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: 10043831
• 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/10043831
• 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; 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：本研究的总体目标是改善及时临床吞咽的可及性 检查（CSE）和吞咽困难治疗的退伍军人中风。本研究的目的 是建立一个CSE协议（CSEP），可用于语音语言病理学（SLP） 远程康复服务，意义：及时的CSE对于预防吞咽困难相关 死亡率、发病率、住院时间延长和医疗费用增加。延误 在SLP服务中，当中风患者在营业时间后、周末或 在假期里。SLP服务的远程康复具有消除所有访问的巨大潜力 卒中幸存者吞咽困难评估和管理的障碍。具体目标： 研究将解决3个具体目标：1）使用 Mann吞咽能力评估（MASA），来自多学科团队的输入， SLP、卒中病房护士和远程卒中咨询师; 2）建立初步的评分员 远程SLP管理和通过mHealth技术对MASA进行评分之间的可靠性， 床旁护士促进，与现场SLP同时和独立评分 MASA;以及3）在VA NTSP设施内试行远程SLP CSEP，以完善移动医疗服务 程序，并确定可行性、可接受性、招聘战略和结果 及时的CSE服务。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.德贝基弗吉尼亚州 医疗中心，与虚拟合作伙伴在弗吉尼亚州国家远程中风计划设施， 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）因中风入院。数据收集/分析程序：远程CSEP- 将使用MASA（唯一经过验证的标准化卒中CSE）制定SLP实践 患者将采用迭代模拟和汇报方法， 最佳技术的mHealth交付每个MASA项目。基本内容分析将 应用于代码汇报会话注释和观察。一旦远程SLP实践的CSEP是 建立后，远程SLP和护士协助者将在患者床边完成CSEP 在患有中风的退伍军人中（N=50）。现场SLP也将在床边， 对所有患者的反应做出同步但独立的临床判断 使用MASA提供的操作定义的MASA问题/任务。初步 将在远程SLP管理和MASA评分之间建立评分员间可靠性 通过mHealth技术，同时提供床边护士协助和现场SLP， 独立评分的MASA。将计算每个MASA的Cohen加权Kappa 项目包括吞咽困难风险、误吸风险以及饮食和 工具性评估。CSEP的迭代优化将继续实现中度至 对MASA的所有项目达成一致。建立初步可靠性的同时 在CSEP中，将迭代开发和完善移动健康交付流程。在 为更大规模的实施研究做准备，CSEP将在退伍军人中进行试点测试（N=5） 因中风住进了退伍军人事务部新技术支持计划机构CSEP的可行性/可接受性将 使用半结构化访谈/问卷在SLP、护士和患者中建立。 将记录成功的征聘战略，并及时衡量远程SLP 将通过图表审查确定服务。