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Introduction: Fatigue is commonly identified by clinicians who evaluate and treat swallowing impairment despite a lack of research in this area. The purpose of this study was to understand the current role of swallowing-related fatigue in dysphagia evaluation with respect to (a) clinician practices, (b) perspectives, and (c) desire for resources regarding swallowing-related fatigue.
Method: A survey was conducted by licensed speechlanguage pathologists who evaluate and treat adult dysphagia. The survey was distributed via dysphagia-focused groups on Facebook and Special Interest Group 13. Data were analyzed descriptively and by thematic analysis for free-text response questions.
Results: Out of 426 prospective respondents, 311 completed the survey (response rate = 73.0%). While 86% of respondents agreed that fatigue may be a concern for individuals with swallowing impairment, there was wide variability in how clinicians define and evaluate swallowing-related fatigue, and the majority (62%) define fatigue in two or more ways. Explicit evaluation of fatigue was reportedly conducted by 45% of respondents during the Clinical Swallowing Evaluation, by 38% during videofluoroscopic swallowing study, and by 53% during Flexible Endoscopic Evaluation of Swallowing. The most common methods for identifying fatigue were general declines in performance over the course of the assessment. Respondents reported much more reliance on patient report during Clinical Swallowing Evaluation (41%) compared to videofluoroscopic swallowing study (7%) and fiberoptic endoscopic evaluation of swallowing (5%). Only 7% of respondents reported being aware of any standardized methods for assessing fatigue, while 97% of respondents affirmed interest in incorporating standardized methods for assessing swallow-related fatigue.
Conclusions: Our results demonstrated wide variability in how currently practicing clinicians define and evaluate swallowing-related fatigue, despite the vast majority considering fatigue to be an important factor in dysphagia evaluation. This study highlights a critical gap in the clinical evaluation of swallowing and requires significant further study to guide clinical practice.
As of February 2021, a search of the American Speech-Language-Hearing Association (ASHA) practice portal webpage for adult dysphagia reveals six mentions of the word "fatigue" under the "Assessment" heading (ASHA, n.d.). These include practice guidelines and considerations for fatigue during all three assessment modalities that are reviewed in detail: noninstrumental assessment (i.e., clinical swallowing exam; Clinical Swallowing Evaluation [CSE]), videofluoroscopic swallowing studies (VFSSs), and fiberoptic endoscopic evaluations of swallowing (FEES).
The consistency...