VFS Interjudge Reliability Using a Free and Directed Search

Abstract

Reports in the literature suggest that clinicians demonstrate poor reliability in rating videofluoroscopic swallow (VFS) variables. Contemporary perception theories suggest that the methods used in VFS reliability studies constrain subjects to make judgments in an abnormal way. The purpose of this study was to determine whether a directed search or a free search approach to rating swallow studies results in better interjudge reliability. Ten speech pathologists served as judges. Five clinical judges were assigned to the directed search group (use checklist) and five to the free search group (unguided observations). Clinical judges interpreted 20 VFS examinations of swallowing. Interjudge reliability of ratings of dysphagia severity, affected stage of swallow, dysphagia symptoms, and attributes identified by clinical judges using a directed search was compared with that using a free search approach. Interjudge reliability for rating the presence of aspiration and penetration was significantly better using a free search ("substantial" to "almost perfect" agreement) compared to a directed search ("moderate" agreement). Reliability of dysphagia severity ratings ranged from "moderate" to "almost perfect" agreement for both methods of search. Reliability for reporting all other symptoms and attributes of dysphagia was variable and was not significantly different between the groups.

Changes in Hyolaryngeal Movement During Swallowing in the Lateral Decubitus Posture

“…Additional studies are required to investigate the thoraco-abdominal biomechanics in the supine and LD postures. Third, pre-swallow jaw motion or tongue muscle activity affects the resting position of the hyoid bone and larynx [ 18 ]. Compared with the UP posture, the LD posture increases the difficulty in holding the food bolus still, which increases the effort of the tongue just before swallowing.…”

“…Analysis of all data was conducted using SPSS version 14.0 (SPSS Inc., Chicago, IL, USA). Cohen’s d was calculated using R [ 18 ] and the package “effsize” [ 19 ].…”

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

“…Six measures used more items than the mean; none scored positive for reliability overall. Two of the six received conflicting ratings (26,56) and two negative (57,58), one scored 'indeterminate' (41), and one study was not evaluated due to 'poor methodological quality' (59). It should also be noted that two studies reported reliability for two different protocols (green coloured boluses vs. white) and diagnoses (aspiration or dysphagia) (43,44); both scored positive for reliability overall in only one protocol or diagnosis (green bolus and dysphagia respectively).…”

Dysphagia: implications for older people

“…[61][62][63] Reliability improves when raters routinely use scales such as the MBSImps or the penetration/aspiration scale. Both assessments are difficult to conduct with patients who have attention and behavioural difficulties and where there are likely to be movement artefacts.…”