IN FOUCS: Building Collaborative Partnerships - 2023
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Item Health-related quality of life of parents of children with feeding disorders in a tertiary care clinical setting in Western province, Sri Lanka.(University of Kelaniya, Sri Lanka, 2023) Nirmani, N.; Dharmarathne, N.I.;BACKGROUND: Parents of children with Feeding Disorders (CFD) have to be much stronger in their lives by keeping good Health-Related Quality of Life (HRQoL), as they are primary caregivers of children. It is extremely beneficial for clinicians and researchers to explore the HRQoL of parents of CFD to continue optimal care for children in Sri Lanka. OBJECTIVE/S: The aim of the study was to examine the impact of children’s Feeding Disorders (FD) on their parents’ health-related quality of life (HRQOL) in Sri Lanka. METHODS: Demographic, economic, and feeding history were obtained from 246 parents of CFD, aged between 6 months and 7 years, who receive feeding therapy at a community multidisciplinary care center. Participants completed standard adapted assessments on identifying the severity of feeding disorders (Pedi-EAT) and its impact on their HRQoL (FS-IS). Statistical analysis was performed on data using the Statistical Package for the Social Sciences (SPSS) version 26.0. RESULTS: The results indicated that caring for CFD issues negatively affected the caregivers’ health-related quality of life (HRQoL). Independent sample t-test revealed that mothers of CFD have significantly lower HRQoL compared to fathers (t (245) = .947, p=.001). HRQoL of parents has not significant different when the severity of feeding disorders of their children was higher. But socio-demographic factors directly affect HRQoL. Similarly, long-term FD in children showed significantly higher worry among parents and restrictions to their daily activities, reducing their HRQoL. CONCLUSION/S: In conclusion, this is the first study of this nature conducted in Sri Lanka to investigate parents’ HRQoL of CFD. The findings of the study expand our understanding of the impact of pediatric feeding disorders on the parents and families, which is a critical element in determining the effectiveness of healthcare intervention for CFD and their prognosis. Clinicians need to pay attention to factors that could improve the HRQoL of parents of CFD, in order to offer more effective care.Item Fathers’ attitudes towards father-child interaction and how they interact with their children aged 2 - 2 ½ years in the home setting in the Puttalam District.(University of Kelaniya, Sri Lanka, 2023) Perera, S.; Hamsa, S.OBJECTIVE/S: The general objectives of this study were to describe fathers’ educational level and socioeconomic status and their effect on their attitudes about father-child interaction, and the quality and the frequency of home-based language strategies used by them with their children aged 2 - 2 ½ years in home setting in Puttalam District. The specific objectives were; To determine whether fathers’ educational level affects their attitudes about father-child interaction and home-based language strategies used by them. To determine whether the fathers’ educational level affects the frequency of home-based language strategies used by them. To determine whether fathers’ socioeconomic status affects their attitudes about father- child interaction and home-based language strategies used by them. To determine whether the fathers’ socioeconomic status affects the frequency of home- based language strategies used by them. METHODS: A Quantitative Cross-sectional study design was conducted with 300 participants who were fathers of typically developing children aged 2 - 2 ½ years. Participants were recruited from MOH clinics in Puttalam District. Data collection of the study was done onsite through a self- administered questionnaire including 4 parts as family demographics, fathers’ educational and socioeconomic status (SES), fathers’ attitudes towards father-child interaction, and quality and frequency of father-child interaction. Data was analyzed using SPSS software. RESULTS: Most of the participants with good attitudes about father-child interaction are fathers aged 40-50 years and fathers whose educational level is from Advanced to graduate level. Most home-based language strategies are also used by fathers aged 40-50 but by fathers with educational levels below Advanced Level. A minority of the participants with good attitudes about father-child interaction are young fathers aged 20-40. Most participants in the self-employing sector have good attitudes about father-child interaction. Fathers who work less than 8 hours per day interact more with their children than fathers who work more than 8 hours per day. CONCLUSION/S: The findings of this study conclude that the educational level and the SES of the fathers affect their attitudes about father-child interaction and the quality and frequency of home-based language strategies used by them. The findings describe that attitudes are ‘good’ when the educational level and the SES are high. But, the quality and the frequency of home-based language strategies are ‘good’ when educational level and SES are low. The age level of fathers directly affects their attitudes and usage of 25 home-based language strategies. The findings confirm that mature fathers have ‘good’ attitudes and high quality and frequency of home-based language strategies than young fathers. Furthermore, the findings describe that fathers’ working hours per day affect their time of interaction with their children. It contributes to determining that the interaction time decreases when the working hours per day increase.Item Translation, cross-cultural adaptation and validation of the abbreviated profile of hearing aid benefit questionnaire with a sample of Sinhala speaking adult hearing aid users in Sri Lanka.(University of Kelaniya, Sri Lanka, 2023) Hewapathiranage, S.H.; Karunarathne, W.G.S.S.; Balasuriya, B.M.L.K.BACKGROUND: Hearing aid amplification plays a crucial role in audiological rehabilitation. The quantification of the benefit of hearing aids in further enhancement is necessary for effective management. The Abbreviated Profile of Hearing Aid Benefit (APHAB) is one of the most widely used self-report questionnaires, used to quantify disability subjectively in everyday life caused by hearing loss as well as to examine the effect of hearing aid intervention in adult hearing aid users. OBJECTIVE/ The purpose of this study was to translate, cross-culturally adapt and validate the Abbreviated Profile of Hearing Aid Benefit (ABHAB) questionnaire in Sinhala. METHODS: A cross-sectional study was conducted to pre-test the validity of the translated ABHAB questionnaire. Authorization from the original authors of the questionnaire was sought and gained. The APHAB was translated into Sinhala and 30 adult participants (male = 56.7% and female = 43.3%) were recruited with a mean age 60.4 years to assess its face validity. The content validation of the APHAB questionnaire was assessed by the degree of relevance and the cultural appropriateness. The Content Validity Index (CVI) was calculated by using item – CVI (I-CVI) and scale – CVI (S-CVI). S-CVI was calculated under Scale CVI Average (S-CVI/AVE) and Scale -CVI Universal Agreement (S-CVI/UA) RESULTS: The obtained responses for face validity indicated a high percentage of agreement. Obtained ICVI for degree of relevance was greater than 0.79 for all the items in the questionnaire, S-CVI/AVE indicated an excellent content validity as it obtained 0.94, while the S-CVI/UA value was lower than 0.8, was not indicated an excellent content validity. For cultural appropriateness, 21 items obtained an I-CVI value greater than 0.79 as relevant items; 3 items obtained values lower than 0.70. As S-CVI/AVE and SCVI/ UA values did not indicated a good content validity for cultural appropriateness, modifications were applied to the items that obtained lower I-CVI values by conducting a review. CONCLUSION/S: The translated, culturally adapted and validated APHAB questionnaire in Sinhala, is a simple and quick instrument to measure the self-reported effectiveness of hearing aids use by people with hearing loss in Sri Lanka. Thus, it can be used in aural rehabilitation and to direct people to relevant therapeutic approaches.Item Knowledge of nurses regarding oro-pharyngeal dysphagia in the Badulla district.(University of Kelaniya, Sri Lanka, 2023) Madushani, R.W.S.; Kodituwakku, G.K.BACKGROUND: Oro-pharyngeal dysphagia is a condition with life threatening complications. In hospital settings, in most occasions nurses are the first health care professionals to come in contact with such patients. Knowledge of oro-pharyngeal dysphagia signs and symptoms, complications, and role of Speech and language therapists in dysphagia assessment and management are crucial for nurses working in such settings. A lack of knowledge of oro-pharyngeal dysphagia can result in detrimental consequences and this can be fatal for the patient. OBJECTIVE/S: The main purpose of this study was to determine the level of knowledge of nurses regarding oro-pharyngeal dysphagia in the Badulla district, Sri Lanka METHODS: A quantitative, descriptive cross sectional survey study was conducted. The study was conducted in the three types of hospitals in Badulla district. 138 nurses working in General, Base, and divisional hospitals in Badulla district were participants of the study. Data were collected through selfadministered questionnaire. The quantitative data were analyzed using descriptive and inferential statistics. RESULTS: Majority of the participants of the study were female (n = 121, 87.7%). Male participants were 17 (12.3%). The mean age of the participants was 34.92 years. The study findings specified that nurses demonstrate moderate knowledge of the signs, symptoms (Average correct response score = 8.1/13, 62.60%) and complications (Average correct response score = 6.1/10, 60.73%) of oro-pharyngeal dysphagia. Knowledge of nurses regarding role of speech and language therapists in oro-pharyngeal dysphagia was 5.4/8 (67.6%). There were no significant differences between the different types of hospitals for the knowledge on signs and symptoms of oro-pharyngeal dysphagia. CONCLUSION/S: The study provided that nurses’ levels of knowledge on oro-pharyngeal dysphagia had only moderate level. Further formal training on dysphagia and collaboration between speech and language therapists and nurses may improve early identification and management of oro-pharyngeal dysphagiaItem Parental experiences of the decision-making process regarding percutaneous endoscopic gastrostomy tube insertion and its post-management in children with developmental disabilities accessing a university clinic in Sri Lanka.(University of Kelaniya, Sri Lanka, 2023) Kumarasinghe, J.K.S.T.; Hettiarachchi, S.BACKGROUND: Feeding difficulties are common in children with developmental disabilities and the Percutaneous Endoscopic Gastrostomy tube is the most common long-term alternative feeding method used among them. Anecdotally in the Sri Lankan context, there appears to be a reluctance to go through a PEG insertion. There is a need to undertake a research study on the parental decision-making process and the post-management of PEG to understand how speech and language therapist can better support parents. OBJECTIVE/S: The main purpose of this study was to explore the parental experiences on the decisionmaking process regarding PEG insertion and its post-management in children with developmental disabilities accessing a university clinic in Sri Lanka. METHODS: This was a qualitative study using a phenomenological approach. Ten parents who have a child with a developmental disability, aged between one to eight years with one to three years of PEG experience with their children were the participants of this study. Semi-structured interviews were conducted using an interview guide which consisted of 10 questions. The qualitative data were analyzed using a simple thematic analysis. RESULTS: The study results indicate the lack of awareness and miscommunication with professionals throughout the decision-making process of PEG and the lack of parental satisfaction with it. However, they were satisfied with the speech and language therapist’s involvement in both decision-making and the monitoring process in the post-management of the PEG procedure. Also, negative societal views made the parents reluctant to consider a PEG and it affected post-PEG management as well by limiting societal participation in meal times due to visibility. The parents also described the strengths and challenges of post-PEG management. All the parents were satisfied with the decision that they made to go through with a PEG for their children with developmental disabilities due to the lack of complications on the PEG procedure and as a long-term alternative feeding method. CONCLUSION/S: Parental awareness on the PEG procedure supports the decision-making process. Professional involvement is important in providing adequate information with a key role for the speech and language therapist.Item Parents’ self- reported experience of feeding-related care of their premature infants while admitted to a neonatal intensive care unit in Sri Lanka: A qualitative study(University of Kelaniya, Sri Lanka, 2023) Bandara, P.M.N.M.; Hettiarachchi, S.BACKGROUND: Preterm infants experience various medical, neurological and developmental complications that may affect feeding skills. They are admitted to the neonatal intensive care unit (NICU) for special care and monitoring. Anecdotally, during the hospitalization in the local NICU, mothers’ and fathers’ involvement and confidence in the feeding-related care of their premature infants is low and there is a lack of interaction between the infant. OBJECTIVE/S: The main objective of this study was to explore both mothers’ and fathers’ experience of feeding-related care of their premature infants while admitted to a Neonatal Intensive Care Unit in Sri Lanka. METHODS: A qualitative study using a phenomenological approach was carried out with a sample of ten couples of participants including ten mothers and ten fathers who have premature infants (born between 28 -37 weeks gestational age) with feeding difficulties who have been hospitalized at a neonatal intensive care unit. A semi structured interview was conducted via telephone using an interview guide with 15 open ended questions. A simple thematic analysis was used to analyze the qualitative data. RESULTS: The findings were analyzed and main three themes and subthemes emerged. The main themes were Parental role, Parent- infant closeness and separation in NICUs and Speech and Language Therapy services support for feeding related care in a local NICU. The results illuminated that the majority of mothers had a minimal role in the NICU and all the fathers reported that they have been excluded from infant care in the NICU. CONCLUSION/S: Overall there is a lack of satisfaction on the minimal involvement in infant feeding care in the NICU which was a major parent. There is a difference between mothers’ and fathers’ perceived experience and knowledge they have received during hospitalization of their infant in the local NICU. In Sri Lanka (a Global South country) fathers are the ‘forgotten’ parent in terms of early feeding interventions. Parents show a satisfaction about the support of the NICU staff and SLT. Speech and language therapists need to take a lead in offering more information and training to parent and involve them more directly in feeding related infant care. The findings of the study will be helpful to make recommendations regarding feeding when working with parents and infants in the SLT clinical settings.Item Translation, cross-cultural adaptation, and validation of Dysphagia Handicap Index (DHI) into Sinhala language.(University of Kelaniya, Sri Lanka, 2023) Karunarathne, I.L.P.; Panterliyon, N.A.BACKGROUND: Dysphagia Handicap Index (DHI) is one of the self-evaluation instruments used for assessing patients with dysphagia. It is a reflection of the patient's quality of life in physical, emotional, and functional aspects. Although it is well-known and most used among English-speaking people, there is no available Sinhala version to be used in Sri Lankan context. The aim of this study was to translate, cross-culturally adapt and validate the DHI into the Sinhala Language. OBJECTIVE/S: The objectives of this study are to translate and cross-culturally adapt the original version of the DHI from English to Sinhala, to evaluate the internal consistency of the Sinhala Dysphagia Handicap Index (S-DHI) and to evaluate the content validity of the S-DHI. METHODS: This study comprised two phases. Phase 1 translation and cross-cultural adaptation of the DHI. It was explained under five stages such as forward translation of the DHI from English to Sinhala, synthesis of the translation, back translation of DHI from Sinhala to English, expert committee review, and pre-testing. Phase 2 involved evaluating the psychometric properties of the scale that was included testing the reliability and validity of the scale. Purposive sampling was the sampling method. A crosssectional was conducted with 125 adults (above 20 years) with dysphagia (target group) and 125 adults without dysphagia (control group). The target group was recruited from four dysphagia clinics at government hospitals in Sri Lanka (District hospitals of Gampaha, Ragama Rehabilitation, and Wathupitiwala). The control group was recruited from Mahara Niladhari Division. Cronbach’s alpha coefficient was implemented to measure the internal consistency of the DHI. The expert panel performed the content validity, including nine speech and language pathologists with three years working experience with dysphagia disorder. The convergent validityof the DHI was assessed using hypothesis testing. RESULTS: The S-DHI and all subscales (physical, emotional, functional) showed higher internal consistency (Cronbach’s alpha o.975, 0.96, 0.979 0.991) respectively. The S-DHI scores between the target group and the control group were significantly different (p<0.05). Content validation test revealed higher validity scores for the degree of relevance, degree of cultural appropriateness, and degree of simplicity (I-CVI= 0.99, 0.98, 0.98). CONCLUSION/S: The S-DHI has achieved higher internal consistency, convergent validity, and content validity. This scale can be used in both clinical and research settings in Sri Lanka.Item Determining the proportion of dysphagia in post-stroke patients admitted to a teaching hospital in Sri Lanka.(University of Kelaniya, Sri Lanka, 2023) Fonseka, O.D.S.; Dharmarathne, N.I.BACKGROUND: Post-stroke dysphagia (PSD) is one of leading cause to increase the number of deaths in stroke patients in worldwide. By today, early identification and detection of post-stroke dysphagia is increased due to its severity. Sri Lanka is low-middle income country (LMIC) and currently there is no study about proportion of post-stroke dysphagia in Sri Lanka. Dysphagia is one of severe complications following stroke. And also, PSD can lead to even death. OBJECTIVE/S: The purposes of the study are to evaluate the proportion of patients with PSD admitted to North Colombo Teaching Hospital, Sri Lanka and to determine the association between communication impairments and post-stroke dysphagia. This is novice research question to Sri Lankan context. METHODS: This analytical cross-sectional study recruited seventeen (n=17) adults age ranging from 18 and above male and female who were consecutively admitted to stroke unit with the diagnosis if ischemic or hemorrhagic stroke during acute period of stroke. Stroke was confirmed by either CT or MRI. Patients who were admitted between 29th of November to 23rd of December 2022 were recruited. GUSS, EAT- 10 were administered to evaluate swallowing. Communication was evaluated when SLT record were not available. Period prevalence was measured to evaluate proportion of post-stroke dysphagia. Chi-square test, Mann-Whitney U test, and Kruskal-Wallis one way ANOVA were used to discover the association between dysphagia and communication impairment and other relevant variables. RESULTS: The proportion of dysphagia following stroke in a teaching hospital in Sri Lanka is 70.58%. Twelve (n=12) were presented with PSD. Mean age was 62.06 (SD=8.86) years. Majority of the sample was male (76.5%). The proportion of dysphagia in ischemic stroke is 52.94%. Association between PSD and communication impairment portrayed statistically significant association (x2 (1) = 5.4 , p=.020). Dysarthria is more prominent communication impairment of the sample (n=14). Overall, 88% of patients having communication impairment. Association between dysarthria and dysphagia (p=.707). CONCLUSION/S: Proportion of post-stroke dysphagia is in critical level and it significantly associates with communication impairments. In order to improve outcomes and minimize post-stroke period complications, immediate evaluation or detection of dysphagia is significant.Item Measurement properties of frenchay aphasia screening test across different languages: A COSMIN systematic review.(University of Kelaniya, Sri Lanka, 2023) Jayasingha, J.A.P.P.; Ariyasena, A.D.K.; Siriwardhana, D.D.BACKGROUND: Aphasia is a language disorder that occurs due to damage to the brain; the left side of the brain contributes more towards language. Aphasia may cause problems in understanding, speaking, reading, or writing (American Speech-Language-Hearing Association, 2022a). The main goals of speech therapy treatments are to enhance communication, restore speech and language ability as much as possible, and teach different communication strategies (Schulman, 2020). Frenchay Aphasia Screening test (FAST) is used to identify aphasia (Enderby et al., 1987). The best-evaluated and most widely used aphasia assessment is the Frenchy aphasia screening test (Salter et al., 2006). No matter how valid this original tool is, a systematic review is yet to be conducted collating the psychometric properties of the FAST test across different languages. It is therefore important to summarize the measurement properties in those studies to analyzed the methodological quality of those validation studies. It will aid in identifying research gaps and inform future research. The study describes the measurement properties of Frenchay Aphasia Screening Test across different languages. OBJECTIVE/S: This systematic review aimed to appraise and summarize the psychometric properties of the Frenchay Aphasia Screening Test across different languages. METHODS: This study was conducted as a systematic review and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 guideline. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD - 383989). Research studies were searched using the following electronic databases: MEDLINE, EMBASE, PsychInfo, AMED, CINAHL Plus, and Web of Science. Reference lists of selected articles were also searched, and a forward citation search was done through Google Scholar. Studies were included if they presented at least one psychometric measurement property described in the consensus-based standards for the selection of health states measurement instrument (COSMIN) risk of bias checklist. Study selection involved two stages: 1) title and abstract screening and 2) full-text review. Disagreements between the two reviewers were discussed in both stages until a consensus was researched. The inter-rater reliability between the two raters was good (kappa=0.76) during the full-text review. The methodological quality of studies on measurement properties was assessed using the COSMIN risk of bias checklist. Data were synthesized according to the COSMIN guidelines. RESULTS: One hundred fifty-two articles were screened; 143 articles were excluded, and nine articles were selected for full-text review; four articles were included from full-text review. Overall, seven articles were included. This review included the original English version and six translations/adaptations of FAST. Two independent reviewers were involved in the article selection to avoid bias. According to the results, the PROM development studies on FAST were low. When considering the methodological quality of 16 measurement properties, hypothesis testing was rated as high as it was analyzed in four studies, and in each of those studies, it was rated as sufficient. The results were inconsistent and insufficient for other measurement properties to make conclusions. CONCLUSION/S: Based on the overall findings, only hypothesis testing demonstrated high-quality evidence for Frenchay Aphasia Screening Test. Furthermore, due to insufficient results, it was not possible to come to a conclusion about the measurement properties of content validity, internal consistency, cross-cultural validity, reliability, and criterion validity of the Frenchay aphasia screening test.Item Experiences and expectations of adults who stutter attending speech and language therapy for stuttering in Sri Lanka.(University of Kelaniya, Sri Lanka, 2023) Ampemohotti, A.M.N.L.; Nonis, D.BACKGROUND: Over the years, the role of adults who stutter in stuttering treatment has evolved from being a passive recipient to an ‘expert’ partner in the collaborative therapeutic process. Therefore, understanding the client’s experiences and expectations regarding stuttering treatment has been recognized as an integral element of an effective therapeutic process. Although several global studies have explored the experiences and expectations of adults who stutter in relation to stuttering treatment, it is an uncharted area related to speech and language therapy in the Sri Lankan context. OBJECTIVE/S: The study explored experiences and expectations of adults who stutter attending speech and language therapy in Sri Lanka. METHODS: This study used a generic qualitative approach. Online semi-structured interviews were conducted with 12 adults who stutter who were attending or had attended speech and language therapy within the past two years at a state university clinic in Sri Lanka. All interviews were conducted in Sinhala language via Zoom. The interviews were audio recorded, transcribed verbatim, translated into English language, and analyzed using a thematic analysis. RESULTS: Four themes emerged from the data: 1) limited awareness of stuttering and its management, 2) impact of stuttering on adults who stutter, 3) experiences of coping with stuttering before attending therapy, and 4) perceptions towards successful management of stuttering. Most of the participants’ experiences before successful management depicted narratives of negative emotions and reactions followed by a lifestyle dominated by avoidance and restriction. The majority of the participants’ expectation of therapy was to improve fluency. Many participants reported that their expectations for therapy were met and that therapy made a positive difference in their lives. Furthermore, the participantsm indicated multiple personal, therapeutic, and social factors that contribute to achieving successful outcomes from therapy. CONCLUSION/S: The current study emphasizes the importance of individualized therapy, designed by considering all the unique perceptions and needs of individuals related to their quality of life to improve the likelihood of successful therapeutic outcomes. The study reveals that being absolutely fluent is not a necessary criterion for the successful management of stuttering. In addition, the findings highlight the need to promote awareness of stuttering and its management and the profession of speech and language therapy among the Sri Lankan public.