Assessing adherence to the evidence base in the management of poststroke dysphagia.
OBJECTIVE
To evaluate the reliability and responsiveness to change of an audit tool to assess adherence to evidence of effectiveness in the speech and language therapy (SLT) management of poststroke dysphagia.


METHODS
The tool was used to review SLT practice as part of a randomized study of different education strategies. Medical records were audited before and after delivery of the trial intervention.


METHODS
Seventeen SLT departments in the north-west of England participated in the study.


METHODS
The assessment tool was used to assess the medical records of 753 patients before and 717 patients after delivery of the trial intervention across the 17 departments. A target of 10 records per department per month was sought, using systematic sampling with a random start.


METHODS
Inter- and intra-rater reliability were explored, together with the tool's internal consistency and responsiveness to change.


RESULTS
The assessment tool had high face validity, although internal consistency was low (ra = 0.37). Composite scores on the tool were however responsive to differences between SLT departments. Both inter- and intra-rater reliability ranged from 'substantial' to 'near perfect' across all items.


CONCLUSIONS
The audit tool has high face validity and measurement reliability. The use of a composite adherence score should, however, proceed with caution as internal consistency is low.
Burton
Christopher
C
Department of Nursing, University of Central Lancashire, Preston, UK. cburton@uclan.ac.uk
Pennington
Lindsay
L
Roddam
Hazel
H
Russell
Ian
I
Russell
Daphne
D
Krawczyk
Karen
K
Smith
Hilary A
HA
D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation*; D004739:England; D019983:Guideline Adherence; D006801:Humans; D007808:Language Therapy; D008485:Medical Audit / Q000379:methods*; D015588:Observer Variation; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D015203:Reproducibility of Results; D013070:Speech Therapy; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation