Alterations and preservations (McCurtin et al., 2023)

Purpose: The intervention of thickened liquids (TL) is commonly used to reduce aspiration in people with dysphagia. Speech-language pathologists (SLPs) have traditionally believed it is an effective intervention. Recent articles highlight limited evidence, poor acceptance, and a variety of unintended consequences. This study explores if current debates have been reflected in SLP practices and perspectives.

Method: An e-survey was developed. Participants were recruited via professional associations in Australia, New Zealand, Ireland, the United Kingdom, and the United States. Descriptive and inferential statistics were used to explore the data. Principal component analysis was used to summarize SLP practices and perspectives.

Results: The 370 respondents represented mainly experienced, confident, hospital-based clinicians. While 20% of respondents frequently recommend TL, 61% believe it to be a burdensome treatment. “Best treatment” and “It works” beliefs continue to underpin decision making. Those who recommend TL most often are most influenced by penetration, coughing, and their own clinical experience. They are more likely to believe TL is evidence based and effective, reduces aspiration, and improves hydration. Person-centeredness is important among all respondents, although significant numbers would implement TL against patient wishes. Improvements in aspiration status and quality of life rank highly as reasons to discontinue TL.

Conclusions: The results of this study suggest that fewer respondents are regularly using TL. Divergent groups are evident with those frequently employing and believing in the efficacy of TL and those who do not. While current debates are influencing practice, there clearly remains a significant number of SLPs continuing to recommend TL. This study’s findings highlight both alterations and preservations in the discipline’s approach to TL and calls for SLPs to reframe our thinking regarding this intervention as well as consider alternative options in this treatment space.

Supplemental Material S1. Examples of papers employed in study design and resulting survey content.

Supplemental Material S2. Significant SLP beliefs and propensity to recommend TL.

Supplemental Material S3. Additional significant belief differences between respondents.

Supplemental Material S4. Significant practice differences based on geography.

Supplemental Material S5. Significant practice differences based on respondent characteristics.

Supplemental Material S6. Significant SLP influences and propensity to recommend TL.

Supplemental Material S7. Significant influence differences based on respondent characteristics.

Supplemental Material S8. Significant evidence and effectiveness beliefs and discontinuation tendencies.

Supplemental Material S9. Significant discontinuation differences based on respondent characteristics.

McCurtin, A., Byrne, H., Collins, L., McInerney, M., Lazenby-Paterson, T., Leslie, P., O’Keeffe, S., O’Toole, C., & Smith, A. (2023). Alterations and preservations: practices and perspectives of speech-language pathologists regarding the intervention of thickened liquids for swallowing problems. American Journal of Speech-Language Pathology, 33(1), 117–134. https://doi.org/10.1044/2023_AJSLP-23-00226