Telehealth and oropharyngeal dysphagia: An integrative review
Telessaúde e disfagia orofaríngea: uma revisão integrativa
Nataly Santana de Araújo; Raíssa Gomes Magalhães; Camila de Alencar Frois; Laura Davison Mangilli
Abstract
Keywords
Resumo
Objetivo: analisar a abordagem fonoaudiológica por meio da telessaúde em pacientes com disfagia e determinar as aplicações e efeitos desta prática.
Métodos: para seleção foram utilizados os descritores: Telerehabilitation, Telemedicine, “Remote Consultation”, “Delivery of Health Care”, “Distance Counseling”, “Therapy, Computer-Assisted”, “Speech-Language Pathology”, “Speech Therapy”, “Deglutition Disorders”, Dysphagia, “Bottle Feeding” e “Enteral Nutrition” nas bases de dados PubMed, MedLine, Scopus e Web of Science e na literatura cinzenta, por meio do Google Acadêmico e ProQuest. Foram selecionados estudos sem delimitação de tempo, nas línguas português, inglês e espanhol, que descrevessem a aplicabilidade e/ou efeitos da telessaúde na prática fonoaudiológica junto à pacientes com alteração da deglutição/disfagia, sem restrição de sexo e idade. Para análise considerou-se: nível de evidência científica e recomendação, modalidade de telessaúde, objetivos, métodos e resultados/conclusão.
Revisão da Literatura: foram encontrados 490 artigos e, após exclusão de duplicatas, análise dos títulos, resumos e leitura completa dos artigos, 22 estudos foram selecionados. Os artigos foram classificados nas modalidades da telessaúde: tele-educação, telediagnóstico, teleconsultoria, telerregulação e telemonitoramento.
Conclusão: as modalidades de telessaúde descritas tiveram grande potencial para promover melhoras significativas em pacientes com alteração de deglutição/disfagia, sugerindo-as como viáveis para serviços fonoaudiológicos. Entre elas, a teleconsulta foi a menos explorada.
Palavras-chave
Referências
1. Furkim AM, Sacco ABF. Eficácia da fonoterapia em disfagia neurogênica usando a escala funcional de ingestão por via oral (FOIS) como marcador. Rev. CEFAC. 2008;10(4):503-12.
2. Mendell DA, Logemann JA. Temporal sequence of swallow events during the oropharyngeal swallow. J Speech, Lang Hear Res. 2007;50(5):1256-71.
3. Zancan M, Lucchesi KF, Mituuti CT, Furkim AM. Onset locations of the pharyngeal phase of swallowing: meta-analysis. CoDAS. 2017;29(2):1-8.
4. Burkhead LM, Sapienza CM, Rosenbek JC. Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia. 2007;20;22(3):251-65.
5. Altman KW, Yu G-P, Schaefer SD. Consequence of dysphagia in the hospitalized patient. Arch Otolaryngol Neck Surg. 2010;136(8):784.
6. Toscano M, Viganò A, Rea A, Vizina A, Passo D'Elia T, Puledda F et al. Sapienza Global Bedside Evaluation of Swallowing after Stroke: the GLOBE-3S study. Eur J Neurol. 2019;26(4):596-602.
7. Santos LB, Mituuti CT, Luchesi KF. Speech therapy for patients with oropharyngeal dysphagia in palliative care. Audiol., Commun. Res. 2020;25:e2262.
8. Penié JB, Porbén SS, Gonzaléz CM, Ibarra AMS. Grupo de apoyo nutricional hospitalario: diseño, composicion y programa de actividades. Rev Cuba Aliment y Nutr. 2000;14(1):55-64.
9. Silva DLS, Lira FOQ, Oliveira JCC, Canuto MSB. Speech therapy practice in the intensive care unit of a hospital of infectious diseases of Alagoas. Rev. CEFAC. 2016;18(1):174-83.
10. Canuto MSB, Pereira RJS. Fonoaudiologia e disfagia em ambiente hospitalar. Rev. Intensiv. 2011;6:28-34.
11. Medeiros GC, Sassi FC, Andrade CRF. Use of silicone bracelet to signal risk of bronchoaspiration in a hospital setting. Audiol., Commun. Res. 2019;24:e2258.
12. Brasil. Ministério da Saúde (MS) [homepage on the internet]. O que é saúde digital? [accessed 2021 jul 27]. Available at:
13. Brasil. Ministério da Saúde (MS) [homepage on the internet]. Programa Telessaúde Brasil Redes. [accessed 2021 jul 27] Available at:
14. Brasil. Decreto n.º 9.795, de 17 de maio de 2019 [homepage on the internet]. Presidencia da República. [accessed 2021 jul 27]. Available at:
15. Beijer L, Rietveld T. Asynchronous telemedicine applications in rehabilitation of acquired speech-language disorders in neurologic patients. Smart Homecare Technol TeleHealth. 2015;3:39-48.
16. ASHA: American-Speech and Hearing Association [homepage on the internet]. Telepractice. [accessed 2021 jul 27]. Available at:
17. Duffy JR, Werven GW, Aronson AE. Telemedicine and the diagnosis of speech and language disorders. Mayo Clin Proc. 1997;72(12):1116-22.
18. Brasil. Ministério da Saúde (MS) [homepage on the internet]. Secretaria de Vigilância em Saúde. Doença pelo coronavírus 2019. [accessed 2021 jul 26]. Available at:
19. Brasil. Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia [homepage on the internet]. Diretrizes Metodológicas: elaboração de revisão sistemáticas e metanálise de estudos observacionais comparativos sobre fatores de risco e prognósticos. Brasília, DF: Ministério da Saúde; 2014b. 132p. [accessed 2021 ago 19]. Available at:
20. McKinney A. EndNote Web: web-based bibliographic management. J Electron Resour Med Libr. 2013;10(4):185-92.
21. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
22. Oxford Centre for Evidence-based Medicine: levels of evidence [homepage on the internet]. 2009 Mar [accessed 2021 ago 19]. Available at:
23. Brady S, Rao N, Gibbons P, Williams L, Hakel M, Pape T. Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure. Adv Med Educ Pract. 2018;9:433-41.
24. Cassel SG, McIlvaine JA. Patient responses to swallowing safety cues: a comparison of traditional face-to-face and tele-dysphagia instructional methods. Surg Rehabil. 2017;1(5):1-7.
25. Catalani B, Luccas GR de, Berretin-Felix G. Educação mediada por tecnologia em disfagia orofaríngea: proposta de ensino na graduação. Rev Grad USP. 2020;4(1):71-83.
26. Malandraki GA, McCullough G, He X, McWeeny E, Perlman AL. Teledynamic evaluation of oropharyngeal swallowing. J Speech, Lang Hear Res. 2011;54(6):1497-505.
27. Malandraki GA, Roth M, Sheppard JJ. Telepractice for pediatric dysphagia: a case study. Int J Telerehabilitation. 2014;6(1):3-16.
28. Raatz MK, Ward EC, Marshall J. Telepractice for the Delivery of Pediatric Feeding Services: a survey of practice investigating clinician perceptions and current service models in Australia. Dysphagia. 2020;35(2):378-88.
29. Burns CL, Ward EC, Gray A, Baker L, Cowie B, Winter N et al. Implementation of speech pathology telepractice services for clinical swallowing assessment: an evaluation of service outcomes, costs and consumer satisfaction. J Telemed. 2019;25(9):545-51.
30. Burns CL, Ward EC, Hill AJ, Kularatna S, Byrnes J, Kenny LM. Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes. Head Neck. 2017;39(5):932-9.
31. Davis L, Copeland K. Effectiveness of computer-based dysphagia training for direct patient care staff. Dysphagia. 2005;20(2):141-8.
32. Ferguson NF, Estis JM. Training students to evaluate preterm infant feeding safety using a video-recorded patient simulation approach. Am J Speech-Language Pathol. 2018;27(2):566-73.
33. Kantarcigil C, Malandraki GA. First step in telehealth assessment: a randomized controlled trial to investigate the effectiveness of an electronic case history form for dysphagia. Dysphagia. 2017;32(4):548-58.
34. Mayadevi M, Thankappan K, Limbachiya SV, Vidhyadharan S, Villegas B, Ouyoung M et al. Interdisciplinary Telemedicine in the Management of Dysphagia in Head and Neck. Dysphagia. 2018;33(4):474-80.
35. Morrell K, Hyers M, Stuchiner T, Lucas L, Schwartz K, Mako J et al. Telehealth stroke dysphagia evaluation is safe and effective. Cerebrovasc Dis. 2017;44(3-4):225-31.
36. Sharma S, Ward EC, Burns C, Theodoros D, Russell T. Assessing swallowing disorders online: a pilot telerehabilitation study. Telemed e-Health. 2011;17(9):688-95.
37. Wall LR, Ward EC, Cartmill B, Hill AJ, Porceddu SV. Adherence to a prophylactic swallowing therapy program during (Chemo) radiotherapy: impact of service-delivery model and patient factors. Dysphagia. 2017;32(2):279-92.
38. Ward EC, Burns CL, Theodoros DG, Russell TG. Impact of dysphagia severity on clinical decision making via telerehabilitation. Telemed e-Health. 2014;20(4):296-303.
39. Ward EC, Sharma S, Burns C, Theodoros D, Russell T. Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation. Dysphagia. 2012;27(4):460-72.
40. Bidmead E, Reid T, Marshall A, Southern V. "Tele Swallowing": a case study of remote swallowing assessment. Clin Gov An Int J. 2015;20(3):155-68.
41. Constantinescu G, Kuffel K, King B, Hodgetts W, Rieger J. Usability testing of an mHealth device for swallowing therapy in head and neck cancer survivors. Health Informatics J. 2018;25(4):1373-82.
42. Perlman AL, Witthawaskul W. Real-time remote telefluoroscopic assessment of patients with dysphagia. Dysphagia. 2002;17(2):162-7.
43. Wall LR, Ward EC, Cartmill B, Hill AJ, Porceddu SV. Examining user perceptions of SwallowIT : a pilot study of a new telepractice application for delivering intensive swallowing therapy to head and neck cancer patients. J Telemed Telecare. 2016;23(1):53-9.
44. Wall LR, Kularatna S, Ward EC, Cartmill B, Hill AJ, Isenring E et al. Economic analysis of a three-arm RCT exploring the delivery of intensive, prophylactic swallowing therapy to patients with head and neck cancer during (Chemo) radiotherapy. Dysphagia. 2019;34(5):627-39.
45. Brasil. Ministério da Saúde (MS) [homepage on the internet]. Saúde Digital e Telessaúde. [accessed 2021 ago 19]. Available at:
Submetido em:
27/05/2023
Aceito em:
09/10/2023