Can we assess swallowing function via telehealth?
Over the past two years, the use of telehealth in the clinical domain of swallowing disorders has significantly increased and become an innovative method to assess and treat dysphagia, while ensuring no in-person contacts. Despite being widely used in clinical practice, systematic investigations on the benefits, the effectiveness and reliability of telehealth visits applied to dysphagia management is scarce. To shed light on this important and timely topic, we present a study investigating the reliability of measuring clinical outcomes during telehealth swallowing evaluations in daily clinical practice.
Twelve adult patients with a neurological disease, internet connection, a device with video and audio, and with a caregiver in the household, underwent a clinical evaluation of swallowing (CSE) via telehealth. CSE consisted of swallowing trials with different volumes and consistencies, the Timed Water Swallow Test (TWST), and the Test of Masticating and Swallowing Solids (TOMASS). Recordings were independently assessed by seven speech and language pathologists to analyze reliability of telehealth assessment, calculated with the Intraclass Correlation Coefficient (ICC). Results suggested that inter- and intra-rater reliability were “good” to “excellent” for the TWST and TOMASS measures and for all signs of dysphagia during the swallowing trials. Camera position, stability of internet connection, and utensils facilitate the confidence of the ratings.
This study suggests that objective swallowing outcome measures, namely the TWST and the TOMASS, as well as subjective observations of oral intake, can be reliably assessed via telehealth. These results add to the body of literature demonstrating the feasibility and reliability of virtual clinical swallowing assessment, therefore supporting its use in clinical practice. Future studies should examine the reliability of these outcomes in a larger cohort of individuals with more severe swallowing dysfunction, cognitive impairments, and a more diverse set of technological parameters.