Interobserver variability in cineradiographic assessment of pharyngeal function during swallow

Ekberg, Olle; Nylander, G; Fork, Frans-Thomas; Sjöberg, Staffan; Birch-Iensen, Marianne; Hillarp, Birgitta

doi:10.1007/bf02406279

Cited by 50 publications

(38 citation statements)

References 5 publications

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“…35,36 Reliability ratios in 1 study were highest for aspiration, particularly for solids, and lowest for functional swallowing components. 36 Levels of agreement in ratings correlate with assessor experience 37 and improve with group discussion among assessors 38 ; similar methods of training to criteria may form a way to improve reliability. 35 …”

Section: Videofluoroscopymentioning

confidence: 99%

Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients

Ramsey

Smithard

Kalra

2003

Stroke

333

223

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Background and Purpose-Dysphagia is common after stroke and is a marker of poor prognosis. Early identification is important. This article reviews the merits and limitations of various assessment methods available to clinicians. Methods-An electronic database search was performed of MEDLINE, EMBASE, and the Cochrane database using such terms as stroke, aspiration, dysphagia, and assessment; extensive manual searching of articles was also conducted. Results-Bedside tests are safe, relatively straightforward, and easily repeated but have variable sensitivity (42% to 92%), specificity (59% to 91%), and interrater reliability (ϭ0 to 1.0). They are also poor at detecting silent aspiration. Videofluoroscopy gives anatomic and functional information and allows testing of therapeutic techniques. However, swallowing is assessed under ideal conditions that are different from clinical settings, and reliability is often poor (ϭ0 to 0.75) in the absence of assessor training. Fiberoptic endoscopy allows swallow assessment and sensory testing but requires specialized staff and equipment. Oxygen desaturation during swallowing may be predictive of aspiration (sensitivity, 73% to 87%; specificity, 39% to 87%) but is more useful in combination with bedside testing than in isolation.

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Section: Videofluoroscopymentioning

confidence: 99%

Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients

Ramsey

Smithard

Kalra

2003

Stroke

333

223

View full text Add to dashboard Cite

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“…The issue of interrater variability in assessing dynamic images of swallowing has been addressed by Ekberg et al [4], Gibson and Phyland [5], and Wilcox et al [6]. These studies all demonstrated the variability in interpretation of videofluoroscopic images of swallowing.…”

mentioning

confidence: 96%

A Study of Interrater Reliability when Using Videofluoroscopy as an Assessment of Swallowing

1998

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Videofluoroscopic assessment of swallowing is widely used in clinical settings. The interpretation of such assessments depends on subjective visual judgments but the reliability of these judgments has been poorly researched. This study measured interrater reliability of judgments, made by speech pathologists, of videofluoroscopic images of subjects swallowing liquid and semisolid boluses. A 5-point rating scale was used in three conditions: individually after careful reading; together with other speech pathologists in group discussion; and individually after the group discussion. Analysis of the ratings for the three conditions revealed that the level of agreement among raters was generally higher for semisolid swallows than for liquid swallows. The highest levels of agreement occurred for ratings made after group discussions. The levels of agreement were lowest when raters worked alone, relying only on reading the scale. Individual rating after group discussion resulted in higher levels of agreement than sole reliance on reading the scale. Factors influencing the levels of interrater agreement, including the timing of observations, bolus consistency, the quality of the image, and the complexity of the task, are discussed.

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“…Thus, the utility of VFSS must be established for the good of both patients and providers. However, no studies have been performed that rigorously examine intrarater reliabilities in VFSS, although there are two existing reports on some aspects of interrater reliability [9,10]. This lack is especially important given the subjective methods of evaluating VFSS.…”

mentioning

confidence: 99%

“…Ekberg et al [9] reported interobserver variability in cineradiographic assessment of pharyngeal function during swallowing. Examinations of 72 patients with dysphagia were reviewed retrospectively and independently by 6 radiologists.…”

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confidence: 99%

Intra- and Interrater Variation in the Evaluation of Videofluorographic Swallowing Studies

1998

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The objective of this study was to determine the inter- and intrarater reliability in evaluating videofluoroscopic swallowing studies (VFSS). Participants included 4 physicians (3 physiatrists and 1 internist) and 5 speech-language pathologists with at least 5 years experience in evaluating VFSS. The main outcomes of the study were reliability ratios of positive and negative tests in inter- and intrarater evaluations. Raters independently rated each of 20 VFSS on two separate occasions. Traits evaluated included oral stage impairment, aspiration, pharyngeal retention, and several functional components: timing of swallow onset, adequacy of velopharyngeal apposition, laryngeal elevation, epiglottic tilt, pharyngeal contraction, and pharyngoesophageal (PE) segment opening. Reliability varied widely depending on food type and the trait under evaluation. Inter- and intrarater reliability ratios did not differ widely. Reliability ratios values typically were highest (greater than 90%) for aspiration, especially with solid food, and lowest for the functional components. It was concluded that inter- and intrarater reliability in VFSS are adequate for evaluating oral stage, laryngeal penetration, and aspiration and pharyngeal retention, but questionable for functional components.

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Interobserver variability in cineradiographic assessment of pharyngeal function during swallow

Cited by 50 publications

References 5 publications

Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients

Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients

A Study of Interrater Reliability when Using Videofluoroscopy as an Assessment of Swallowing

Intra- and Interrater Variation in the Evaluation of Videofluorographic Swallowing Studies

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