Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus

Abstract

Purpose: International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool. Materials and Methods: A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round. Results: Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool. Conclusions: Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed.Implications for Rehabilitation Dysphagia is an added complication following cervical spinal cord injury (cSCI) affecting morbidity, mortality and quality of life. Early identification of dysphagia risk allows focused interventions that reduce associated nutritional and respiratory impairments. Best practice recommendations based on expert consensus provide a baseline of appropriate interventions, in the absence of empirical evidence. A multi-professional approach to rehabilitation encourages a consistent and coordinated approach to care across acute and rehabilitation settings.