The Boston Residue and Clearance Scale: Preliminary Reliability and Validity Testing

Abstract

Background: There is no appropriately validated scale with which to rate the problem of residue after swallowing. The Boston Residue and Clearance Scale (BRACS) was developed to meet this need. Initial reliability and validity were assessed. Methods: BRACS is an 11-point ordinal residue rating scale scoring three aspects of residue during a fiberoptic endoscopic evaluation of swallowing (FEES): (1) the amount and location of residue, (2) the presence of spontaneous clearing swallows, and (3) the effectiveness of clearing swallows. To determine inter-rater and test-retest reliability, 63 swallows from previously recorded FEES procedures were scored twice by 4 raters using (1) clinical judgment (none, mild, mild-moderate, moderate, moderate-severe, severe) and (2) BRACS. Concurrent validity was tested by correlating clinical judgment scores with BRACS scores. Internal consistency of the items in BRACS was examined. A factor analysis was performed to identify important factors that suggest grouping within the 12 location items in BRACS. Results: BRACS showed excellent inter-rater reliability (intraclass correlation coefficient, ICC = 0.81), test-retest reliability (ICC: 0.82-0.92), high concurrent validity (Pearson's r = 0.76), and high internal consistency (Cronbach's α = 0.86). Factor analysis revealed 3 main latent factors for the 12 location items. Conclusion: BRACS is a valid and reliable tool that can rate the severity of residue.

Predictive clinical factors for penetration and aspiration in Parkinson's disease

“…As discussed before in our previous paper, the wide range in the reported prevalence of dysphagia in PD patients may be caused by differences in assessment techniques and selected populations as well as varying definitions of dysphagia . For example, assessment and rating of residues still lack a gold standard, and the impact of the residue severity, quantity, and position for dysphagia and aspiration risk remains unclear . Therefore, we focused on critical aspiration in this study.…”

“…1,2,40 For example, assessment and rating of residues still lack a gold standard, 41,42 remains unclear. 37,[42][43][44] Therefore, we focused on critical aspiration in this study.…”

“…35 Residues were classified from 0 to 3 based on the "Boston Residue and Clearance Scale". 36,37 Build-up phenomenon, a special variant of residues occurring with an increase in firm consistencies in the valleculae after each swallow, was also recorded. Build-up severity was rated from 0 (no build-up), 1 (moderate) to 2 (severe).…”

Protocolos De Avaliação Da Deglutição: Norteadores E Limitações

“…Essa alteração pode ser causada por movimentação ou força da musculatura reduzidas e/ou por diminuição da sensibilidade do trato vocal. É aceitável a presença de estase de 10% a 15% da oferta após a primeira deglutição 9,29 . Nesse estudo, os 2 fonoaudiólogos que realizam avaliações objetivas por meio da VED em sua prática clínica, referiram que a estase não consta nos instrumentos empregados em sua rotina.…”

“…Nesse estudo, os 2 fonoaudiólogos que realizam avaliações objetivas por meio da VED em sua prática clínica, referiram que a estase não consta nos instrumentos empregados em sua rotina. Porém, na literatura encontra-se a escala Protocolos de avaliação da deglutição BRACS -Boston Residue and Clearance Scale, instrumento que foi desenvolvido com o intuito de avaliar a presença, a quantidade e a localização de resíduo faríngeo, bem como verificar a eficiência do clareamento da estase 29,30 :…”