, Volume 33, Issue 6, pp 818–826 | Cite as

Inter-rater Agreement of Clinicians’ Treatment Recommendations Based on Modified Barium Swallow Study Reports

  • Laurie SlovarpEmail author
  • Jennifer Danielson
  • Julie Liss
Original Article


The modified barium swallow study (MBSS) is a commonly used radiographic procedure for diagnosis and treatment of swallowing disorders. Despite attempts by dysphagia specialists to standardize the MBSS, most institutions have not adopted such standardized procedures. High variability of assessment patterns arguably contribute to variability of treatment recommendations made from diagnostic information derived from the MBSS report. An online survey was distributed to speech-language pathologists (SLPs) participating in American Speech Language Hearing Association (ASHA) listservs. Sixty-three SLPs who treat swallowing disorders participated. Participating SLPs reviewed two MBSS reports and chose physiologic treatment targets (e.g., tongue base retraction) based on each report. One report primarily contained symptomatology (e.g., aspiration, pharyngeal residue) with minimal information on impaired physiology (e.g., laryngeal incompetence, reduced hyolaryngeal elevation/excursion). In contrast, the second report contained a clear description of impaired physiology to explain the dysphagia symptoms. Fleiss kappa coefficients were used to analyze inter-rater agreement across the high and low physiology report types. Results revealed significantly higher inter-rater agreement across clinicians when reviewing reports with clear explanation(s) of physiologic impairment relative to reports that primarily focused on symptomatology. Clinicians also reported significantly greater satisfaction and treatment confidence following review of reports with clear description(s) of impaired physiology.


Dysphagia Modified barium swallow Inter-rater agreement Physiologic impairment Compensatory Restorative Swallowing 


Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest.

Ethical Approval

This research was approved by the University of Montana Institutional Review Board.

Informed Consent

All participants read an informed consent statement at the beginning of the survey and clicked a “Yes” button to indicate their consent and continue with the study.

Supplementary material

455_2018_9907_MOESM1_ESM.docx (94 kb)
Supplementary material 1 (DOCX 93 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Communicative Sciences and DisordersUniversity of MontanaMissoulaUSA
  2. 2.Arizona State UniversityTempeUSA

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