Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation?

Abstract

Purpose: Cervical auscultation (CA) uses a stethoscope or microphone to complement the clinical swallow examination by interpreting swallowing sounds and swallow-respiratory coordination. This study investigated the effects of structured CA training on CA-rating agreement with Flexible Endoscopic Evaluation of Swallowing (FEES) and CA rater reliability. Method: Thirty-nine speech-language pathologists participated in a structured CA training course at Gothenburg University. They rated nine swallow-respiratory sound recordings which were simultaneously recorded during FEES. Swallow sounds were rated six weeks prior to the CA-workshop using two binary yes/no questions, (1) Safe, (2) Dysphagia, and a third Dysphagia Severity rating. Swallow sounds were rated again (re-randomised) one month post CA-workshop. Result: Agreement with FEES (validity) improved significantly (p < 0.05) pre-post training for the Safe and Dysphagia questions, with post training sensitivities >90% and specificities at 76% and 85% respectively. Dysphagia severity rating improved non-significantly. Intra-rater reliability improved significantly with kappa statistics >0.90 post training. Improvements for inter-rater reliability were noted, though non-significant. Conclusion:Results demonstrate that with structured training, the validity of CA (to detect a Safe/Dysphagic swallow) significantly improves, as does intra-rater reliability. This is congruent with literature identifying the positive effects of structured training improving instrumental dysphagia assessment.

Development and evaluation of a survey instrument to assess veterinary medical record suitability for multi-center research studies

“…We believe that the limited printed guidance associated with the survey and the lack of formal reviewer training prior to survey use may have affected inter-rater agreement and contributed to the larger number of records that did not pass qualification and verification. In general, structured rater instructions and training improve agreement and validity in a variety of assessments, ranging from radiographic or other clinical measurements to those relying on survey instruments (12,13). When looking at the 123 records that did pass qualification and verification questions by both reviewers, there was substantial inter-rater agreement with respect to total survey quality points.…”

Acoustic characteristics associated with liquid swallowing sounds of different bolus consistencies in young healthy adults

“…It therefore should be not used as a standalone instrument for diagnosis of dysphagia. Yet, in a more recent study reported by Bergström and Cichero (2021), with structured training, both validity and reliability of cervical auscultation for dysphagia carried out by speech and language therapists were significantly improved.…”

Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES

“…A one-hour consensus training was developed by the authors, based on previous research [12,[18][19][20][27][28][29][30] and sent to all raters who were required to rate if the swallowrespiratory sequences were safe and/or dysphagic. See Online Resource 3 as an example of consensus training information regarding swallow-respiratory sound interpretation.…”

“…Recent work by Bergström & Cichero [12] identified that early CA studies, often reported poorer CA validity and reliability results [23][24][25][26]. These CA studies were conducted with suboptimal methodology, including (1) poor swallow-respiration sound and sampling methodology, (2) inconsistent/no CA training, (3) variable assessment parameters/ratings for CA versus instrumental assessment, and (4) no provision of definitions − all critical factors for robust research within CA.…”

“…Evidenced-based medicine (EBM), first coined by Sackett [ 11 ], challenges clinicians to consider (1) relevant scientific evidence, (2) clinical judgement, with (3) patient values and preferences. Optimal dysphagia and oral intake management requires information not from one assessment only, but from all clinical signs, symptoms, patient factors, health support services and various influencing factors [ 8 , 10 , 12 ]. In recent years, the concept of EBM has expanded and now requires the clinician to consider also the health system (e.g.…”