sought to determine whether patient characteristics account for slight differences in inter-rater reliability.
Methods: Kendall’s tau-b and Wilcoxon Signed Rank test for related samples were used to look for significant differences between teleswallow and bedside swallow recommendations for patients with left and right stroke locations or varying levels of stroke severity measured by NIHSS. Evaluations for robot vs bedside swallow screens were categorized as in “agreement” or “disagreement”. Logistic regressions, with age and gender added as covariates, were then used to test the effects of NIHSS and stroke location on the odds of agreement of teleswallow and bedside swallow recommendations.
Results: One hundred stroke patients received both evaluations with median 42.0 minutes between evaluations. The average patient age was 67.7 (±14.4) and 50% were female. Median NIHSS score was 4 (interquartile range (IQR) = 7), and 53% (n = 48) of patients had left-brain strokes and 47% (n = 42) had right-brain strokes. Our analysis showed no significant differences between recommendations for stroke location, for either liquid or solid textures. There was also no significant impact on the odds of agreement based on severity, by NIHSS score, for solid textures. However, the odds of agreement between recommendations for liquid textures were 13% less per NIHSS point (OR = 0.876, 95% CI 0.772 - 0.993, p = 0.04).
Conclusion: Stroke severity had a small impact on the agreement between teleswallow and bedside recommendations for liquid, but not solid, diet textures.