ArticleDysphagia2017
Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review.
Article in Dysphagia, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03672552 (Implementing the Frazier Free Water Protocol to Improve Hydration and Quality of Life in Long Term Care Residents), which is not on this map. Cited by 26 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Implementing the Frazier Free Water Protocol to Improve Hydration and Quality of Life in Long Term Care Residents
Who cites it
26 citing papers in PubMed, 3 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Barriers and Facilitators to implementation of the Free Water Protocol in the Acute Stroke Unit Setting: A Mixed Methods Systematic Review.Dysphagia · 2025Pooled it
- A comprehensive review of the diagnosis and treatment of Parkinson's disease dysphagia and aspiration.Expert review of gastroenterology & hepatology · 2020Pooled it
- Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review.Dysphagia · 2020Pooled it
- Article
- [Oropharyngeal dysphagia as a neurogeriatric syndrome].Zeitschrift fur Gerontologie und Geriatrie · 2026Review
- Barriers and facilitators to implementation of the Free Water Protocol - findings from a national survey of acute stroke unit staff.BMC health services research · 2026Article
- Best Evidence Summary for Integrated Care Management of Dysphagia in Hospitalized Older Adults.Journal of multidisciplinary healthcare · 2026Review
- The crux of NPO paradox revealed by increased pneumonia incidence in post-stroke dysphagia patients with dietary restrictions.Scientific reports · 2025Article
- Analysis of Patients' Dietary Status/Restrictions Following Instrumental Swallow Evaluations in Skilled Nursing Facilities.Dysphagia · 2025Article
- Prevalence of dehydration in older hospitalized patients with oropharyngeal dysphagia.GeroScience · 2025Article
- Exploring the Neuropsychological Correlates of Swallowing Disorders in People with Parkinson's Disease: a Cross-Sectional Study.Dysphagia · 2025Article
- Article
- Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice.Dysphagia · 2024Article
- Swallowing interventions for older in-hospital patients: have we appropriately selected the desired outcomes?Revista da Associacao Medica Brasileira (1992) · 2024Article
- Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2023Article
- Evaluation of Esophageal Dysphagia in Elderly Patients.Current gastroenterology reports · 2023Review
- Baby Intensive Early Active Treatment (babiEAT): A Pilot Randomised Controlled Trial of Feeding Therapy for Infants with Cerebral Palsy and Oropharyngeal Dysphagia.Journal of clinical medicine · 2023Article
- Implementation of a free water protocol at a long term acute care hospital.Scientific reports · 2023Article
- Effects of Oral Health Interventions in People with Oropharyngeal Dysphagia: A Systematic Review.Journal of clinical medicine · 2022Review
- White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults.Dysphagia · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain 'nil by mouth', as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients' perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.