Clinical Practice Guideline Appraisal and Algorithm Development to Identify Recommendations Related to Nursing Practice for Post-Stroke Dysphagia
Journal of Clinical Nursing
Jiang, L., Zhang, W., et al. (2023).
Journal of Clinical Nursing, 32(17-18), 6089-6100.
<p>This umbrella review of clinical practice guidelines provides a summary of recommendations for the screening and treatment of post-stroke dysphagia. Though it is written for a nursing audience, recommendations within the scope of speech-language pathology will be included in this article summary.</p>
<p> </p>
<p>This umbrella review contains a series of guidelines, only some of which are published in English and relevant to SLP practice. Included guidelines that provide additional information related to the Evidence Maps are listed in the Associated Article(s) section below.</p>
Jiangsu University (China); Jiangsu Higher Education Association (China)
This umbrella review includes several clinical practice guidelines. The following are published in English and available within this Evidence Map: <br />
<ul>
<li><span style="color: #333333;">Dziewas, R., Michou, E., et al. (2021). European Stroke Organization and European Society for Swallowing Disorders Guideline for the Diagnosis and Treatment of Post-Stroke Dysphagia. <em>European Stroke Journal</em>, 6(3), LXXXIX-CXV. https://doi. org/10.1177/23969873211039721 </span></li>
<li><span style="color: #333333;">Powers, W. J., Rabinstein, A. A., et al. (2019). Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. <em>Stroke</em>, 50(12), e344–e418. https://doi.org/10.1161/STR.0000000000000211 </span></li>
<li><span style="color: #333333;">Teasell, R., Salbach, N. M., et al. (2020). Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation Following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019. <em>International Journal of Stroke,</em> 15(7), 763–788. https://doi.org/10.1177/1747493019897843</span></li>
</ul>
August 1, 2017 to August 6, 2022
Clinical practice guidelines
10 (5 used to generate key recommendations)
<div>Recommendations regarding post-stroke dysphagia screening in hospitals included: </div>
<ul>
<li><span style="color: #333333;">Formal dysphagia screening is recommended for all patients with acute stroke. </span></li>
<li><span style="color: #333333;">Dysphagia screening should be conducted by a trained healthcare provider. </span></li>
<li><span style="color: #333333;">Following admission, swallowing screening should occur as soon as possible. </span></li>
<li><span style="color: #333333;">Water swallow tests or multiple consistency tests may be used. </span></li>
<li><span style="color: #333333;">Patients with acute stroke should not receive anything by mouth (e.g., food, drink, oral medication) until a screening has been completed and the patients’ swallowing has been deemed safe. </span></li>
<li><span style="color: #333333;">The use of the Global Bedside Evaluation of Swallowing After Stroke (GLOBE-3S) or bedside clinical assessment are suggested for screening. </span></li>
<li><span style="color: #333333;">Abnormal results from swallowing screens should prompt referral to dysphagia clinicians for further assessment.</span></li>
</ul>
<div>Recommendations regarding treatment of post-stroke dysphagia included:</div>
<ul>
<li><span style="color: #333333;">Patients, families, and care partners should be educated on swallowing, aspiration prevention, and feeding recommendations. </span></li>
<li><span style="color: #333333;">Oral health care interventions, including patient training and education regarding oral hygiene, are suggested to reduce pneumonia risk. </span></li>
<li><span style="color: #333333;">Dysphagia intervention programs should be individualized and tailored to the patients’ specific swallowing impairments. </span></li>
<li><span style="color: #333333;">Intervention programs should involve compensatory strategies and rehabilitative exercises. These can include the chin tuck posture, the Mendelsohn maneuver, the Shaker technique, the Masako maneuver, and/or expiratory muscle strength training. </span></li>
<li><span style="color: #333333;">Texture modified diets and/or thickened liquids may be used following medical order. </span></li>
<li><span style="color: #333333;">Patients should be permitted and encouraged to self-feed to reduce aspiration risk.</span></li>
</ul>
