Understanding and enhancing dysphagia associated measurement and clinical processes: validation of the BRACS residue rating instrument and evaluation of clinical care patterns at Boston Medical Center
| Autor: | Krisciunas, Gintas P. |
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| Rok vydání: | 2024 |
| Předmět: | |
| Druh dokumentu: | Thesis/Dissertation |
| Popis: | Eating and drinking are human behaviors that most people take for granted. They are a prerequisite for proper nutrition, but they also define people personally and culturally. Unfortunately, every year 1 in 25 people experience trouble swallowing (dysphagia). Dysphagia is associated with reduction in quality of life, and increased risk of weight loss, dehydration, malnutrition, pneumonia, and death. The nature and severity of dysphagia is commonly assessed with Flexible Endoscopic Evaluation of Swallowing (FEES). A FEES exam allows direct observation of food/liquid passing through the throat, and allows a clinician to assess swallow safety and efficiency. Swallow efficiency, a critical aspect of the swallow evaluation, is assessed by measuring the severity of residue, defined by food/liquid left in the throat after a swallow. In the absence of well-designed measurement tools, residue is often assessed as “none/mild/moderate/severe” without operational definitions which hinders meaningful measurement or communication of swallow dysfunction. In addition to FEES, a variety of clinical procedures and patient reported outcome questionnaires can be used to evaluate the nature and severity of a patient’s dysphagia. However, there are no universally recognized evidence-based guidelines that inform treating clinicians as to which clinical procedures and which questionnaires should be employed to optimize dysphagia assessment and treatment outcomes. It is unknown whether this lack of guidance leads to inadvertent and/or inequitable variation in dysphagia assessment practices. To address these dysphagia assessment challenges, three projects were conducted. Project 1 entailed comprehensive reliability and validity testing of a novel visuoperceptual residue rating scale called BRACS. Project 2 entailed establishing preliminary BRACS interpretability using modified Delphi and bookmarking methodologies to identify clinically meaningful BRACS score categories. Projects 1&2 demonstrated that BRACS is a psychometrically sound residue rating instrument that can be confidently incorporated into clinical practice and as a clinical trial outcome. Project 3, which was distinct from projects 1&2, explored whether clinician and patient factors were associated with variable dysphagia assessment practices, namely provision of patient reported outcome questionnaires. Five drivers of variation were identified, paving the way for replication studies and remediation strategies aimed at minimizing assessment variation, and maximizing clinical care equity. 2026-05-10T00:00:00Z |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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