title: Assessing adherence to the evidence base in the management of poststroke dysphagia.
abstract: 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.
authors.affiliation: Department of Nursing, University of Central Lancashire, Preston, UK. cburton@uclan.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Burton
authors.forename: Lindsay
authors.initials: L
authors.lastname: Pennington
authors.forename: Hazel
authors.initials: H
authors.lastname: Roddam
authors.forename: Ian
authors.initials: I
authors.lastname: Russell
authors.forename: Daphne
authors.initials: D
authors.lastname: Russell
authors.forename: Karen
authors.initials: K
authors.lastname: Krawczyk
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Smith
mesh_terms: 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