RESUMO
The objective was to develop an interdisciplinary weaning protocol (IWP) for patients with tracheostomy tubes due to acquired brain injury, and to effect evaluate implementation of the IWP on decannulation rates and weaning duration. An expert panel completed a literature review in 2018 to identify essential criteria in the weaning process. Based on consensus and availability in clinical practice, criteria for guiding the weaning process were included in the protocol. Using the IWP, dysphagia is graded as either severe, moderate, or mild. The weaning process is guided through a protocol which specified the daily duration of cuff deflation until decannulation, along with recommendations for treatment and rehabilitation interventions. Data from 337 patient records (161 before and 176 after implementation) were included for effect evaluation. Decannulation rate during hospitalization was unchanged at 91% vs. 90% before and after implementation (decannulation rate at 60 days was 68% vs. 74%). After implementation, the weaning duration had decreased compared to before implementation, hazard ratio 1.309 (95%CI: 1.013; 1.693), without any increased risk of tube-reinsertion or pneumonia. Furthermore, a tendency toward decreased length of stay was seen with median 102 days (IQR: 73-138) and median 90 days (IQR: 58-119) (p = 0.061) before and after implementation, respectively. Scientific debate on weaning protocols for tracheostomy tubes are encouraged.
RESUMO
PURPOSE: To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD). MATERIALS AND METHODS: Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN). RESULTS: Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five. CONCLUSIONS: There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted.Implication for rehabilitationAssessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information.Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable.Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments.Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD.
