Training support staff to modify fluids to appropriate safe consistencies for adults with intellectual disabilities and dysphagia: an efficacy study.
Handing carers TIM tubes during thick-fluid training keeps drinks safer for months compared with paper instructions alone.
01Research in Context
What this study did
Berkovits et al. (2014) ran a randomized trial with support staff who help adults with intellectual disability and dysphagia. Half the carers got the usual thick-fluid training plus TIM tubes. The other half got only written instructions.
TIM tubes are small plastic strips that show four safe drink thicknesses. Staff match the drink to the strip. The study checked how close each mix was to the doctor-ordered thickness right after training and again months later.
What they found
Carers who used TIM tubes hit the safe thickness far more often than the paper-only group. The gap stayed modest but clear several months later.
In short, adding a simple visual tool beat handing out a memo.
How this fits with other research
van Vonderen et al. (2012) and Winett et al. (1991) also show that staff need more than a lecture. Video feedback or video-based BST lifted carer skills and the gains held for five to six months, lining up with the TIM-tube follow-up data.
St. Peter et al. (2021) pitted three training styles head-to-head and found that hands-on BST or interactive computer training beat a plain video. Berkovits et al. (2014) echo that theme: a cheap hands-on prop (TIM tubes) outdid paper alone.
Sauna-Aho et al. (2025) looked at every dysphagia test used with adults with ID and found only four tools with solid proof. TIM tubes were not among the four, yet Berkovits et al. (2014) show the tubes still help carers deliver safer drinks. The papers do not clash; Minttu judged diagnostic tests while D et al. tested a teaching aid.
Why it matters
If you supervise carers who thicken drinks, slip a set of TIM tubes into the training kit. The strips cost pennies, need no tech, and give staff an instant visual check. One short practice round can cut choking risk for months.
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02At a glance
03Original abstract
BACKGROUND: Modifying the consistency of food and drink is a strategy commonly used in the management of dysphagia for people with intellectual disabilities (ID). People with ID often depend on others for the preparation of food and drink and therefore depend on those caregivers achieving the correct consistency to keep them safe and avoid discomfort during mealtimes. Clinical experience and prior research have demonstrated that although training can improve modification, carers often find modification difficult and potentially stressful and recommend additional support for carers. Fluid consistency is often modified through the addition of powdered thickener. This study investigates the efficacy of typical training and use of consistency guides, the Thickness Indicator Model (TIM) tubes, in helping carers to modify fluids accurately. METHOD: A 3 × 3 pre-post experimental design with a control group was employed to compare the observed accuracy of modification across three groups and at three time points (pre-intervention baseline, immediately post-training intervention and 3-10 months post-training). Sixty-two paid carers who supported people with ID were recruited to participate in the study and each was randomly allocated to one of the three groups: a control group given written guidance only, a group who received typical training and written guidance and a group who received training, written guidance and the TIM tubes. RESULTS & CONCLUSIONS: Typical training resulted in significantly greater carer accuracy in modifying fluid consistencies when compared with written guidance alone. Use of the TIM tubes also significantly improved accuracy in the modification of drinks compared with the group who modified with the aid of written guidance alone. At 3-10-month follow-up only the group who received typical training alongside the TIM tubes were significantly more accurate than the Written Guidance group. Further research is warranted to ascertain the effectiveness of the training and the utility of the TIM tubes in improving accuracy over a longer time scale and in individuals' usual living environments.
Journal of intellectual disability research : JIDR, 2014 · doi:10.1111/jir.12013