A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

Abstract

(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR–) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD’s prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.

Short-Term Therapeutic Adherence of Hospitalized Older Patients with Oropharyngeal Dysphagia after an Education Intervention: Analysis of Compliance Rates, Risk Factors and Associated Complications

“…The VVS-T uses different volumes and viscosities for evaluating safety signs of swallowing (cough, decreased oxygen saturation, and voice changes) and efficacy signs (poor labial seal, multiple swallows, and pharyngeal residue). This test is not only a clinical tool for screening, but also for diagnosis of OD with high sensitivity (93.2%) and a specificity (81.4%) for clinical diagnosis of OD, including severity, and it is simple and fast to perform [ 1 , 20 ]. This tool can be used to provide accurate indications on the optimal bolus volume and viscosity for dysphagia patients [ 1 ], as it was used in the recent study of older patients with dementia and dysphagia [ 18 ].…”

“…This test is not only a clinical tool for screening, but also for diagnosis of OD with high sensitivity (93.2%) and a specificity (81.4%) for clinical diagnosis of OD, including severity, and it is simple and fast to perform [ 1 , 20 ]. This tool can be used to provide accurate indications on the optimal bolus volume and viscosity for dysphagia patients [ 1 ], as it was used in the recent study of older patients with dementia and dysphagia [ 18 ].…”

“…Oropharyngeal dysphagia (OD) is common in hospitalized older patients with prevalence rates between 7.9% and 86% [ 1 , 2 , 3 ]. This heterogeneity is attributed to the inclusion of different populations and various diagnostic tools.…”

Individualized Nutritional Support for Hospitalized Patients With Oropharyngeal Dysphagia After Stroke: A Randomized Controlled Trial

“…The volume-viscosity swallow test (V-VST) is a validated tool for the systematic assessment and clinical diagnosis of OD and provides accurate indications of the optimal bolus volume and viscosity for patients with OD. The diagnostic sensitivity and specificity of V-VST for OD can reach 93.17% and 81.39%, respectively ( 8 ). The design and implementation of texture-modified diet intervention based on V-VST results can effectively improve oral intake, weight, handgrip strength, and phase angle in older adults with OD ( 9 ).…”

Reply to the Letter to the Editor regarding “Dysphagia in non-intubated patients affected by COVID-19 infection”

“…It is important to underline that VVST detects a desaturation that owns specific features: a decrease in oxygen saturation ≥ 3 must occur to be considered a significant predictor of aspiration. This reduction immediately follows the swallowing of tested bolus and is transitory, lasting not more than few seconds [ 4 ]. Thus, these characteristics allow an easy distinction between dysphagic desaturation and progressive, not temporary desaturation due to SARS-CoV-2.…”