Our research focuses on understanding swallowing impairment (dysphagia) and its impact on patients. Our aim is to conduct research that will assist clinicians in providing the best possible care for dysphagia and ultimately help to reduce the burden of dysphagia for patients, their caregivers and the community.

Study Status: active

Institute: Krembil Research Institute

Study Purpose: To compare the benefit of early (PRO-ACTIVE) versus late (REACTIVE) swallowing treatments in patients with head and neck cancer who receive radiotherapy.

Background: For people with head and neck cancer, swallowing food, liquids and even saliva can become challenging. The swallowing difficulty can result from the cancer itself or from cancer treatment, such as radiotherapy. Patients with swallowing problems cannot eat enough to stay healthy. It is challenging for them to maintain a healthy weight. They are also not able to enjoy a meal with family and friends. All these reduce a patient’s quality of life. It also affects a patient’s recovery from cancer treatment. Patients may need to rely on a feeding tube for many months to get proper nutrition after their cancer treatment. Speech pathologists help these patients manage their swallowing problems. There are 3 types of therapy: 1. RE-ACTIVE - Patients get therapy only after they have swallowing problems to make the swallowing problems better. Therapy includes focus on eating a variety of foods as well as exercises to help keep the swallowing muscles active. 2. PRO-ACTIVE EAT - Patients get therapy before the swallowing problems have started to prevent or lessen the swallowing problems. Therapy includes focus on eating a variety of foods 3. PRO-ACTIVE EAT+ EXERCISE - Patients get therapy before the swallowing problems have started. Therapy includes focus on eating a variety of foods as well as exercises to help keep the swallowing muscles active. All of these swallowing therapies are effective to some level. However, we do not know which therapy works best. This study compares how well PRO-ACTIVE therapies work to reduce the need for a feeding tube in patients with head and neck cancer after receiving radiotherapy.

Study Methods: The PRO-ACTIVE study is a large trial occurring in 13 cancer hospitals across Canada and the USA. Patients, caregivers, healthcare providers and administrators helped plan and monitor the study conduct. The study includes 952 patients with head and neck cancer receiving radiotherapy who will be treated by one of the 3 PRO-ACTIVE swallowing therapies. These will be will be offered during radiotherapy. We will track how well each therapy reduces the need for feeding tubes at 3 and 12 months after the radiotherapy ends. We will also track patient quality of life, weight loss and other swallowing related health problems. The study will help us understand which therapy works best for patients with head and neck cancer after radiotherapy.

Health Conditions: Cancer, Digestive system conditions

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Study Status: completed

Institute: Krembil Research Institute

Study Purpose: This study was done to find out if a new online training program called “TOR-BSST© eLearning” is as good as the current, in-person training for teaching healthcare workers to accurately screen for swallowing problems.

Background: Swallowing problems (called dysphagia) affect about 60% of patients with stroke. This can raise the chances of complications like pneumonia, weight loss, and even death. For this reason, it is important to check for dysphagia in patients with stroke when they first come to the hospital. The Toronto Bedside Swallowing Screening Test (TOR-BSST©) is a test used to check for dysphagia. It is recommended by Canadian stroke guidelines and used in hospitals across Canada and in other countries. Right now, every healthcare worker who uses the TOR-BSST© has to complete an in-person 4-hour training course led by a speech-language pathologist (SLP). However, not all hospitals are able to provide this training.

Study Methods: Participants included healthcare workers who hadn't learned how to test for swallowing problems before and who take care of patients with stroke. They were put into one of three groups for the study: Group 1: Completed the usual 4-hour in-person training and then used the TOR-BSST© on 2 patients with stroke while an SLP watched. Group 2: Completed the new eLearning and then used the TOR-BSST© on 2 patients with stroke while an SLP watched. Group 3: Completed eLearning followed and then used the TOR-BSST© on 2 patients with stroke while another member of the team (not an SLP) watched. We used an online test to check how accurate each group was, and compared their results.

Key Findings: A total of 82 nurses joined from 4 hospitals in Ontario, Quebec, and Alberta. Our results found that there were no differences among the three groups. This study shows that the new TOR-BSST© eLearning is just as good at helping healthcare workers correctly test for swallowing problems as the usual in-person training. A shorter, online training will be easier for hospitals to offer. This will make sure that more patients with stroke are checked for swallowing problems sooner.

Health Conditions: Stroke

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Dr. Rosemary Martino held the inaugural Tier 2 Canada Research Chair in Swallowing Disorders (2013-2023). She is an expert in the area of swallowing disorders (dysphagia) and clinical epidemiology. Her Swallowing Lab research team includes several Research Coordinators, research Speech Language Pathologists, and graduate/post-graduate research students.

The focus of Dr. Martino’s research is dysphagia, more specifically oropharyngeal dysphagia, secondary to neurological, cancer and cardiovascular etiologies. Dr. Martino’s research aims to discover high-level evidence to determine whether swallowing interventions are beneficial in reducing or eliminating unnecessary consequences such as pneumonia, malnutrition, dehydration, anxiety, depression, poor quality life and even death.

For a list of Dr. Martino's publications, please visit PubMed, Scopus, Publons or ORCID.

• Canada Research Chair (Tier II) in Swallowing Disorders
• Professor (Primary Appointment), Department of Speech Language Pathology, University of Toronto
• Director, Swallowing Lab, University Health Network / University of Toronto
• Professor (Cross-Appointment), Rehabilitation Sciences Institute, University of Toronto
• Professor (Cross-Appointment), Department of Otolaryngology - Head and Neck Surgery, University of Toronto