Adult dysphagia intervention through telepractice : a scoping review

Dhaya, Anisha (2019-04)

Thesis (MSL&HT)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: Dysphagia is a serious, life-endangering disorder, experienced by an increasing number of people. Worldwide, there are a limited number of healthcare professionals to provide face-to-face dysphagia intervention. Telepractice has been suggested as a potential solution. The question this scoping review aimed to answer is: How is telepractice applied to adult dysphagia intervention? Objective: To explore the application of telepractice to adult dysphagia intervention, at a national and international level. Inclusion criteria: Data was restricted to literature where participants involved were over the age of 18 years, and experiencing feeding and/or swallowing difficulties at that point in time. The core concepts were telepractice, and adult dysphagia intervention. Sources were only included if published during or after the year 2000, and full text was available in English. Experts were consulted to determine the challenges to implementation in South Africa, based on the results obtained. Experts were required to be: registered with the Health Professions Council of South Africa, providers of adult dysphagia intervention on a weekly basis for the last five years, practice in the Western Cape and be able to communicate effectively in English. Search strategy: The following Boolean search string was used to search 18 databases on 20 April 2018: (Telehealth OR Telecare OR Telemedicine OR Telepractice OR Teletherapy OR Telerehabilitation OR Telestroke OR Tele-dysphagia OR Tele-intervention OR “Telephone intervention” OR “Video conferencing”) and (Dysphagia OR Swallow* OR Feeding OR Deglutition) not (Child* Or Paediatric OR Pediatric OR Adolescent OR Infant). Extraction of results: Results were screened by title, and abstract to remove irrelevant articles. Remaining articles were screened by full text by the researcher and an inter-rater. Consensus was reached on which articles to include. The reference lists of these articles were screened by title and identified titles were screened by abstract and full text where necessary. The final selection of studies was charted according to the following categories: author(s), year of publication, location of study, areas of intervention, method of telepractice (equipment, procedure, internet requirements, and duration), and key findings. Presentation of results: Twenty-two articles were included. Dysphagia management was detailed in six articles. Specifically, three focused on rehabilitative management, two on compensatory management, and two on unspecified management. Instrumental assessment, was detailed in eight of the studies. Six studies focused on clinical swallow examinations, two on screening, and one on case history. Two studies focused on dysphagia assessment in general. One study focused on referral. Experts identified lack of resources, poor internet access, and lack of legislature about reimbursement, as key challenges. Proposed solutions included: using existing equipment, free Wi-Fi or USSD programmes, and developing reimbursement policies. Conclusions: Telepractice shows promising opportunities for adult dysphagia intervention with regards to screening, assessment, management and referral. Studies are still required to investigate the use of telepractice in prevention, health promotion and counselling pertaining to adult dysphagia. There is a need for policy development regarding reimbursement of dysphagiarelated telepractice services. Experts believe adult dysphagia intervention can be provided using telepractice in South Africa, if adapted to the needs of our context.

AFRIKAANSE OPSOMMING : Agtergrond: Disfagie is ‘n ernstige, lewensgevaarlike versteuring wat ‘n toenemende aantal mense aantas. Wêreldwyd, is daar ‘n beperkte hoeveelheid gesondheidswerkers wat disfagie intervensie van aangesigtot- aangesig kan bied. Telepraktyk word aanbeveel as ‘n potensiële oplossing. Die vraag wat hierdie omvangsbepaling beoog om te antwoord is: Hoe word telepraktyk aangewend tot disfagie intervensie? Doelwit: Om die toepassing van telepraktyk in volwasse disfagie intervensie, nasionaal en internasionaal, te verken. Insluitingskriteria: Data was beperk tot literatuur waar deelnemers wat betrokke was, oor die ouderdom van 18 jaar oud was en voeding en/of sluk probleme op daardie stadium ervaar het. Die kernkonsepte was telepraktyk en volwasse disfagie intervensie. Bronne was slegs ingesluit indien dit gedurende, of na die jaar 2000 gepubliseer was en die volle teks in Engels beskikbaar was. Die navorser het deskundiges in die veld geraadpleeg om die uitdagings van die implementering in Suid-Afrika, gebaseer op die verkryde resultate, te bespreek. Deskundiges was vereis om: geregistreerd by die Raad vir Gesondheidsberoepe van Suid-Afrika te wees, verskaffers te wees van volwasse disfagie intervensie op ‘n weeklikse basis vir die afgelope 5 jaar, te praktiseer in die Wes-Kaap en in staat te wees daartoe om effektiewelik in Engels te kommunikeer. Soekstrategieë: Die volgende Boolean soekstring was op 20 April 2018 gebruik om die 18 databasisse te deursoek: (Telehealth OR Telecare OR Telemedicine OR Telepractice OR Teletherapy OR Telerehabilitation OR Telestroke OR Tele-dysphagia OR Tele-intervention OR “Telephone intervention” OR “Video conferencing”) and (Dysphagia OR Swallow* OR Feeding OR Deglutition) not (Child* Or Paediatric OR Pediatric OR Adolescent OR Infant). Onttrekking van resultate: Resultate was gesif volgens titel en abstrak om irrelevante artikels te verwyder. Oorblywende artikels se volle teks was gesif deur die navorser en ‘n internasiener. Konsensus was bereik oor watter artikels ingesluit moet word. Die verwysingslyste van hierdie artikels was gesif volgens titel en geïdentifiseerde titels was gesif volgens abstrak en volle teks waar nodig. Die finale seleksie van studies was gekarteer volgens die volgende kategorieë: outeur(s), jaar van publikasie, plek van studie, areas van intervensie, metode van telepraktyk (toerusting, prosedure, internet vereistes, en durasie), en kernbevindinge. Aanbieding van resultate: Twee-entwintig Artikels was ingesluit. Disfagie behandeling was gedetailleerd in ses artikels. Rehabiliterende behandeling was gefokus op in drie artikels, kompenserende behandeling in twee, en ongespesifiseerde behandeling in twee artikels. Instrumentele assesserings was gedetailleerd in agt van die studies. Ses studies het gefokus op kliniese sluk ondersoeke, twee op sifting, en een op gevalsgeskiedenis. Daar was twee studies wat algemeen gefokus het op disfagie assessering. Een studie het gefokus op verwysing. Die kern uitdagings wat deur die paneel van deskundiges geïdentifiseer is, was ‘n tekort aan hulpbronne, swak internet toegang sowel as ‘n tekort aan wetgewing rakende vergoeding. Voorgestelde oplossings sluit in: Die gebruik van bestaande hulpbronne, gratis Wi-Fi of USSD programme, en die ontwikkeling van vergoedingsbeleide. Konklusie: Telepraktyk bied belowende geleenthede vir volwasse disfagie intervensie met betrekking tot siftings, assessering, behandeling en verwysings. Studies word steeds vereis om die gebruik van telepraktyk in voorkoming, gesondheidsbevordering en berading met betrekking tot volwasse disfagie te ondersoek. Daar is ‘n behoefte vir beleid ontwikkeling rakende vergoeding van dienste rakende disfagie intervensie via telepraktyk dienste. Kundiges glo volwasse disfagie intervensie kan deur middel van telepraktyk in Suid Afrika gebied word, indien aangepas by ons konteks.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105746
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