Page 76 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

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Chapter 3
patients (36%) took the bolus anyways. None of the patients had (silent) aspiration on solids. All healthy participants performed the test three times, while all HNC patients performed the test twice and 21 out of 40 patients could perform the test three times. This was because some patients did not want to participate anymore after two trials, mainly because the amount to be ingested when performing the SPEAD-test three times was too much.
Results of the first trial of the SPEAD-test are summarized in Table 3. Eleven patients (29%) used a spoon to ingest the thick liquid compared to none of the healthy participants. Within the patients, using a spoon was not correlated to degree of dysphagia scored by the SLP (correlation coefficient 0.04, p = .824). Three patients (8%) needed water to eat the cracker while none of the healthy participants did.
Association of SPEAD-rate with participant characteristics
A higher SPEAD-rate is fairly correlated with younger age (ρ = 0.44, p < .001), as well as a greater body height (ρ = 0.36, p = .001), not having a dental prosthesis (ρ = 0.42, p < .001), and not using a spoon during the test (ρ = 0.25, p = .026). Gender was weakly correlated (ρ = 0.18, p = .124), with males having a higher SPEAD-rate in this sample.
Safety, feasibility, and costs
No unsafe situations occurred. Also, none of the healthy participants found the test uncomfortable or had remarks about it. Of the HNC patients, six had remarks about the test. Three disliked the taste of the tick liquid, two thought the quantity of the thick liquid was too much, and three thought the cracker was too dry or tasteless.
Taking the three consistencies including the two one-minute breaks in between took 188 s ranging from 148 s to a maximum of 373 s or six minutes. The time needed to prepare the test and clean up afterwards was approximately two minutes. In case only SPEAD-rate is calculated, which takes approximately two minutes, maximal time needed to take the test is estimated to be maximally eleven minutes in participants with the slowest eating and drinking speed. In case recordings are evaluated on number of swallows and chews an additional seven minutes should be added to the assessment time.
The total costs of the products needed was approximately €2 per test (i.e., one trial of thin liquid, thick liquid and solid).
Reliability
Results of reliability analyses including all 78 participants are presented in Table 4. Both test- retest, intra-rater and inter-rater reliability of duration measurements were good to excellent. Reliability on the assessment of the number of swallows was moderate to excellent and good to excellent for the number of chews. A small learning effect was noticeable, because the median duration for thin liquid in the first, second and third trial was 11 s (range 4-150 s), 10 s (range 4-81 s) and 10 s (4-60 s), respectively. For thick liquid, this was 24 s (range 7-89 s), 19 s (range 7-91 s) and 19 s (7-105 s) and for solid this was 38 s (range 13-156 s), 37 s (range 14-129 s) and 34 s (14-160 s).