Imperial College London

Dr Margaret Coffey

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 0152margaret.coffey10

 
 
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Location

 

South WingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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15 results found

Sparks F, Dipper L, Coffey M, Hilari Ket al., 2023, Approaches to tracheoesophageal voice rehabilitation: a survey of the UK and Irish speech and language therapists’ current practice and beliefs, International Journal of Language & Communication Disorders, Vol: 58, Pages: 1481-1495, ISSN: 1368-2822

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>(1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy.</jats:p></jats:sec><jats:sec><jats:title>Methods &amp; Procedures</jats:title><jats:p>A self‐administered 10‐min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs’ provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post‐registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis.</jats

Journal article

Dawson C, Clunie G, Evison F, Duncan S, Whitney J, Houchen-Wolloff L, Bolton CE, Leavy OC, Richardson M, Omer E, McAuley H, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Greening NJ, Nolan CM, Wootton DG, Daynes E, Donaldson G, Sargent J, Scott J, Pimm J, Bishop L, McNarry M, Hart N, Evans RA, Singh S, Yates T, Chalder T, Man W, Harrison E, Docherty A, Lone NI, Quint JK, Chalmers J, Ho L-P, Horsley AR, Marks M, Poinasamy K, Raman B, Wain LV, Brightling C, PHOSP-COVID collaborative Group, Sharma N, Coffey M, Kulkarni A, Wallace Set al., 2023, Prevalence of swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19: the PHOSP-COVID analysis, BMJ Open Respiratory Research, Vol: 10, ISSN: 2052-4439

Objective: Identify prevalence of self-reported swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19.Design: Multicentre prospective observational cohort study using questionnaire data at visit 1 (2–7 months post discharge) and visit 2 (10–14 months post discharge) from hospitalised patients in the UK. Lasso logistic regression analysis was undertaken to identify associations.Setting: 64 UK acute hospital Trusts.Participants: Adults aged >18 years, discharged from an admissions unit or ward at a UK hospital with COVID-19.Main outcome measures: Self-reported swallow, communication, voice and cognitive compromise.Results: Compromised swallowing post intensive care unit (post-ICU) admission was reported in 20% (188/955); 60% with swallow problems received invasive mechanical ventilation and were more likely to have undergone proning (p=0.039). Voice problems were reported in 34% (319/946) post-ICU admission who were more likely to have received invasive (p<0.001) or non-invasive ventilation (p=0.001) and to have been proned (p<0.001). Communication compromise was reported in 23% (527/2275) univariable analysis identified associations with younger age (p<0.001), female sex (p<0.001), social deprivation (p<0.001) and being a healthcare worker (p=0.010). Cognitive issues were reported by 70% (1598/2275), consistent at both visits, at visit 1 respondents were more likely to have higher baseline comorbidities and at visit 2 were associated with greater social deprivation (p<0.001).Conclusion: Swallow, communication, voice and cognitive problems were prevalent post hospitalisation for COVID-19, alongside whole system compromise including reduced mobility and overall health scores. Research and testing of rehabilitation interventions are required at pace to explore these issues.

Journal article

Allen JE, Clunie G, Ma JK-Y, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer Aet al., 2022, Translating ultrasound into clinical practice for the assessment of swallowing and laryngeal function: a speech and language pathology-led consensus study, Dysphagia, Vol: 37, Pages: 1586-1598, ISSN: 0179-051X

Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1–13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

Journal article

Govender R, Behenna K, Brady G, Coffey M, Babb M, Patterson JMet al., 2021, Shielding, hospital admission and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic: A cross-sectional survey from the first national lockdown, INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS, Vol: 56, Pages: 1064-1073, ISSN: 1368-2822

Journal article

Newington L, Wells M, Adonis A, Bolton L, Bolton Saghdaoui L, Coffey M, Crow J, Fadeeva Costa O, Hughes C, Savage M, Pakzad-Shahabi L, Alexander Cet al., 2021, A qualitative systematic review and thematic synthesis exploring the impacts of clinical academic activity by healthcare professionals outside medicine, BMC Health Services Research, Vol: 21, ISSN: 1472-6963

Background: There are increasing opportunities for healthcare professionals outside medicine to be involved in and lead clinical research. However, there are few roles within these professions that include time for research. In order to develop such roles, and evaluate effective use of this time, the range of impacts of this clinical academic activity need to be valued and understood by healthcare leaders and managers. To date, these impacts have not been comprehensively explored, but are suggested to extend beyond traditional quantitative impact metrics, such as publications, citations and funding awards. Methods: Ten databases, four grey literature repositories and a naïve web search engine were systematically searched for articles reporting impacts of clinical academic activity by healthcare professionals outside medicine. Specifically, this did not include the direct impacts of the research findings, rather the impacts of the research activity. All stages of the review were performed by a minimum of two reviewers and reported impacts were categorised qualitatively according to a modified VICTOR (making Visible the ImpaCT Of Research) framework. Results: Of the initial 2,704 identified articles, 20 were eligible for inclusion. Identified impacts were mapped to seven themes: impacts for patients; impacts for the service provision and workforce; impacts to research profile, culture and capacity; economic impacts; impacts on staff recruitment and retention; impacts to knowledge exchange; and impacts to the clinical academic. Conclusions: Several overlapping sub-themes were identified across the main themes. These included the challenges and benefits of balancing clinical and academic roles, the creation and implementation of new evidence, and the development of collaborations and networks. These may be key areas for organisations to explore when looking to support and increase academic activity among healthcare professionals outside medicine. The modified VICTO

Journal article

Devabalan Y, Malik A, Coffey M, Clarke Pet al., 2021, Video laryngoscope-guided (GlideScope®) injection of botulinum toxin in laryngectomy patients with limited neck extension, CLINICAL OTOLARYNGOLOGY, Vol: 46, Pages: 116-118, ISSN: 1749-4478

Journal article

Dawson C, Roe J, Starmer H, Brady G, Nund R, Coffey M, Govender R, Patterson JM, Nankivell P, Topping A, Sharma N, Parmar S, Elkington C, Merrit M, Stanbury D, Pracy Pet al., 2020, Patient advocacy in head and neck cancer: Realities, challenges and the role of the multi-disciplinary team, Clinical Otolaryngology, Vol: 45, Pages: 437-444, ISSN: 0307-7772

This paper explores the concept of advocacy in head and neck cancer. We define inherent challenges in the development and success of advocacy within this context and offer ways to embed it within clinical practice. We outline what advocacy is, ways in which it may benefit people with head and neck cancer and the engagement required from healthcare professionals to facilitate advocacy to improve outcomes.

Journal article

Coffey M, Tolley N, Howard D, Hickson Met al., 2018, An investigation of reliability of the Sunderland Tracheosophageal Voice Perceptual Scale, Folia Phoniatrica et Logopaedica, Vol: 71, Pages: 16-23, ISSN: 1021-7762

Background: The Sunderland Tracheosophageal Voice Perceptual scale (SToPS) is the only perceptual rating scale designed specifically for tracheosophageal voice [Hurren et al.: Clin Otolaryngol. 2009 Dec; 34(6): 533–8]. Objective: To investigate the inter rater reliability of the SToPS when analyzing alaryngeal voice. Methods: Prospective evaluation of inter rater reliability of the SToPS based on audio recordings of 230 voice samples from 41 laryngectomy patients rated by 3 experts. Interval data were analyzed using intraclass correlation coefficients (ICC) while categorical data were analyzed using Kappa. Results: ICC of above 0.6 was observed between raters for each prosthesis on a majority of parameters demonstrating a good level of reliability. Reliability was fair (ICC of between 0.40 and 0.59) on Q11 (Articulatory precision) and Q12 (Paralinguistics). Reliability was also fair (0.21–0.40) or slight (0.00–0.20) for Q2 (Tonicity), which was analyzed using Kappa. Kappa above 0.61 signified a good level of reliability. Conclusions: This study demonstrates good rater reliability for the majority of parameters on the SToPS scale, supporting the use of this tool within the clinical realm. However, further research is required to ascertain if any methods of increasing inter rater reliability on those parameters which did not reach good reliability can be identified.

Journal article

Coffey M, Tolley N, Howard D, Hickson Met al., 2018, Evaluating the effect of different voice prostheses on alaryngeal voice quality, The Laryngoscope, Vol: 128, Pages: 2460-2466, ISSN: 0023-852X

ObjectiveTo investigate the difference between voice prostheses in terms of voice quality as experienced by patients and as judged by expert raters.MethodsSubjects had up to six voice prostheses placed in a random order. A voice sample was elicited for each patient on each prosthesis. Auditory perceptual voice analysis of each voice sample was undertaken by expert raters using the Sunderland Tracheoesophageal Voice Perceptual Scale (SToPS). Raters also identified the best overall prosthesis for voice for each patient. Raters were blinded to patient details, type of laryngectomy surgery, type of voice prosthesis, and scores of other raters. After each prosthesis trial, patients self‐evaluated voice using a questionnaire developed for this purpose.ResultsExpert raters were not able to identify a best overall voice prosthesis using SToPS. Expert raters most frequently chose the Blom‐Singer Classic Indwelling (InHealth Technologies, Carpinteria, CA) as the overall best prosthesis for voice for each patient. Patient self‐evaluation scores indicated a preference for the Blom‐Singer Classic Indwelling Prosthesis (InHealth Technologies) for voice, whereas preference for best overall prosthesis was for the Provox NID (Atos Medical AB, Hörby, Sweden)ConclusionExpert raters did not identify a best prosthesis for voice using SToPS, although the Blom‐Singer Classic Indwelling (InHealth Technologies) was most frequently chosen as best for voice. Patient self‐evaluation indicated a difference between preference of prosthesis for voice and preference for best overall voice prosthesis. Individual patients had their own personal preferences, suggesting they should be involved in the choice of their voice prosthesis.

Journal article

Coffey MM, Tolley N, Howard D, Hickson Met al., 2018, Double Blind Study Investigating the Effect of Different Voice Prostheses on Ease of Swallowing and Residue Post Laryngectomy., Dysphagia, Vol: 33, Pages: 616-626, ISSN: 1432-0460

Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies.

Journal article

Coffey MM, Tolley N, Howard D, Drinnan M, Hickson Met al., 2018, An Investigation of the Post-laryngectomy Swallow Using Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES)., Dysphagia, Vol: 33, Pages: 369-379, ISSN: 1432-0460

This study investigates the post-laryngectomy swallow. Presence and degree of residue on the post-laryngectomy swallow as observed on videofluoroscopy and FEES is described. In addition, videofluoroscopy and FEES are assessed for reliability and inter-instrument agreement. 30 laryngectomy subjects underwent dysphagia evaluation using simultaneous videofluoroscopy and FEES. These were reviewed post-examination by three expert raters using a rating scale designed for this purpose. Raters were blinded to subject details, type of laryngectomy surgery, pairing of FEES and videofluoroscopy examinations and the scores of other raters. There was a finding of residue in 78% of videofluoroscopy ratings, and 83% of FEES ratings. Comparison of the tools indicated poor inter-rater reliability and poor inter-instrument agreement. Dysphagia is an issue post laryngectomy as measured by patient self-report and by instrumental evaluation. However, alternative dysphagia rating tools and dysphagia evaluation tools are required to enable accurate identification and intervention for underlying swallow physiology post laryngectomy.

Journal article

Clarke P, Radford K, Coffey M, Stewart Met al., 2016, Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines, JOURNAL OF LARYNGOLOGY AND OTOLOGY, Vol: 130, Pages: S176-S180, ISSN: 0022-2151

Journal article

Coffey M, Edels Y, Clarke P, 2015, Problem solving after complications of tracheo-oesophageal valve (voice prosthesis) insertion, Journal of ENT Masterclass

Journal article

Coffey M, Tolley N, 2015, Swallowing after laryngectomy, CURRENT OPINION IN OTOLARYNGOLOGY & HEAD AND NECK SURGERY, Vol: 23, Pages: 202-208, ISSN: 1068-9508

Journal article

Moradi P, Glass GE, Atherton DD, Eccles S, Coffey M, Majithia A, Speirs AJD, Clarke PM, Wood SHet al., 2010, Reconstruction of Pharyngolaryngectomy Defects Using the Jejunal Free Flap: A 10-Year Experience from a Single Reconstructive Center, PLASTIC AND RECONSTRUCTIVE SURGERY, Vol: 126, Pages: 1960-1966, ISSN: 0032-1052

Journal article

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