Development and Pilot Test of a Clinical Swallowing Examination (CSE) Protocol for Telerehabilitaion Delivery of SLP Services

用于远程康复提供 SLP 服务的临床吞咽检查 (CSE) 方案的开发和试点测试

• 批准号: 10431765
• 负责人: Jane Ann Anderson
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-11-01 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10431765
• 关键词: Address; Affect; Agreement; American Heart Association; American Stroke Association; Aspirin; Businesses; Clinical; Code; Competence; Consultations; Data; Data Collection; Deglutition; Deglutition Disorders; Development; Diet; Early Diagnosis; Enteral Feeding; Evaluation; Face; Food; Goals; Guidelines; Health Care Costs; Health Technology; Healthcare; Holidays; Hospital Costs; Hospitalization; Hospitals; Hour; Hydration status; Improve Access; Inpatients; Intervention; Interview; Language; Length; Liquid substance; Lung; Measures; Medical center; Methods; Mind; Modification; Morbidity - disease rate; Nurses; Oral; Outcome; Participant; Pathologist; Patients; Performance; Pharmaceutical Preparations; Pilot Projects; Preparation; Procedures; Process; Protocols documentation; Quality of life; Questionnaires; Recommendation; Registered nurse; Rehabilitation therapy; Research; Research Personnel; Risk; Screening procedure; Services; Site; Source; Speech; Speech-Language Pathology; Standardization; Stroke; Structure; Techniques; Technology; Tennessee; Testing; Time; United States Department of Veterans Affairs; Veterans; Wireless Technology; acute stroke; base; disability; implementation study; innovation; mHealth; medical complication; military veteran; mortality; multidisciplinary; nasogastric feeding; nutrition; patient response; pilot test; prevent; programs; recruit; remote location; screening; simulation; skills; stroke patient; stroke rehabilitation; stroke survivor; stroke symptom; telerehabilitation; telestroke; temporal measurement; virtual; ward

Purpose: The overarching goal of this study is to improve access to timely clinical swallowing examination (CSE) and dysphagia treatment in veterans with stroke. The purpose of this study is to establish a CSE protocol (CSEP) that can be used for speech-language pathology (SLP) telerehabilitation services, Significance: A timely CSE is critical to prevent dysphagia related mortality, morbidity, prolonged length of hospitalization, and increased healthcare costs. Delays in SLP services will occur when stroke patients present after business hours, on weekends or during holidays. Telerehabilitation for SLP services has great potential to eliminate all access barriers in dysphagia assessment and management for stroke survivors. Specific Aims: The study will address 3 specific aims: 1) Develop/refine a CSEP for tele-SLP practice using the Mann Assessment of Swallowing Ability (MASA) with input from a multidisciplinary team of SLPs, stroke ward nurses, and telestroke consultants; 2) Establish preliminary inter-rater reliability between a tele-SLP administering and scoring the MASA via mHealth technology with bedside nurse facilitation, versus an on-site SLP simultaneously and independently scoring the MASA; and 3) Pilot the tele-SLP CSEP within a VA NTSP facility to refine mHealth delivery processes and to establish feasibility, acceptability, recruitment strategies and outcome measurements for ‘timely CSE services. Methods: This is an exploratory study using both qualitative and quantitative methods. The study will be conducted at the Michael E. DeBakey VA Medical Center, with virtual partners at the VA National TeleStroke Program facility in Murfreesboro, Tennessee. Participant will include SLPs (N=3), registered nurses (N=20) and veterans (N=55) admitted with stroke. Data Collection/Analysis Procedures: The CSEP for tele- SLP practice will be developed using the MASA, the only validated, standardized CSE for stroke patients. Iterative simulation and debrief methods will be applied to establish and document optimal techniques for mHealth delivery of each MASA item. Basic content analysis will be applied to code debrief session notes and observations. Once a CSEP for tele-SLP practice is established, a tele-SLP and a nurse facilitator, at the patient’s bedside, will complete the CSEP on veterans admitted with stroke (N=50). An on-site SLP will also be at the bedside and will make simultaneous but independent clinical judgements concerning patient responses to all MASA questions/tasks using the operational definitions provided by the MASA. Preliminary inter-rater reliability will be established between a tele-SLP administering and scoring the MASA via mHealth technology with bedside nurse facilitation and an on-site SLP simultaneously and independently scoring the MASA. Cohen’s weighted kappa will be calculated for each MASA item including dysphagia risk, aspiration risk, as well as recommendations for diet and instrumental assessment. Iterative refinement of the CSEP will continue to achieve moderate to strong agreement for all items of the MASA. Simultaneous to establishing preliminary reliability of the CSEP, mHealth delivery processes will be iteratively developed and refined. In preparation for a larger implementation study, the CSEP will be pilot tested in veterans (N=5) admitted with stroke in a VA NTSP facility. Feasibility/acceptability of the CSEP will be established among SLPs, nurses and patients using semi-structured interviews/questionnaires. Successful recruitment strategies will be documented and measurement of timely tele-SLP services will be determined via chart review.

目的：这项研究的总体目标是改善及时的临床吞咽的机会 中风退伍军人的检查（CSE）和吞咽困难。这项研究的目的 是建立可用于语音语言病理（SLP）的CSE协议（CSEP） Telerehabilitation Services，意义：及时的CSE对于预防吞咽困难至关重要 死亡率，发病率，长期住院时间和增加医疗费用。延迟 在营业时间，周末或 在假期。 SLP服务的Telerehabilitation具有消除所有访问的巨大潜力 吞咽困难评估和中风存活的障碍。具体目的： 研究将针对3个具体目的：1）使用Tele-SLP实践开发/完善CSEP Mann评估吞咽能力（MASA），并通过多学科团队的投入 SLP，中风病房护士和远程顾问； 2）建立初步评估者 通过MHealth技术对MASA进行管理和对MASA进行评分之间的可靠性 床头护士设施，与现场SLP相比，简单地独立得分 马萨； 3）在VA NTSP设施中驾驶Tele-SLP CSEP，以完善MHealth交付 流程并建立可行性，可接受性，招聘策略和结果 及时的CSE服务的测量。方法：这是一项探索性研究 定性和定量方法。该研究将在Michael E. Debakey VA进行 医疗中心，与VA国家遥控计划设施的虚拟合作伙伴在 田纳西州默弗里斯伯勒。参与者将包括SLP（n = 3），注册护士（n = 20）和 退伍军人（n = 55）被中风接纳。数据收集/分析程序：Tele-CSEP SLP实践将使用MASA开发，MASA是唯一经过验证的标准化CSE的中风的CSE 患者。迭代模拟和汇报方法将用于建立和记录 MASA项目的MHealth交付的最佳技术。基本内容分析将是 应用于代码汇报会话说明和观察。曾经是Tele-SLP练习的CSEP 在患者的床边建立的Tele-SLP和护士主持人将完成CSEP 在接受中风的退伍军人（n = 50）上。现场SLP也将在床旁，将 对患者对所有人的反应做出简单但独立的临床判断 MASA使用MASA提供的操作定义的问题/任务。初步的 评估者间的可靠性将在Tele-SLP管理和评分MASA之间建立 通过MHealth Technology，带有床旁护士设施和现场SLP， 独立得分。 Cohen的加权Kappa将为每个MASA计算 包括吞咽困难的风险，攻击风险以及饮食和饮食建议的项目 工具评估。 CSEP的迭代精致将继续实现现代化 MASA所有项目的强有力协议。同时建立初步可靠性 在CSEP中，MHealth交付过程将在迭代和完善。在 为更大的实施研究做准备，将在退伍军人中测试CSEP（n = 5） 在VA NTSP设施中接受中风。 CSEP的可行性/可接受性将是 使用半结构化访谈/问卷调查，在SLP，护士和患者之间建立。 将记录成功的招聘策略，并及时测量Tele-SLP 服务将通过图表审查确定。