1. Telehealth Stroke Dysphagia Evaluation Is Safe and Effective
- Author
-
Kateri J. Spinelli, Kate Morrell, Megan Hyers, Karissa Schwartz, Jenniffer Mako, Tamela Stuchiner, Lisa R Yanase, and Lindsay Lucas
- Subjects
Male ,medicine.medical_specialty ,Speech-Language Pathology ,020205 medical informatics ,Wilcoxon signed-rank test ,02 engineering and technology ,Telehealth ,Logistic regression ,Oregon ,03 medical and health sciences ,Esophagus ,0302 clinical medicine ,Swallowing ,Predictive Value of Tests ,Odds Ratio ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Prospective Studies ,Stroke ,Aged ,Aged, 80 and over ,Observer Variation ,business.industry ,Remote Consultation ,Reproducibility of Results ,Odds ratio ,Middle Aged ,medicine.disease ,Dysphagia ,Deglutition ,Logistic Models ,Neurology ,Point-of-Care Testing ,Predictive value of tests ,Physical therapy ,Female ,Neurology (clinical) ,medicine.symptom ,Deglutition Disorders ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Background: Rapid evaluation of dysphagia poststroke significantly lowers rates of aspiration pneumonia. Logistical barriers often significantly delay in-person dysphagia evaluation by speech language pathologists (SLPs) in remote and rural hospitals. Clinical swallow evaluations delivered via telehealth have been validated in a number of clinical contexts, yet no one has specifically validated a teleswallow evaluation for in-hospital post-stroke dysphagia assessment. Methods: A team of 6 SLPs experienced in stroke care and a telestroke neurologist designed, implemented, and tested a teleswallow evaluation for acute stroke patients, in which 100 patients across 2 affiliated, urban certified stroke centers were sequentially evaluated by a bedside and telehealth SLP. Inter-rater reliability was analyzed using percent agreement, Cohen's kappa, Kendall's tau-b, and Wilcoxon matched-pairs signed rank tests. Logistic regression models accounting for age and gender were used to test the impact of stroke severity and stroke location on agreement. Results: We found excellent agreement for both liquid (91% agreement; kappa = 0.808; Kendall's tau-b = 0.813, p < 0.001; Wilcoxon signed rank = -0.818, p = 0.417) and solid (87% agreement; kappa = 0.792; Kendall's tau-b = 0.844, p < 0.001; Wilcoxon signed rank = 0.243, p = 0.808) dietary textures. From regression modeling, there is suggestive but inconclusive evidence that higher National Institute of Health Stroke Scale (NIHSS) scores correlate with lower levels of agreement for liquid diet recommendations (OR [95% CI] 0.895 [0.793-1.01]; p = 0.07). There was no impact of NIHSS score for solid diet recommendations and no impact of stroke location on solid or liquid diet recommendations. Qualitatively, we identified professional, logistical, technical, and patient barriers to implementation, many of which resolved with experience over time. Conclusions: Dysphagia evaluation by a remote SLP via telehealth is safe and effective following stroke. We plan to implement teleswallow across our multistate telestroke network as standard practice for poststroke dysphagia evaluation.
- Published
- 2017
- Full Text
- View/download PDF