Videofluoroscopy Practice in India: A Survey of Speech-Language Pathologists

Owing to differences in clinical approaches toward videofluoroscopic swallowing studies (VFSS), professional and governing bodies in some countries have implemented guidelines for performing VFSS. However, in India, the establishment of such practice guidelines is in initial stages of acceptance and there are no uniform guidelines. The aim of the current study was to investigate and describe the clinical practice patterns related to VFSS assessments among Speech-Language Pathologists (SLPs) in India. An electronic survey consisting of 34 questions categorized into four main sections (demographic details and education; current practice; instrumental and technical considerations; protocol and assessment methods) was sent to SLPs registered with the Indian Speech and Hearing Association (ISHA) through email and social media from August 2020 to January 2021. A total of 129 eligible responses were received. More than 50% of the participants used a standard assessment and analysis protocol. Barium and water-soluble contrasts were mostly used, and 97% of participants did not know what percent weight to volume (w/v) or volume to volume (v/v) contrast to fluid were used. Considerable amount of variability was observed in the responses of our participants, which was consistent with international surveys of VFSS practice patterns. Lack of adequate radiation safety measures was also observed. Our findings suggest a need to increase awareness and training among Indian SLPs in technical and procedural aspects of VFSS, and more sensitization toward radiation safety. ISHA should consider forming a committee to develop and adopt uniform nationwide practices in VFSS. Future studies exclusively investigating barriers and facilitators to VFSS practice in the Indian scenario are necessary.

Current videofluoroscopy practice in the United Kingdom: A survey of imaging professionals

INTRODUCTION

Videofluoroscopy (VFSS) is a frequently used radiological investigation for dysphagia and is conducted within a radiology setting by speech and language therapists (SLTs) working alongside imaging personnel (radiologists and/or radiographers). Previous surveys of SLT practice have reported variability in VFSS protocols and procedures. The aim of this study was to explore current clinical practice for VFSS from the perspective of imaging personnel engaged in VFSS within the United Kingdom.

METHODS

A comprehensive online survey enabled exploration of current practices of imaging professionals. Target participants were diagnostic imaging personnel (radiographers and radiologists) with experience of working in VFSS clinics. Descriptive statistics describe and summarise the data alongside inferential statistics where appropriate.

RESULTS

54 survey participants represented 40 unique acute healthcare organisations in the UK, in addition to two respondents from the Republic of Ireland. The survey demonstrated high variance in clinical practice across all stages of the VFSS procedure. Clinicians were not always compliant with current UK guidelines and the roles and responsibilities of different professionals working within the clinics were often not clearly defined.

CONCLUSION

Further research is required to develop new international, interprofessional VFSS guidelines to standardise service delivery for VFSS, improving diagnostic accuracy, efficiency and patient experience.

IMPLICATIONS FOR PRACTICE

In the absence of VFSS guidelines for imaging personnel, practitioners should familiarise themselves with the UK Royal College of Speech and Language Therapists VFSS Position paper; IR (ME)R guidelines and DRLs for the client groups with which they work to guide clinics and improve practice. Clinicians should revisit protocols and clinical governance regarding safe practice in order to improve the quality of care within the VFSS clinic.

Oesophageal screening during videofluoroscopy: International practices and perspectives of speech-language pathologists

Purpose: The aim of this study was to investigate international oesophageal screening (OS) practices during videofluoroscopy (VFS) amongst speech-language pathologists (SLPs) and to establish SLP perspectives regarding OS during VFS.Method: A 25-item online survey was developed and disseminated internationally. Respondents were SLPs with dysphagia and VFS experience. Information was sought on OS practices and perspectives. Descriptive statistics were used to analyse results.Result: A total of 202 SLPs completed the survey from USA, UK, Ireland, New Zealand, Australia and Austria. Fifty-eight per cent (n = 117/202) of SLPs internationally include an OS during VFS. This rate varies across USA (81%; 91/113), UK (69%; 18/26) and Ireland (60%; 18/30). Only 25% (29/117) of SLPs use a validated OS protocol. Most SLPs perform an OS in an anterior-posterior view (55%; 64/117) with patients seated (54%; 64/117). Bolus consistencies administered vary greatly. SLPs evaluate oesophageal bolus clearance (81% (95/117), bolus redirection (64%; 75/117), oesophageal transit time (49%; 57/117) and oesophageal pathology (11%; 13/117). Perceived challenges include scope of practice, patient positioning, protocol uncertainty and multidisciplinary support.Conclusion: Over half of SLPs internationally responding to the survey include an OS during VFS. Few follow validated protocols and analysis practices vary. OS guidelines and training opportunities are needed to ensure validated OS protocols are adopted into clinical practice.