“One of the biggest grey areas”: A focus group study exploring dosage of swallowing exercises from speech-language pathologist perspectives

Abstract

Purpose: To explore the perspectives and practices of speech-language pathologists on dosage of swallowing exercises in stroke rehabilitation. Method: Online focus groups involved 20 speech-language pathologists working in various settings across Australia. Focus group data were recorded, deidentified, and analysed using inductive thematic analysis guided by an interpretivist phenomenological approach. Result: Analysis resulted in four main themes: (1) “Getting the most bang for your buck”: Importance of dosage in swallowing, (2) “No patient is identical”: Personalising swallowing exercise dosage to the patient, (3) “You’ve got what you should do, and then what you can do”: Gap between recommendations and practical application, and (4) “Not much guidance out there about dosage”: More research needed to guide dosage. Speech-language pathologists agreed that dosage was theoretically important for swallowing exercises, but practical application of dosage was impacted by patient factors, limited access to resources, and lack of research-based guidelines. Conclusion: Speech-language pathologists reported trying to provide optimal care despite multiple barriers to prescribing dosages of swallowing exercises in practice. Personalising exercise dosage to the patient, creative clinician strategies, improved and equitable access to resources, and research-based guidelines on swallowing exercise dosages are needed to address these barriers.