Measuring Outcomes for Success…..What are You Using?

The Dysphagia Toolbox

I have written about the Dysphagia Toolbox before.    The Dysphagia Toolbox used to be a website that offered links to standardized and reliable tools that you can use in dysphagia assessment and with reassessment.  

 

                                       

 

Why a toolbox?

The one thing I can’t help thinking is why we call it a toolbox.  Do most of you actually carry a toolbox full of your must-have dysphagia assessment/treatment equipment?  Mine is usually jammed in my lab coat pockets or on top of my clipboard, if I remember to even bring that with me!  Although I often imagine SLPs running around with a toolbox.   

 

Dysphagia Apron?

Maybe saying our dysphagia “apron” would be more appropriate??  Now, I have recently seen the SLP fanny pack, which may also be an option!

 

                                                     

 

Anway, I digress…

 Outcome Measures

There are several outcome measures that are freely available for us to use from the Dysphagia Toolbox.  Outcomes should be taken at baseline, when therapy is initiated and can be used to show progress during reassessment and to show progress for discharge. 

There are questionnaires that the patient completes, indicating current symptoms when eating/drinking including:

 Self-Rating Assessments

Eating Assessment Tool-10 (EAT-10) which has 10 areas where the patient rates their swallowing to determine the impact of dysphagia on the patient’s daily function.

 The Sydney Swallow Questionnaire has 17 areas that the patient rates from rarely to always by placing an “x” on a line drawn for them.  You can read the research to support it here.   

Dysphagia in Multiple Sclerosis (DYMUS) is a questionnaire consisting of 10 patients that the patient uses to answer yes or no.

Swallowing Disturbance Questionnaire is a self-questionnaire with 15 items that are rated by the patient on a scale of 0-3 on the frequency of occurrence of various issues related to swallowing.

Swallowing after Total Laryngectomy Questionnaire (SOAL) a questionnaire to assist patients in rating their swallowing following total laryngectomy.

MD Anderson Dysphagia Inventory (MDADI) is a self-inventory to determine difficulty with swallowing for patients with head and neck cancer.

Swal Qol-A questionnaire about quality of life with dysphagia.  (This is a link to Scribd.   You can sign up for a free membership for 30 days and download the Swal Qol immediately.)

Clinicians may use:

The Functional Oral Intake Scale (FOIS) where they rate the patient’s diet level on a scale from 1-7, with a description of each diet provided.  The FOIS is also available as an app now!  

 The FOIS is actually much the same as the ASHA NOMS, which can be used to give a numeric patient rating by the diet they are currently consuming.  (You do have to take a training to use the NOMS and report findings to be able to use the NOMS.)

 The Penetration Aspiration Scale gives numbers regarding how deep penetration/aspiration occurs and if it was cleared or not.  This can be used during MBSS or during FEES to describe the penetration/aspiration.

 The Modified Barium Swallow Impairment Profile is a standardized means to modifieds with rating scores given to each of 17 physiological events during swallows of multiple consistencies.  Training is required to become a registered user of the MBSImP.

 The Mann Assessment of Swallowing Ability (MASA) is completed the the SLP as they complete a bedside or clinical swallow evaluation.  This gives a numeric score (up to 200) and provides a rating scale (mild, moderate severe) for both dysphagia and aspiration.  The MASA is also available in a version for patients with cancer called the MASA-C.  Did you know the MASA is available as an app?

The Yale Swallow Protocol is a screen that can be used to determine if a patient needs further evaluation of dysphagia or not.

Dysphagia Screening Questionnaire a screening tool for professionals to screen for dysphagia following stroke.

Just a small dent….. 

This is a small list of some of the outcome measures available to us.  You want to look for measures that are both valid and reliable.  Outcomes give us a way to measure progress by stating where the patient began and ended therapy.  It is crucial in this day and age with Medicare to measure your outcomes in a clear and precise manner.