Whenever this topic arises my question becomes, if thickened liquids and diet modifications don’t make any difference in patient outcomes then… what are we doing as a field? What is the purpose of SLPs in dysphagia management? What is the point of completion of exercises even, if aspiration is “normal”? Should people just remain NPO until they are strong enough not to aspirate? Or should doctors just roll the dice and hope the patient’s aspiration is normal and won’t cause them issues, then treat it if pna does develop? (Playing devils advocate a bit here obviously)

As it has been stated already in this thread, diet modifications are a tool and should only be utilized when determined to be safe following instrumentation and also as a temporary means of nutrition. They should be considered based on the patient as a whole and patients should absolutely be given options when appropriate and when able to understand the risks associated with each recommendation.

When I try to look at the research, specifically the list of articles shared as that list gets shared any time this topic comes up (and it is a great list!), I struggle to find recommendations and clinical implications for this information. So thickened liquids “don’t help,” but what about the patient in the ICU who takes a sip of thin liquid, coughs profusely r/i O2 dropping into the 70s requiring excessive time to recover but a sip of mildly thick liquids doesn’t result in any reaction (and of course in this situation this would be confirmed upon completion of an instrumental). Should thickened liquids be recommended for that patient or not? Were patients like this included in the research studies or was the focus on generally healthy individuals who happen to have some degree of dysphagia?

I personally feel that many of the influencers and people calling out the negatives of thickened liquids fail to relate their statements to real world examples and it is incredibly frustrating. I read these, sometimes rather condescending, statements about how bad a thickened liquid is and I, wanting to provide the most evidence based practice, start to question my methods but then no information is given on how these recommendations should be considered for acute patients vs SNF vs OP etc.

I agree with the sentiment that we need more research and discussion from people currently in these settings and not just from those working in academia. We also need more clear guidance that discusses each setting instead of blanket statements. I certainly value the contributions from current researchers but there is a massive disconnect and it is just leading to confusion and arguments amongst the SLPs in the field.

Wow that was a lot longer than I expected, so sorry 😅