McRae, J; Hayton, J; Smith, C
(2022)
Speech and language therapy service provision in spinal injury units compared to major trauma centres in England: Are services matched?
Int J Lang Commun Disord, 57 (1).
pp. 6-20.
ISSN 1460-6984
https://doi.org/10.1111/1460-6984.12671
SGUL Authors: McRae, Jacqueline
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Abstract
BACKGROUND: National UK guidance makes recommendations for speech and language therapy staffing levels in critical care and rehabilitation settings. Traumatic spinal cord injury patients often require admission primarily to critical care services within a major trauma centre prior to transfer to a specialist spinal injury unit but may not receive similar levels of care. Dysphagia and communication difficulties are recognised features of cervical spinal cord injury; however, little is known about access to speech and language therapy services to provide rehabilitation and improve outcomes. AIMS: The aim of this study was to compare the workforce and clinical practices of speech and language therapy services in eight spinal injury units and four major trauma centres in England through an online survey. METHODS & PROCEDURES: An online survey was created with 26 multiple-choice questions across seven sub-sections, with options for free-text comments. These were sent to a named speech and language therapy contact at each of the specified units. Responses were uploaded into Excel for analyses, which included descriptive statistics and analysis of themes. OUTCOMES & RESULTS: Responses were received from 92% (11/12) speech and language therapy services invited, which included seven out of eight spinal injury units and all four major trauma centres. No units met national staffing recommendations. Staff in spinal injury units provided an average of 27 h per week input to the unit compared to 80 h in a major trauma centre. Despite caseload variations, speech and language range of therapy involvement and prioritisation process were equivalent. Access to instrumental assessment varied, with less use of Fibreoptic Endoscopic Evaluation of Swallowing in spinal injury units despite its clinical value to the spinal cord injury caseload. CONCLUSIONS & IMPLICATIONS: Speech and language therapy services delivering post-acute and long-term rehabilitation to spinal cord injury patients are limited by their resources and capacity, which restricts the level of therapy delivered to patients. This may have an impact on clinical outcomes for communication and swallowing impairments. Further evidence is needed of the interventions delivered by speech and language therapists and outcomes will be beneficial alongside benchmarking similar services. WHAT THIS PAPER ADDS: What is already known on this subject In England, people who sustain a spinal cord injury are admitted to a major trauma centre prior to transfer to a specialist spinal injury unit. Dysphagia and communication impairments are recognised as a complication of cervical spinal cord injury and benefit from speech and language therapy intervention. National recommendations exist for staffing levels, expertise and competencies for speech and language therapists working in critical care and rehabilitation units. What this study adds This study identified variations in the levels of speech and language therapy staffing, seniority, service delivery and access to instrumental assessments for dysphagia between major trauma centres and spinal injury units. None of the services complied with national staffing recommendations. Clinical implications of this study Speech and language therapy services in spinal injury units are often available part-time or have limited access to diagnostic tools which limits the range and intensity of rehabilitation input available. This has clinical implications for outcomes for swallowing and communication as well as long-term consequences for integrating back into community.
Item Type: |
Article
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Additional Information: |
This is the peer reviewed version of the following article: McRae, J., Hayton, J. & Smith, C. (2022) Speech and language therapy service provision in spinal injury units compared to major trauma centres in England: Are services matched? International Journal of Language & Communication Disorders. 57: 6– 20, which has been published in final form at https://doi.org/10.1111/1460-6984.12671. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited. |
Keywords: |
communication, critical care, dysphagia, spinal cord injuries, workforce, Deglutition Disorders, England, Humans, Language Therapy, Speech, Speech Therapy, Spinal Cord Injuries, Spinal Injuries, Trauma Centers, Humans, Deglutition Disorders, Spinal Cord Injuries, Spinal Injuries, Language Therapy, Speech Therapy, Speech, Trauma Centers, England, communication, critical care, dysphagia, spinal cord injuries, workforce, 1103 Clinical Sciences, 1702 Cognitive Sciences, 2004 Linguistics, Speech-Language Pathology & Audiology |
SGUL Research Institute / Research Centre: |
Academic Structure > Institute of Medical & Biomedical Education (IMBE) |
Journal or Publication Title: |
Int J Lang Commun Disord |
ISSN: |
1460-6984 |
Language: |
eng |
Dates: |
Date | Event |
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17 January 2022 | Published | 12 September 2021 | Published Online | 18 August 2021 | Accepted |
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Publisher License: |
Publisher's own licence |
Projects: |
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PubMed ID: |
34510665 |
Web of Science ID: |
WOS:000695081300001 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/114638 |
Publisher's version: |
https://doi.org/10.1111/1460-6984.12671 |
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