Interrater Reliability of Videofluoroscopic Swallow Evaluation

Abstract

The past two decades have brought an enormous widening of interest in and knowledge about swallowing disorders. The most frequently used technique for swallow evaluation is X-ray videofluoroscopy. Most interventions are based on this examination. Only a few studies assessing interobserver reliability of videofluoroscopy have been published. The aim of our study was to assess the interobserver reliability of videofluoroscopy for swallow evaluation. Fifty-one consecutive dysphagic patients referred for videofluoroscopy were entered into the study regardless of their underlying disorder. The first swallow (5 ml of a semisolid radio-opague contrast media) of each patient was assessed in the lateral projection by 9 independent, experienced observers from different international swallow centers. All studies were evaluated according to a standardized protocol sheet and the interobserver reliability was calculated. The interobserver reliabilities assessed as kappa coefficient for parameters of the oral and pharyngeal phase, for the temporal occurrence of penetration/aspiration, and for the location of bolus residue ranged from 0.01 to 0.56. High reliability with an intraclass coefficient of 0.80 was achieved only with the well defined penetration/aspiration score. Our study underlines the need for exact definitions of the parameters assessed by videofluoroscopy, in order to raise interobserver reliability. To date, only aspiration is evaluated with high reliability by videofluoroscopy, whereas the reliability of all other parameters of oropharyngeal swallow is poor.

Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia

“…2,3 Furthermore, VFSS is a valuable test in detecting stroke patients with aspiration at risk of aspiration pneumonia. 4 However, interpretation of the results of VFSS is dependent upon the competence of examiners, 5,6 and they can only show findings resulting from neuromuscular causes of oropharyngeal dysphagia. 7 The objective measure of pharyngeal strength is pharyngeal manometry.…”

Functional lumen imaging of the gastrointestinal tract

“…Video fluoroscopy is the gold standard for measuring upper esophageal sphincter (UES) function, yet it is an extremely subjective test and the outcome depends to a large extent on the practitioner [20]. Even for experienced examiners, the use of video fluoroscopy and swallow studies to determine and quantify the extent of movement and opening in the pharyngoesophageal segment region of the UES can be very challenging.…”

Assessing children’s swallowing: parent and professional perceptions

“…Although it is regarded as an important assessment in identifying aspiration, inter -rater reliability between professionals such as speech and language therapists (SLTs) and radiologists is variable. The inter -rater reliability is low when interpreting recordings of adults swallowing in relation to the severity of swallow dysfunction (Bryant et al, 2012;Perry & Love, 2001;Stoeckli et al, 2003). Aspiration of solid foods appears to have a higher rater -reliability compared to fluid rater-reliability in adult studies (Kuhlemeier et al, 1998;Scott et al, 1998).…”