Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation.
Thiani Pillay, Mershen Pillay
PMID 34342487WHAT IT FOUND
Clinical reasoning in swallow assessments is driven more by experience than training.
Experts argue that rigid protocols fail in low-resource settings, requiring flexible, context-aware decision-making to adapt to patient needs and limited equipment.
Key findings
01Experience and intuition, rather than formal training, are the primary guides for clinical reasoning in dysphagia assessments.
02Clinical decisions are heavily influenced by the setting, with community-based therapists relying more on bedside assessments due to lack of access to instrumental tools.
03Effective practice in low-resource contexts requires flexible, non-linear reasoning that adapts standard protocols to local constraints and patient needs.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The included studies were all from high-income countries, which may limit the generalizability of the literature findings to low-resource contexts, despite the expert consultation. The search was restricted to the last 49 years and focused specifically on the Clinical Swallow Evaluation, excluding studies on instrumental assessments or broader dysphagia management. The expert consultation was limited to South Africa, using it as a proxy for low-middle income contexts, which may not capture the full diversity of global resource constraints.
Declared interests
The authors declared no conflicts of interest. The study was approved by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal.
The easy way to misread this
Do not interpret the preference for experience as a dismissal of evidence-based practice. The review suggests that experience informs how evidence is applied in complex, real-world contexts, not that it replaces the need for clinical knowledge.