Browsing by Person "Toft, Kate"

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Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice
(Wiley, 2024-03-05) Toft, Kate; Best, Catherine; Donaldson, Jayne
Background The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians’ perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment. Results Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms ‘swallowing’, ‘eating’ and ‘dysphagia’; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred. Conclusions This study indicates that MDADI's content validity is ‘insufficient’ when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research.
Behaviour change technique taxonomy: A method of describing head and neck cancer dysphagia intervention delivery
(Wolters Kluwer, 2017) Toft, Kate; Stringer, Helen
Purpose of review The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). Recent findings Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. Summary Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.
Current Concepts and Considerations in Measuring Dysphagia-Related Quality of Life for People with Head and Neck Disease
(Springer, 2023-04-18) Clunie, Gemma; Toft, Kate; Simson, Gavriella; Dawson, Camilla; Govender, Roganie
Purpose of Review To provide an overview of current concepts and considerations in the measurement of dysphagia-related quality of life (QoL) for people with head and neck disease. We describe key psychometric and other tool properties that are important to consider when deciding which dysphagia QoL tool to use in practice. The review seeks to establish which tool/s best meet the required properties. Recent Findings Currently, no single dysphagia QoL tool meets all criteria. However, a few (SWAL QoL, MDADI, SOAL) meet several parameters and we highlight the current evidence base for these assessments. Summary QoL is essential to providing holistic clinical care and could also be an important outcome in research when evaluating interventions. Existing tools may benefit from re-validation studies which take account of progress made in the fields of instrument development, cross-cultural validity and patient centredness. It is also crucial to recognise that the value of capturing QoL in clinical practice is only realised by subsequent follow-up with the individual patient.
Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer—the SiP study protocol
(BMC, 2016-08-04) Wells, Mary; King, Emma; Toft, Kate; MacAulay, Fiona; Patterson, Joanne; Dougall, Nadine; Hulbert-Williams, Nick; Boa, Sally; Slaven, Eleanor; Cowie, Julie; McGarva, John; Niblock, Patricia Gail; Philp, Julie; Roe, Justin
Background: Head and neck cancer (HNC) is the sixth most common cancer worldwide, and the functional, psychological and social consequences of HNC cancer and its treatment can be severe and chronic. Dysphagia (swallowing problems) affects up to two thirds of patients undergoing combined chemoradiotherapy. Recent reviews suggest that prophylactic swallowing exercises may improve a range of short- and long-term outcomes; however, the importance of psychological and behavioural factors on adherence to swallowing exercises has not been adequately studied. This study aims to develop and test the feasibility of a Swallowing intervention Package (SiP) designed in partnership with patients, speech and language therapists (SLTs) and other members of the head and neck multi-disciplinary team (MDT), for patients undergoing chemoradiotherapy (CRT) or radiotherapy (RT) for head and neck cancer. Methods/design: This feasibility study uses quantitative and qualitative research methods, within a quasi-experimental design, to assess whether patients will tolerate and adhere to the SiP intervention, which aspects of the intervention can be implemented and which cannot, whether treatment fidelity can be achieved across different contexts, whether study processes and outcome measures will be feasible and acceptable and to what extent the intervention is likely to have an impact on swallowing dysfunction and quality of life. Patients are being recruited from five sites in Scotland and England (three interventions and two usual care). The SLT based in the relevant intervention centre teaches the exercise programme and provides supporting materials. A combination of patient-reported outcome measures (PROMs), adherence measures and clinical swallowing assessments are used prior to intervention (baseline), at the end of treatment, 3 and 6 months post-treatment. Discussion: This collaborative study has taken a unique approach to the development of a patient-centred and evidence-based swallowing intervention. The introduction of an e-SiP app provides an exploration of the use of technology in delivering this intervention. The study provides an opportunity to examine the feasibility of delivering and participating in a supported swallowing intervention across several different NHS sites and will provide the evidence needed to refine intervention and study processes for a future trial. Trial registration: NCRI portfolio, 18192 & 20259
Feasibility and outcomes of fibreoptic endoscopic evaluation of swallowing following prophylactic swallowing rehabilitation in head and neck cancer
(Wiley, 2019-03-20) Patterson, Joanne; Toft, Kate; McAuley, Fiona; King, Emma; McLachlan, Kirsty; Roe, Justin W. G.; Wells, Mary
Objectives: Investigate the feasibility and outcomes of fibreoptic endoscopic evalua‐tion of swallowing (FEES) following a programme of prophylactic swallowing exer‐cises in head and neck cancer (HNC) patients treated with radiotherapy.Design: Prospective, single cohort, feasibility study.Setting: Three head and neck cancer centres in Scotland.Participants: Pre‐radiotherapy HNC patients who consented to participate in a pro‐phylactic swallowing intervention.Outcome measures: Fibreoptic endoscopic evaluation of swallowing recruitment and retention rates, assessment acceptability and compliance, qualitative process evaluation.Results: Higher rates of recruitment and retention were achieved in centres where FEES equipment was available on‐site. Travel and anticipated discomfort were barri‐ers to recruitment. Data completion was high for all rating scales, with good reliabil‐ity. Following radiotherapy, swallowing safety significantly deteriorated for liquid boluses (P = 0.005‐0.03); pharyngeal residue increased for liquid and semi‐solid bo‐luses. Pharyngo‐laryngeal oedema was present pre‐treatment and significantly in‐creased post‐radiotherapy (P = 0.001). Patients generally reported positive experience of FEES for their own learning and establishing a baseline.Conclusions: Fibreoptic endoscopic evaluation of swallowing is an acceptable method of assessing patients for a prophylactic swallowing intervention and offers some ad‐ditional information missing from VF. Barriers have been identified and should be taken into account in order to maximise recruitment for future trials.
Global assessment of swallow function (GASF) following VMAT radiotherapy for head and neck squamous cell carcinoma
(Elsevier, 2024-08-30) Toft, Kate; McLachlan, Kirsty; Winton, Mark; Mactier, Karen; Hare, Nadine; Nugent, Claire; Wincott, Lucie; Srinivasan, Devraj; Mackenzie, Joanna; Nailon, Bill; Noble, David
Aim This study aimed to conduct a global assessment of swallow function (GASF) using a range of swallow outcome tools, in a cohort of patients pre- and post-treatment with image-guided volumetric modulated arc therapy (VMAT) radiotherapy. Materials and methods All patients receiving radical (chemo)radiation for SCC of the larynx, oro-, hypo- or nasopharynx between October 2016 – 2021 were eligible for inclusion. Patients were treated with VMAT radiotherapy according to institutional and national protocols. Patients underwent GASF pre- and 6 months post-treatment. Data were collated from the MD Anderson Dysphagia Inventory (MDADI), the Functional Oral Intake Scale (FOIS), the Performance Status Scale-Head and Neck: Normalcy of Diet scale (PSS-NoD), the 100 ml water swallow test (WST) for capacity and maximal interincisal opening (MIO). Results One hundred and seventy-five patients were included. 55.2 % of patients experienced a fall in MDADI-Composite score greater than the published meaningful clinical important difference (MCID).A trend for a decrease in FOIS score reflects a decrease in range of diet textures and increase in reliance on enteral feeding at 6 months post-treatment. Mean PSS-NoD score decreased reflecting increased restriction in diet textures.20 patients’ WST capacity improved by the minimal clinically important difference of > 4mls whilst 37 % of patients experienced a decrease in WST capacity of 4mls or more. 12.6 % of patients developed trismus following radiotherapy. Conclusions This paper adds new detail to the understanding of the decline in measured eating, drinking and swallowing function that patients treated with VMAT radiotherapy experience at 6 months post treatment. However, gaps are highlighted in the evidence base in terms of interpretation of swallow outcomes tool scores; future research in HNC should include ongoing discussion and development around robust outcomes tools and data collection.
Personalised 3D printed respirators for healthcare workers during the COVID-19 pandemic
(Frontiers Media, 2022-08-01) Roche, Aidan D.; McConnell, Alistair C,; Donaldson, Karen; Lawson, Angus; Tan, Spring; Toft, Kate; Cairns, Gillian; Colle, Alexandre; Coleman, Andrew A.; Stewart, Ken; Digard, Paul; Norrie, John; Stokes, Adam A.
Widespread issues in respirator availability and fit have been rendered acutely apparent by the COVID-19 pandemic. This study sought to determine whether personalized 3D printed respirators provide adequate filtration and function for healthcare workers through a Randomized Controlled Trial (RCT). Fifty healthcare workers recruited within NHS Lothian, Scotland, underwent 3D facial scanning or 3D photographic reconstruction to produce 3D printed personalized respirators. The primary outcome measure was quantitative fit-testing to FFP3 standard. Secondary measures included respirator comfort, wearing experience, and function instrument (R-COMFI) for tolerability, Modified Rhyme Test (MRT) for intelligibility, and viral decontamination on respirator material. Of the 50 participants, 44 passed the fit test with the customized respirator, not significantly different from the 38 with the control (p = 0.21). The customized respirator had significantly improved comfort over the control respirator in both simulated clinical conditions (p < 0.0001) and during longer wear (p < 0.0001). For speech intelligibility, both respirators performed equally. Standard NHS decontamination agents were able to eradicate 99.9% of viral infectivity from the 3D printed plastics tested. Personalized 3D printed respirators performed to the same level as control disposable FFP3 respirators, with clear communication and with increased comfort, wearing experience, and function. The materials used were easily decontaminated of viral infectivity and would be applicable for sustainable and reusable respirators.