Cleft lip and palate feeding intervention : a scoping review

Brand, Bea-Mari (2020-03)

Thesis (MSL&HT)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT : Background: Infants with cleft lip and palate (CLP) often suffer from feeding difficulties before surgical intervention. Speech therapists can provide different types of feeding intervention for this population. A scoping review was suggested to determine the evidence-based practice for feeding intervention in the CLP population. The research question for this scoping review was: What management strategies and associated outcomes are described in the research literature for feeding difficulties in the CLP population? Objectives: To summarize available literature on CLP feeding management strategies and their associated outcomes, as well as to identify gaps in the evidence base of feeding intervention in the CLP population. Methods: Arksey and O’Malley’s (2005) scoping review methodological framework was utilized and included all six stages of the framework. Inclusion criteria: Only articles published between 1990 and 2018 were included. The studies needed to be either published or translated into English or Afrikaans. The age range of the research participants was from newborn to six years of age. The primary diagnosis had to be cleft lip, cleft palate or CLP, which was not related to other syndromes. The articles had to include feeding intervention as well as an outcome for that intervention. Only primary research was included in this scoping review. Search strategy: The following Boolean search string was used to search through 5 databases: (“cleft lip and palate” OR “cleft lip” OR “cleft palate” OR craniofacial) AND (feeding OR swallowing OR breastfeeding OR dysphagia OR eating OR deglutition) AND (manage* OR rehabilitation OR treatment OR intervention OR therapy). Extraction of data: Screening measures first included the titles of the articles, then the abstracts, and finally, full-text reviews. The charting of the final selection of articles was grouped according to the following categories: title, authors, year of publication, location of the study, design, participants, timing of intervention, feeding intervention and associated outcomes. After the data was extracted from the articles, interviews were held with experienced speech therapists to determine their perceptions on the studied subject. Analysis of results: Thirty-one articles were included in this scoping review. The main feeding intervention themes included: caregiver training (43%), use of feeding utensils (40%), use of prostheses (14%) and alternative feeding (3%). The use of various modified bottles and teaching caregivers feeding strategies were some of the commonly reported strategies in the articles. Generally, positive outcomes were reported in the articles, such as weight gain. The interviewed speech therapists, however, prefer to use other interventions in their clinical practice compared to the feeding interventions reported in the research. Their clinical contexts had an influence on the type of feeding intervention prescribed for their patients. Conclusions: The results from the research and the perceptions of the therapists indicated a need for more evidence-based research within the South African and other low- and middle-income countries’ contexts, as most of the available research is from high-income countries. A recommendation for speech therapists in low- and middle-income countries is that they need to rely more on their clinical experience than the available research to provide evidence-based practice.

AFRIKAANSE OPSOMMING : Agtergrond: Babas met gesplete lip en verhemelte (GLV) het dikwels voedingsprobleme voor chirurgie plaasvind. Spraakterapeute kan verskillende tipes voedingsintervensies vir hierdie teikengroep bied. ‘n Omvangsbepaling was voorgestel om die bewysgebaseerde praktyk vir voedingsintervensie in die GLV populasie te ondersoek. Die navorsingsvraag vir hierdie omvangsbepaling was: Watter behandelingstrategieё en gepaardgaande uitkomstes word in die navorsingsliteratuur oor voedingsprobleme in die GLV populasie beskryf? Doelwitte: Om die beskikbare literatuur rondom GLV voedingsbehandeling in terme van die intervensie strategieë en hul gepaardgaande uitkomstes op te som asook om leemtes in bewysgebaseerde navorsing van voedingsintervensies met die GLV populasie te identifiseer. Metode: ‘n Omvangsbepalings-raamwerk van Arksey en O’Malley (2005) was gebruik wat al ses stadiums van die omvangsbepalings-raamwerk insluit. Insluitingskriteria: Net artikels tussen die jare 1990 en 2018, is ingesluit. Die studies moes in Afrikaans of Engels of vertaal in Afrikaans of Engels wees. Die ouderdom van deelnemers kon tussen pasgebore tot ses jaar oud wees. Die primêre diagnose van die deelnemers moes gesplete lip, gesplete verhemelte of GLV, wat nie verwant is aan ander sindrome nie, insluit. Die artikels moes ‘n voedingsintervensie insluit asook ‘n uitkomste verwant aan die intervensie. Net primêre navorsing was in die omvangsbepaling ingesluit. Soekstrategieё: Die volgende Boolean soekstring was gebruik om deur vyf databasisse navorsing te doen: (“cleft lip and palate” OR “cleft lip” OR “cleft palate” OR craniofacial) AND (feeding OR swallowing OR breastfeeding OR dysphagia OR eating OR deglutition) AND (manage* OR rehabilitation OR treatment OR intervention OR therapy). Uittreksel vanuit data: Die titels van die artikels was eerste gesif en daarna die opsommings. Die hele artikel was met die finale sifting deurgegaan. Die finale keuse van artikels was volgens die volgende kategorieë gekarteer: titel, outeur, jaar van publikasie, plek van die studie, studie ontwerp, deelnemers, tyd van intervensie, voedingsintervensies en gepaardgaande uitkomstes. Na afloop van die uittreksel van die data vanuit die artikels, was onderhoude met ervare spraakterapeute gehou om te bepaal wat hulle persepsies rondom die onderwerp van hierdie studie is. Analise van resultate: Een-en-dertig artikels was in hierdie omvangsbepaling ingesluit. Die hooftemas rondom voedingsintervensie was versorger opleiding (43%), voeding gereedskap (40%), prostese (14%) en alternatiewe voeding (3%). Die gebruik van verskeie aangepaste bottels en opleiding van versorgers om verskillende voedingstrategieё toe te pas, was van die intervensies wat die meeste in die artikels voorgekom het. Positiewe uitkomstes, soos gewig toename, was oor die algemeen gerapporteer. Die spraakterapeute het egter ander voedingsintervensies verkies in hulle kliniese praktyk teenoor die voedingsintervensies wat in die navorsing berig was. Hulle kliniese konteks het ‘n groot invloed op watter tipe voedingsintervensies vir hulle pasiёnte voorgeskryf word. Gevolgtrekking: Die resultate van die navorsing en die persepsies van die spraakterapeute dui ‘n behoefte aan vir meer bewysgebaseerde navorsing binne die konteks van Suid-Afrika en ander ontwikkelende lande, omdat meeste navorsing vanaf hoё inkomste lande kom. Die aanbeveling vir spraakterapeute in lae en gemiddelde inkomste lande is dat hul meer op hul kliniese ervaring moet staatmaak as die beskikbare navorsing om sodoende bewysgebaseerde praktyk te verskaf.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/108052
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