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Table 1 Non-evidence-based arguments for and against use of modified diets

From: Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified?

Argument Pro Con
Modifying diets has a rational pathophysiological basis. Dietary modifications make swallowing easier and safer in those with dysphagia
The risk of aspiration in instrumental studies is often reduced by dietary modification.
Similar dietary modifications in everyday life might reduce aspiration pneumonia.
Many physiologically rational healthcare interventions have ultimately been shown not to benefit patients.
Aspiration pneumonia is not a direct and inevitable consequence of aspiration.
Modifying diets will not influence the aspiration of saliva and secretions.
Instrumental swallowing assessment bears little resemblance to eating in real life.
Evidence-based decision making is not just about clinical trial evidence. There is sometimes an overemphasis on (the lack of) trial evidence.
Absence of evidence is not evidence of absence.
Decision making requires the integration of the best evidence available with clinical expertise and patient values.
The absence of robust evidence is problematic because modifying diets is intrusive and carries significant possible hazards as well as benefits.
Many practitioners overestimate the benefits of modified diets.
There is evidence that clinical experience outweighs research evidence and patient preferences in determining everyday practice regarding modified diets.
Modified diets are justified if consent is obtained. Patients should make their own decision after receiving adequate information about the potential benefits and risks of modified diets. Strong beliefs that modified diets are beneficial might influence how practitioners present risks and benefits to patients.
There are exceptions to the need for research evidence Modified diets may be required if there is an immediate and significant distress related to feeding or a high risk of asphyxiation.
Modified diets may be justified if used in conjunction with an active swallow rehabilitation program.
An individual treatment trial is warranted if there is reasonable expectation of benefit, the patient agrees, and there is follow-up to assess the impact of treatment.
Follow-up assessment is not always available, perhaps especially in residential care settings.