A Liquid Thickener Presentation Format for the Therapeutic Management of Dysphagia-A Promising Step Forward in Addressing the Challenges Associated With Thickened Fluids in Swallowing Disorders?

introductionThickening fluids in routine care of patients with Oropharyngeal dysphagia (OD) can improve swallow safety but may be counteracted by reduced palatability, enjoyment, embarrassment, and isolation related to drinking thickened fluids (TFs). TFs are also associated with increased caregiver burden and significant lifestyle alterations. Thus, there persists a need to overcome these disadvantages. Precise Thick∼N INSTANT (PTI) is an innovative thickener product in viscosity-inhibited liquid form that presents a promising step forward in addressing the challenges. This prospective multi-centre single-arm feasibility study of acceptability (derived from measured variables gastrointestinal (GI) tolerance, palatability, compliance and user experience) compared PTI to usual mode of care (powder) in a cohort of patients with OD.

methodsOral fluids were thickened with PTI, adhering to standardised requirements, and were tested for palatability (primary outcome), ease of use, GI symptoms and compliance by medically diagnosed patients with OD for 14 days, following 7days under usual mode of care and a 5-day washout period. Data was analysed descriptively, presenting effect sizes with associated precision and indicative significance testing of key variables.

resultsTwenty-four participants provided usable data. Mean overall palatability ratings revealed significantly higher palatability perceptions (p < 0.001) in uncorrected paired-samples t-testing for PTI-TFs (difference in means 3.83 [95% CI 2.60 to 5.05]) on 10-point visual analogue scale, favouring beverages thickened with PTI over usual mode of care. Compared with usual mode of care, PTI thickener showed substantive improvements in all individual palatability and satisfaction/ease of use attributes, equivalent or improved symptoms of GI and excellent levels of GI tolerance and compliance. GI side effects (e.g., nausea, bloating) were mild and of short duration.

conclusionPTI-TFs were more palatable, acceptable, and well tolerated in patients with OD and strongly preferred over powder thickened TFs, with improved compliance and reduced wastage. PTI is a palatable, acceptable and well-tolerated way to support optimal hydration in adults with OD. WHAT THIS PAPER ADDS: What is already known on this subject Thickening fluids in routine care of patients with OD can improve swallow safety but can be counteracted by reduced palatability and enjoyment, embarrassment, and isolation related to drinking thickened fluids (TFs). TFs are also associated with increased caregiver burden and significant lifestyle alterations. OD concomitant with aphasia is common in some OD subpopulations; however, these patients are typically excluded from research due to the lack of aphasia friendly survey tools. There persists a need to overcome these disadvantages. What this paper adds to existing knowledge The current investigation is the first study to directly compare acceptability (derived from the measured variables palatability, tolerance, ease of use and preference) for TFs thickened using different thickener presentation formats in the same patient cohort. The liquid thickener intervention is a palatable, acceptable, and well-tolerated way to support optimal hydration in adults with OD. In addition, aphasia-accessible study materials have been developed to facilitate future recruitment and data collection from this underserved subgroup. What are the potential or actual clinical implications of this work? PTI thickened beverages are recommended for consumption by patients suffering from OD as an alternative to powdered thickened TFs. PTI is a palatable, acceptable, and well-tolerated way to support optimal hydration in adults with OD prescribed TFs. This study also highlights an important methodological advancement in OD research related to inclusion of participants with language impairment.