What happens if you cannot swallow?
Dr. Rosemary Martino and her research Team are finding new ways to identify swallowing problems (dysphagia) earlier and more accurately to reduce serious complications such as pneumonia, malnutrition and depression. To do this, they are developing a new test called the Medical Outcomes of Dysphagia (MOD). This work receives funding from the Canadian Institutes of Health Research (CIHR) and the Canadian Cancer Society Research Institute (CCSRI). It includes all patients, regardless of etiology and including those with stroke, Parkinson’s disease, cardiovascular disease or head and neck cancer.
The MOD was conceptualized to describe the medical outcomes related to dysphagia. Using a qualitative approach, earlier work from this lab explored the dimensions of medical impairment, which generated the items that comprise the MOD tool, incorporating the three most relevant perspectives: those of clinicians, caregivers and patients. This work was the first to compare all three perspectives, and resulted in three major findings: first, clinicians, patients and caregivers considered the same three medical domains to be important for patients with dysphagia, namely pulmonary, nutrition and psychological consequences; second, although the same, patients prioritized these consequences differently than clinicians or caregivers with priority given to psychological issues; and finally, patients’ perceptions of psychological issues changed over time with acute patients focusing on anxiety and chronic patients on depression. As an extension of this earlier work, Dr. Martino’s lab is currently conducting the psychometric validation of the MOD on a large sample of patients with dysphagia. The MOD tool includes three subscales –MOD-Pulm, MOD-NH, and MOD-Psych.
The “MOD Squad”, which leads study screening, recruitment and protocol activities, is a multi-disciplinary team of health professionals, including Speech Language Pathologists, a Respiratory Therapist and a Registered Dietitian. In addition, a roster of over 60 clinicians that span five health professions (Occupational Therapists, Physical Therapists, Registered Dietitians, Respiratory Therapists and Speech Language Pathologists) has received special training to administer the MOD scales to study participants, who include any eligible patients with dysphagia from the University Health Network.
Across all of her research, Dr. Martino and her lab focus on initiatives that have a broad clinical impact and that will generate resources and knowledge to help clinicians of all disciplines. Most importantly, these resources will assist clinicians in establishing protocols to identify dysphagia early and to track the benefit of their interventions on medical complications. Early detection of dysphagia is critical to improve overall patient health, and also to ensure cost benefits through improved interventions.