台灣語言治療師執行成人吞嚥障礙評估的現況調查：臨床評估項目之決策考量與儀器檢查使用狀況

Adult Dysphagia Evaluation Practices of Speech and Language Therapists in Taiwan: Clinical Swallowing Examination Decision-Making and Instrumental Examination

陳如筠(Ru-Yun Chen) ； 池育君(Yu-Chun Chih)

《台灣聽力語言學會雜誌》 48期 (2023/06) Pp. 1-26

https://doi.org/10.6143/JSLHAT.202306_(48).0001

摘要

本研究探討台灣語言治療師執行成人吞嚥障礙評估的現況，包括：一、臨床評估的核心項目為何、決策考量與其實證支持率，以及二、吞嚥儀器檢查的取得率、執行狀況與影響因素。本研究採用問卷調查法，招募具有台灣語言治療師證照、於台灣累積一年以上的臨床經驗，過去一年內曾於台灣執行成人吞嚥障礙業務的語言治療師填寫問卷，共收回155份有效問卷進行分析。研究結果顯示，台灣語言治療師使用的臨床評估核心項目共13項，其中69.2%經實證顯示具良好診斷性效能。選擇臨床評估項目的原因依序為臨床經驗（82.4%）、教育訓練（78.1%）、讀過相關文獻（58.1%）。儀器檢查取得狀況的部分，吞嚥儀器檢查取得率為49.7%。影響因素的部分，達顯著差異且具有中度以上效果量或關聯性程度的背景變項與吞嚥障礙評估變項共6組，例如：「工作場域」與「可否取得儀器」。本研究所蒐集的台灣語言治療師執行成人吞嚥障礙評估的現況資料，可供醫療端以及教育訓練單位作為參考。

關鍵字

成人吞嚥障礙評估 ； 臨床評估 ； 決策考量 ； 儀器檢查 ； 問卷調查

並列摘要

The purpose of this survey study was to obtain a comprehensive view of the adult dysphagia evaluation practice patterns of speech-language pathologists (SLPs) in Taiwan, specifically in terms of (1) core components, decision-making on certain components of clinical swallowing examination (CSE), and the condition of data-based support, and (2) availability, execution and factors of utilization of swallowing instrumental examination. SLPs who were certified SLPs in Taiwan, had more than one year of clinical experience, and had been providing services to individuals with dysphagia in the past year in Taiwan were recruited to fill out a self-administered survey. A total of 155 questionnaires were returned. Results indicated that there were 13 core components of CSE, and 69.2% of them had valid diagnostic performance. Reasons of using components of CSE were clinical experiences (82.4%), education and training (78.1%), and evidence support (58.1%). As for the instrumental examination, 49.7% of SLPs had access to swallowing instrumental examination. There were six pairs of background and practice patterns variables with significant correlation and valid effect size, such as workplace versus access to swallowing instrumental examination. The study obtained a comprehensive view of adult dysphagia evaluation practice patterns of SLPs in Taiwan which can be used as a reference for medical and educational training institutions.

並列關鍵字

Adult dysphagia evaluation ； Clinical swallowing examination (CSE) ； Decision-making ； Instrumental examination ； Survey study

參考文獻

戴千淑、鄭朝惠、黃千恩、林少瑜、劉子菁、梁穎（2020）。提升腦中風病人急性後期照護下轉率。榮總護理，37，360-368。doi:10.6142/VGHN.202012_37(4).0004

Akoglu, H. (2018). User’s guide to correlation coefficients. Turkish Journal of Emergency Medicine, 18, 91-93. doi:10.1016/j.tjem.2018.08.001

Andrews, M., & Pillay, M. (2017). Poor consistency in evaluating South African adults with neurogenic dysphagia. South African Journal of Communication Disorders, 64, a158. doi:10.4102/sajcd.v64i1.158

Bateman, C., Leslie, P., & Drinnan, M. J. (2007). Adult dysphagia assessment in the UK and Ireland: Are SLTs assessing the same factors?. Dysphagia, 22, 174-186. doi:10.1007/s00455-006-9070-3

Beavan, J., Conroy, S. P., Harwood, R., Gladman, J. R. F, Leonardi-Bee, J., Sach, T., ... Gaynor, C. (2010). Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial. Age and Ageing, 39, 624-630. hdoi:10.1093/ageing/afq088