Clinical practice guidelines for videofluoroscopic swallowing studies: A systematic review

Area of Science:

• Medical Imaging
• Clinical Practice Guidelines
• Swallowing Disorders

Background:

• Clinical practice guidelines (CPGs) aim to standardize evidence-based care.
• Videofluoroscopic Swallowing Study (VFSS) is crucial for dysphagia assessment, but guideline variability is suspected.
• Lack of standardized VFSS guidelines may lead to inconsistent clinical practice.

Purpose of the Study:

• To systematically identify and appraise all available Videofluoroscopic Swallowing Study (VFSS) clinical practice guidelines (CPGs) worldwide.
• To assess the quality and suitability of existing VFSS CPGs for informing clinical practice.

Main Methods:

• Systematic search of academic databases and other sources for VFSS CPGs.
• Independent review of CPGs by a Speech and Language Therapist and a Radiographer using a content checklist.
• Quality assessment of CPGs using the Appraisal of Guidance for Research & Evaluation II (AGREE II) instrument.

Main Results:

• Seven VFSS CPGs were identified globally; none were co-designed by or targeted at radiographers.
• Significant variation exists in professional content, recommendations, evidence base, and focus across the identified CPGs.
• Average AGREE II scores varied widely (22%-93%), with no CPG scoring highly across all domains.

Conclusions:

• There is a lack of standardization among VFSS guidelines, with substantial differences in quality and content.
• Six of the seven identified CPGs are not recommended for clinical use.
• Only one VFSS CPG is recommended for use after significant modifications, highlighting a need for improved guideline development.