Online citations, reference lists, and bibliographies.

Implementing The Free Water Protocol Does Not Result In Aspiration Pneumonia In Carefully Selected Patients With Dysphagia: A Systematic Review

Anna Gillman, R. Winkler, N. Taylor
Published 2016 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
Share
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.
This paper references
10.1044/1058-0360(2005/008)
Dysphagic independent feeders' justifications for noncompliance with recommendations by a speech-language pathologist.
Nancy Colodny (2005)
Quality of life for patients with dysphagia : what really matters ?
C Karagiannis (2013)
Consequence of dysphagia in the hospitalised patient
KW Altman (2010)
10.1007/S00455-008-9172-1
Effects of Event-related Electrical Stimulation on Motor Evoked Potentials at the Submental Muscle Group
Sebastian H Doeltgen (2008)
10.1136/jech.52.6.377
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
S. H. Downs (1998)
Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration
J. C. Higgins (2013)
10.1016/j.ijsu.2010.02.007
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
David Moher (2010)
10.1007/s00455-011-9353-1
Effects of oral intake of water in patients with oropharyngeal dysphagia
Martha JP Karagiannis (2011)
Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration
Jp Higgins (2011)
Oropharyngeal dysphagia, free water protocol and quality of life: an update from a prospective clinical trial.
Martha JP Karagiannis (2014)
Implementation of a water protocol in a rehabilitation setting
C Carlaw (2008)
10.1097/HTR.0b013e3182a2e849
North American Brain Injury Society's Eleventh Annual Conference on Brain Injury: September 18–21, 2013New Orleans, LA
Mariusz Ziejewski (2013)
10.1016/S0002-9343(99)00290-9
Response of the lungs to aspiration.
Richard M. Effros (2000)
Effects of a free water protocol on inpatients in a neurological rehabilitation setting
S Pooyania (2013)
10.1044/SASD20.4.116
Why I Like the Free Water Protocol
Susan E. Langmore (2011)
10.1136/bmj.328.7454.1490
Grading quality of evidence and strength of recommendations
D. Atkins (2004)
10.1044/SASD20.4.109
Water, Water Everywhere, But Why? Argument Against Free Water Protocols
J. Coyle (2011)
10.1056/NEJM200103013440908
Aspiration pneumonitis and aspiration pneumonia
P. Marik (2001)
10.1007/s00268-005-1100-z
Randomized controlled trial.
A. Sanabria (2005)
Implementation of a water protocol in a rehabilitation setting for clients with thin liquid dysphagia: preliminary results of a randomized trial
Carlaw (2010)
10.5014/ajot.2016.704002
The Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE) 2016 Statement.
Robyn L Tate (2016)
10.1001/archoto.2010.129
Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources.
Kenneth W Altman (2010)
10.1016/j.jcrc.2012.05.005
Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: a systematic review and meta-analysis.
Lauren Speed (2013)
Implementation of a water protocol in a rehabilitation setting. Paper presented at the American SpeechLanguage Hearing Association Convention
C Carlaw (2009)
The challenges of initiating the Frazier Water Protocol on an acute care stroke unit
V. Weber (2009)
10.1079/BJN20041149
The effects of fluid restriction on hydration status and subjective feelings in man.
S. Shirreffs (2004)
10.1136/bmj.b2535
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
David Moher (2009)
10.1007/S00455-009-9234-Z
Intra- and inter-rater reliability of hyoid displacement measured by ultrasound
Phoebe Macrae (2009)
10.1111/j.1365-277X.2009.00944.x
Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia.
A. Vivanti (2009)
10.4236/OJTR.2015.34018
Effects of a Free Water Protocol on Inpatients in a Neuro-Rehabilitation Setting
Sepideh Pooyania (2015)
10.1177/154596839701100301
A Randomized Control Study to Determine the Effects of Unlimited Oral Intake of Water in Patients with Identified Aspiration
Bernard R. Garon (1997)
An oral water protocol in rehabilitation patients with dysphagia for liquids
A Becker (2008)
10.1152/ajpgi.1990.258.5.G675
Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing.
R. Dantas (1990)
Compliance of geriatric dysphagic patients with safe-swallowing instructions
AE Leiter (1996)
Effects of a free water protocol for patients with dysphagia
C Bronson-Lowe (2008)
Critical Review: The effects of a free-fluid protocol on individuals with thin-liquid dysphagia
Alyssa Schwartzentruber (2011)
10.1097/JNN.0b013e3182135adf
Comparison of Outcomes Before and After Implementation of a Water Protocol for Patients With Cerebrovascular Accident and Dysphagia
Kimberly L. Frey (2011)
10.1111/j.1478-5153.2011.00465.x
Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates.
N. Roberts (2011)
10.1007/s00455-016-9694-x
Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial
J. Murray (2016)
10.1097/00020840-199812000-00008
Evaluation and Treatment of Swallowing Disorders
J. Logemann (1983)
Quality of life for patients with dysphagia: what really matters? Dysphagia
C. Karagiannis (2013)
10.7326/0003-4819-107-2-309
Hypernatremia in elderly patients. A heterogeneous, morbid, and iatrogenic entity.
N. Snyder (1987)
10.1093/clinids/16.Supplement_4.S314
Bacterial colonization of saliva and plaque in the elderly.
M. Terpenning (1993)
10.1093/qjmed/hch050
Dehydration and venous thromboembolism after acute stroke.
J. Kelly (2004)
10.1097/HTR.0b013e318255ceae
Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI
Kelly J. Miller (2013)
A randomized controlled trial of a water protocol for clients with thin liquid dysphagia
C Carlaw (2009)
10.1186/2049-6958-8-39
Can we use influencing factors to predict aspiration pneumonia in the United Kingdom?
Judi Hibberd (2013)
10.3109/02699052.2012.660091
Music therapy assessment tool for low awareness states (MATLAS): Establishing reliability and validity
Wendy L Magee (2013)
A CLUSTER RANDOMISED TRIAL OF DIFFERENT STRATEGIES OF ANTIBIOTIC USE TO REDUCE THE INCIDENCE AND CONSEQUENCE OF CHEST INFECTION IN ACUTE STROKE PATIENTS WITH DYSPHAGIA (STROKE-INF)
David G. Smithard (2009)
10.1111/j.1365-2842.2006.01634.x
Preliminary study on the effect of oral care on recovery from surgery in elderly patients.
Misuzu Sato (2006)
10.1044/sasd14.1.4
The Frazier Free Water Protocol
Kathy Panther (2005)
10.1007/s004550011003
Effect of Liquid Bolus Consistency and Delivery Method on Aspiration and Pharyngeal Retention in Dysphagia Patients
Keith V. Kuhlemeier (2014)
10.5014/ajot.2016.016857
Use of a Modified Frazier Water Protocol in Critical Illness Survivors With Pulmonary Compromise and Dysphagia: A Pilot Study.
Shari Bernard (2016)
10.2105/AJPH.84.8.1265
The burden and outcomes associated with dehydration among US elderly, 1991.
J. Warren (1994)
10.1902/jop.2006.060010
Systematic review of the association between respiratory diseases and oral health.
A. Azarpazhooh (2006)
10.1007/s00455-011-9366-9
Outcomes of a Pilot Water Protocol Project in a Rehabilitation Setting
Caren Carlaw (2011)
Water access for individuals with dysphagia who aspirate: research challenges
RJ Stewart (2012)
10.1044/SASD18.1.25
Aspiration pneumonitis and aspiration pneumonia.
P. Marik (2001)
10.1001/archneur.1994.00540220099020
Aspiration and relative risk of medical complications following stroke.
M. Holas (1994)
10.1111/j.1741-2358.2012.00637.x
Oral health care and aspiration pneumonia in frail older people: a systematic literature review.
C. D. van der Maarel-Wierink (2013)
10.1007/s004550011002
The Effect of Compliance on Clinical Outcomes for Patients with Dysphagia on Videofluoroscopy
Jenny Low (2001)
10.1007/978-1-4419-1499-6_2
Methodological Approach to Assessing the Evidence
Joan F. Kennelly (2011)
Quality of life for patients with dysphagia : what really matters ?
A Becker (2010)
Quality of life for patients with dysphagia: what really matters? Dysphagia
M. Karagiannis (2010)
10.1067/moe.2002.123493
Effect of professional oral health care on the elderly living in nursing homes.
M. Adachi (2002)
10.1044/1058-0360(2005/003)
Thickened liquids: practice patterns of speech-language pathologists.
J. M. Garcia (2005)
10.1007/PL00009559
Predictors of Aspiration Pneumonia: How Important Is Dysphagia?
S. Langmore (1998)



This paper is referenced by
10.1016/j.jamda.2019.06.005
It Is Time to Revamp Approaches to Managing Dysphagia in Nursing Homes.
Steven A. Levenson (2019)
10.1093/BMB/LDZ027
Hydration Interventions for older people living in residential and nursing care homes: overview of the literature.
Glenda Cook (2019)
10.1007/978-3-030-28852-5
Neurologic and Neurodegenerative Diseases of the Larynx
Philip A. Weissbrod (2020)
10.1016/j.jvoice.2018.07.016
Personality, Psychological Factors, and Behavioral Tendencies in Children With Vocal Nodules: A Systematic Review.
Jeong Min Lee (2018)
10.1007/s12603-018-1043-3
Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study
A. Martín (2018)
10.1111/ger.12309
An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation
Jo-Anne Murray (2018)
10.1016/j.rmclc.2019.09.005
MANEJO HOSPITALARIO DE LA PERSONA MAYOR CON DISFAGIA
Macarena Paz Espinoza Venegas (2020)
10.1002/ncp.10239
Dysphagia: Interprofessional Management, Impact, and Patient‐Centered Care
Carol McGinnis (2019)
10.1007/s00455-019-10016-x
Motor Learning Feeding Interventions for Infants at Risk of Cerebral Palsy: A Systematic Review
Amanda Khamis (2019)
10.1055/S-0043-120963
Oropharyngeale Dysphagie im Alter – Abklärung und Therapieoptionen
Rainer Wirth (2018)
10.4018/978-1-7998-2261-5.ch011
Dysphagia Management in Culturally-Linguistically Diverse Populations
Kellyn Dailey Hall (2020)
10.1016/j.clnu.2017.09.002
Systematic review and evidence based recommendations on texture modified foods and thickened liquids for adults (above 17 years) with oropharyngeal dysphagia - An updated clinical guideline.
A. Beck (2018)
10.12788/jhm.3141
Things We Do for No Reason: The Use of Thickened Liquids in Treating Hospitalized Adult Patients with Dysphagia
William C Lippert (2019)
10.4037/ccn2019238
Implementation and Analysis of a Free Water Protocol in Acute Trauma and Stroke Patients.
Helen Kenedi (2019)
10.1044/PERSP3.SIG13.28
The Ice Chip Protocol: A Description of the Protocol and Case Reports
Jessica M. Pisegna (2018)
10.1186/s12877-018-0839-7
Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?
Shaun T. O’Keeffe (2018)
Semantic Scholar Logo Some data provided by SemanticScholar