The Stability, Reliability, and Validity of Videofluoroscopy Measures for Patients with Head and Neck Cancer

Abstract

The purpose of this study was to contrast the psychometric properties (stability, test-retest reliability, construct, and concurrent validity) of three different tools used for evaluating videofluoroscopy swallowing studies (VFSS): (1) rating the presence or absence of a swallowing disorder, (2) the Bethlehem Assessment Scale (BAS), and (3) biomechanical measures. These three tools were applied to the same three examinations of two different consistencies (liquid and semisolid), taken from 40 VFSSs of patients with head and neck (H&N) cancer. Stability of swallowing across three swallows was a concern for three measures with the liquid consistency and nine measures with the semisolid consistency. Test-retest reliability was found to vary considerably for the two consistencies (liquids, 0.53-1.00; semisolids, 0.45-1.00). Examination of construct validity of the BAS and biomechanical measures indicated that six factors represented swallowing function, but different factors represented swallowing under liquid and semisolid conditions. Concurrent validity of the presence/absence of disorder variables was less than adequate. These results are discussed in the following contexts: (1) psychometric properties of VFSS may not be adequate for clinical and research environments and (2) psychometric properties of VFSS measures appear to vary as a function of bolus consistency.

Impact of demographics, tumor characteristics, and treatment factors on swallowing after (chemo)radiotherapy for head and neck cancer

“…Percentage of pharyngeal residue and penetration–aspiration, both taken from the VFSS images, have been shown to be reliable and valid measures 14. Percentage of pharyngeal residue was defined as an approximate percentage of the residue within all areas of the pharynx, relative to the entire bolus swallowed.…”

“…For all statistical analysis, data from the second swallow were used because these most accurately represent the “true” swallow 14…”

Psychometric Properties of Visuoperceptual Measures of Videofluoroscopic and Fibre-Endoscopic Evaluations of Swallowing: A Systematic Review

“…This interpretation of recordings produced by VFSS and FEES typically involve the dysphagia clinician viewing the recordings several times and making subjective judgements based on the visuoperceptual features of the images they perceive to be significant. This means that although the FEES and VFSS are frequently referred to as an 'objective' assessment, their interpretation is subjective because there is currently no consensus of standardised criteria to evaluate swallow features (23,24). One method to overcome this limitation is the use of a measure to interpret video recordings.…”

Development and feasibility of a Swallowing intervention Package (SiP) for patients receiving radiotherapy treatment for head and neck cancer—the SiP study protocol

“…This instrumental test allows quantification of endpoints of swallowing pathophysiology, swallowing efficiency and airway invasion (laryngeal penetration and aspiration) [34]. The alternative to FEES—videofluoroscopy (VF) [35]—exposes patients to radiation, is more expensive, less practical to implement and is associated with greater loss to follow up. Blinded FEES assessments will be analysed by the SLT consultants using reliability testing.…”