Compensatory interventions to facilitate swallowing in adults with dysphagia to fluids

Research specification

Introduction

Our Health Technology Assessment (HTA) Programme invites applications in response to specific research questions. These have been identified, developed and prioritised for their importance to stakeholders including:

• Department of Health and Social Care
• NHS
• patients and public

Research question

Which compensatory interventions currently being used to facilitate swallowing in adults with dysphagia to fluids are most suitable for future studies of comparative effectiveness?

1. Patient group: Adults diagnosed with dysphagia to fluids.
   • it will be for you to define and justify the patient group (taking into consideration published and ongoing research) but they are encouraged to keep it as broad as possible.
   • the HTA Programme is interested in developing the evidence-base for patient groups where the evidence is especially lacking and the use of compensatory interventions for dysphagia to fluids is common, for example, adults in care homes, adults with a learning disability.
   • you need to plan to work in accordance with the underlying principles and provisions of the Mental Capacity Act and Adults with Incapacity (Scotland) Act when working with research participants who lack, or may lack, capacity.
2. Interventions: Any compensatory intervention used to facilitate swallowing in adults with dysphagia to fluids, for example, free water protocols, thickened fluids, sensory modification, flow rate, bolus size and positioning. Rehabilitative interventions, which aim to produce lasting functional change to swallowing, are excluded from this study.
3. Important outputs:
   • findings of a survey of current practice, which should include the factors that influence healthcare professionals’ decision-making about which compensatory interventions are offered
   • patients/carers’ views and preferences on the use of compensatory interventions
   • the current evidence base for each compensatory intervention in use, the advantages and disadvantages of each intervention, the safety profile, and on what basis effectiveness can be evaluated
   • consensus views of healthcare professionals and patients/carers on research recommendations for future studies that would make a difference for patients, carers and practice. Delineation of the most suitable interventions and appropriate outcomes for a study of comparative effectiveness

Rationale

Dysphagia to fluids is a condition where a person has difficulty swallowing liquids, which can lead to thin fluid aspiration, i.e. the accidental inhalation of liquid into the lungs. It often occurs with another health condition and can be experienced at any age. If not managed effectively, it can lead to other health problems such as respiratory complications. As eating and drinking is an integral part of social life, dysphagia to fluids can also have a negative impact on a person’s quality of life.

Increasing the evidence base for treating dysphagia is an important priority for the Royal College of Speech and Language Therapists (RCSLT). The RCSLT conducted a priority setting partnership to identify the key research questions in the area and also produced a position paper on the use of thickened fluids. One of the research questions identified was to evaluate the effectiveness of compensatory interventions, which are used to facilitate swallowing in people with dysphagia to fluids. Although dysphagia to fluids is prevalent across many health and social care settings, there is a lack of effectiveness evidence to inform the decision-making of clinicians, patients and their families.

The sparse evidence base means that there is currently little indication of which compensatory interventions could be evaluated in a study. Therefore, as an initial step towards strengthening the evidence base and addressing clinical uncertainty, the HTA Programme is interested in commissioning research to help understand current clinical practice in the use of compensatory interventions, healthcare professionals’ decision-making about which compensatory interventions are offered, the existing evidence for and the advantages and disadvantages of each intervention, and the views and preferences of patients/carers. As part of this research, an important output will be to give recommendations for future research based on consensus views of healthcare professionals and patients/carers.

Funding opportunity scope

This is a focused funding opportunity, and our intention is to fund a single study.

Study design

It will be applicants to define and justify the study design required to produce the important outputs, but it is anticipated that it will include:

• a survey of current practice
• a systematic review of the current evidence for each compensatory intervention being used
• qualitative work with healthcare professionals and patients/carers

Setting: You are to define and justify the most appropriate setting(s) for their specific patient group.

Outputs

Pathways to Impact – we are focused on the impact of the research we fund. You are asked to consider the timing and nature of deliverables in your proposals; and encouraged to maximise the impact of your research by explaining how you will mobilise knowledge and ensure that it is useful and relevant to stakeholders such as:

• policy makers
• special interest groups
• charities
• other stakeholders

Duration and costs

It is anticipated that applications to this funding opportunity will be between £300,000 and £400,000, however, there is no formal upper or lower limit.

You are advised that we are custodians of public funds and value for money is one of the key criteria that peer reviewers and funding committee members will assess applications against.

Eligibility

This funding opportunity does not have specific eligibility requirements; the standard eligibility criteria for the HTA Programme apply

NIHR research inclusion

In line with the NIHR principles of inclusion, it is important that you fully consider inclusion throughout the whole research lifecycle and provide information on any associated costs.

This includes (but is not limited to):

• your research design
• the participants you recruit and how you have considered diverse, under-served populations, health inequalities and exclusion criteria
• research methods
• data and statistical analysis
• knowledge mobilisation and dissemination of findings

Supporting information

A background document is available that provides further information to support your application. It is intended to summarise what prompted the funding opportunity and the existing evidence base, including relevant work from the HTA and the wider NIHR research portfolio. It was researched and written based on information obtained from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy, please email htaresearchers@nihr.ac.uk.