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Dysphagia

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

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

  • Laurie Slovarp
  • Jennifer Danielson
  • Julie Liss
Original Article
  • 156 Downloads

Abstract

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.

Keywords

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

Notes

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)

References

  1. 1.
    Baijens L, Barikroo A, Pilz W. Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. Eur J Radiol. 2013;82(10):1683–95.CrossRefGoogle Scholar
  2. 2.
    Becker S, McLeroy K, Carpenter M. Reliability of observations from modified barium swallow studies. J Med Speech Lang Pathol. 2005;13(2):97–108.Google Scholar
  3. 3.
    Bryant KN, Finnegan E, Berbaum K. VFS interjudge reliability using a free and directed search. Dysphagia. 2012;27(1):53–63.CrossRefGoogle Scholar
  4. 4.
    Hind JA, Gensler G, Brandt DK, Gardner PJ, Blumenthal L, Gramigna GD, et al. Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial. Dysphagia. 2009;24(2):211–7.CrossRefGoogle Scholar
  5. 5.
    Kuhlemeier KV, Yates P, Palmer JB. Intra- and interrater variation in the evaluation of videofluorographic swallowing studies. Dysphagia. 1998;13(3):142–7.CrossRefGoogle Scholar
  6. 6.
    Scott A, Perry A, Bench J. A study of interrater reliability when using videofluoroscopy as an assessment of swallowing. Dysphagia. 1998;13(4):223–7.CrossRefGoogle Scholar
  7. 7.
    Stoeckli SJ, Huisman TA, Seifert B, Martin-Harris BJ. Interrater reliability of videofluoroscopic swallow evaluation. Dysphagia. 2003;18(1):53–7.CrossRefGoogle Scholar
  8. 8.
    Wilcox F, Liss JM, Siegel GM. Interjudge agreement in videofluoroscopic studies of swallowing. J Speech Hear Res. 1996;39(1):144–52.CrossRefGoogle Scholar
  9. 9.
    Gibson E, Phyland D, Marschner I. Rater reliability of the modified barium swallow. Aust J Hum Commun Disord. 1995;23(2):54–60.CrossRefGoogle Scholar
  10. 10.
    Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, et al. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.CrossRefGoogle Scholar
  11. 11.
    O’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia. 1999;14(3):139–45.CrossRefGoogle Scholar
  12. 12.
    Bateman C, Leslie P, Drinnan MJ. Adult dysphagia assessment in the UK and Ireland: are SLTs assessing the same factors? Dysphagia. 2007;22(3):174–86.CrossRefGoogle Scholar
  13. 13.
    Martino R, Pron G, Diamant NE. Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist. Dysphagia. 2004;19(3):165–76.CrossRefGoogle Scholar
  14. 14.
    McCullough G, Wertz R, Rosenbek J, Dinneen C. Clinician’s preferences and practices in conducting clinical/bedside and videoflouroscopic swallowing examinations in an adult, neurogenic population. Am J Speech Lang Pathol. 1999;8:149–63.CrossRefGoogle Scholar
  15. 15.
    Mathers-Schmidt BA, Kurlinski M. Dysphagia evaluation practices: inconsistencies in clinical assessment and instrumental examination decision-making. Dysphagia. 2003;18(2):114–25.CrossRefGoogle Scholar
  16. 16.
    Pettigrew CM, O’Toole C. Dysphagia evaluation practices of speech and language therapists in Ireland: clinical assessment and instrumental examination decision-making. Dysphagia. 2007;22(3):235–44.CrossRefGoogle Scholar
  17. 17.
    Fleiss J. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76:378–82.CrossRefGoogle Scholar
  18. 18.
    Jaffer NM, Ng E, Au FW-F, Steele CM. Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors. Am J Roentgenol. 2015;204(1):49–58.CrossRefGoogle Scholar
  19. 19.
    Martin-Harris B, Logemann JA, McMahon S, Schleicher M, Sandidge J. Clinical utility of the modified barium swallow. Dysphagia. 2000;15(3):136–41.CrossRefGoogle Scholar
  20. 20.
    Logemann JA. Role of the modified barium swallow in management of patients with dysphagia. Otolaryngol Head Neck Surg. 1997;116(3):335–8.CrossRefGoogle Scholar
  21. 21.
    Martin-Harris B, Bronwyn J. The videofluoroscopic swallowing study. Phys Med Rehabil Clin. 2008;19(4):769–85.CrossRefGoogle Scholar
  22. 22.
    Lee JW, Randall DR, Evangelista LM, Kuhn MA, Belafsky PC. Subjective assessment of videofluoroscopic swallow studies. Otolaryngol Head Neck Surg. 2017;156(5):901–5.CrossRefGoogle Scholar

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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