Abstract：
Patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation programs (PRPs) are not routinely screened for dysphagia. An Australian regional health service audit revealed that patients with COPD are frequently referred to speech pathology during acute admissions, rather than proactively to mitigate the risk of dysphagia-related consequences. Referral patterns to speech pathology using a novel transdisciplinary approach for identifying at risk for dysphagia patients in a PRP were explored. The aim of this study was to investigate the impact of a transdisciplinary dysphagia screening questionnaire on speech pathology referrals within a cohort of patients with COPD enrolled in a PRP. This quasi-experimental study introduced a dysphagia screening questionnaire in a PRP using a transdisciplinary approach. A retrospective audit of PRP patients (n = 563) between 01/01/2014 and 31/12/2018 was conducted to identify the frequency of referrals to speech pathology for dysphagia. Data was compared to a cohort of patients (n = 50) enrolled in the PRP (from 01/02/21 to 30/11/21) after introduction of the questionnaire using Fisher\'s exact test. Less than 1% (n = 4/563) of PRP patients were referred to speech pathology prior to implementation of the questionnaire. Following the implementation, referrals to speech pathology significantly increased to 16% (8/50) (X2 = 7.72, P < 0.05; odds ratio = 7.89 95% CI [1.94, 32.1]). Introducing a dysphagia screening questionnaire increased referrals to speech pathology from a PRP. This study demonstrated the potential for a transdisciplinary approach in early screening for patients at risk of dysphagia for patients with COPD. Further research is encouraged to explore patient motivation towards speech pathology input with COPD-related dysphagia and clinicians\' perceived self-efficacy in using the questionnaire.
摘要：
肺康复计划（PRP）中的慢性阻塞性肺疾病（COPD）患者未常规筛查吞咽困难。澳大利亚区域卫生服务审核显示，COPD患者在急性入院期间经常被称为言语病理学，而不是主动减轻吞咽困难相关后果的风险。探索了使用新型跨学科方法识别PRP中吞咽困难患者风险的言语病理学转诊模式。这项研究的目的是调查跨学科吞咽困难筛查问卷对PRP招募的COPD患者队列中言语病理学转诊的影响。这项准实验研究使用跨学科方法在PRP中引入了吞咽困难筛查问卷。在2014年1月1日至2018年12月31日期间对PRP患者（n=563）进行回顾性审核，以确定吞咽困难的语音病理学转诊频率。使用Fisher精确检验，将数据与PRP（从01/02/21到30/11/21）招募的一组患者（n=50）进行比较。在实施问卷之前，不到1％（n=4/563）的PRP患者被称为言语病理学。实施后，语音病理学转诊率显着增加至16％（8/50）（X2=7.72，P<0.05；比值比=7.8995％CI[1.94，32.1]）。引入吞咽困难筛查问卷增加了PRP对言语病理学的转诊。这项研究证明了跨学科方法在COPD患者存在吞咽困难风险的患者早期筛查中的潜力。鼓励进行进一步的研究，以探索患者对COPD相关吞咽困难的言语病理学输入的动机和使用问卷的临床医生的自我效能感。
