Just add water: Can water protocols improve dysphagia management outcomes?

There have been many advances in the rehabilitation of dysphagia over the past decade, yet compensatory strategies, particularly food and fluid modification, tend to dominate speech-language pathology practice. This paper explores the evidence for the use of thickened fluids as one such compensatory strategy for managing the risk of aspiration pneumonia, and revisits the evidence for water protocols (WP) as an alternative. Findings from systematic reviews suggest water protocols do not increase the odds of pneumonia in carefully selected patients, particularly those in inpatient rehabilitation with acquired neurological conditions, with trends towards improved fluid intake, hydration and quality of life. Yet the uptake of WPs into clinical practice remains sporadic. In the second part of this paper we raise questions about the barriers to the uptake of WPs as a stimulus for discussion within the profession.