Interrater and Intrarrater Reliability of the Exeter Dysphagia Assessment Technique Applied to Healthy Elderly Adults

Abstract

The purpose of this study was to evaluate the inter- and intrarater reliabilities of the Exeter Dysphagia Assessment Technique in a sample of elderly adults. This procedure uses noninvasive methods to record aspects of oral motor efficiency and synchronization of respiration during swallowing with the aid of specially developed equipment. Changes in the direction of nasal air flow, time of lip or tongue/spoon contact, and the time/frequency of swallow sounds are monitored and analyzed. Seventy records were evaluated independently by three trained assessors on three consecutive occasions. Interrater reliability was found to be good to very good for five of the respiratory variables assessed and moderate for the sixth. Interrater agreement was also very good for three of the timed oropharyngeal events assessed and moderate for the fourth. Intrarater reliability was very good for the same five respiratory variables and moderate for the sixth. Intrarater agreement was also very good for three of the timed oropharyngeal events and moderate for the fourth. Repeat evaluations of these records showed that agreement between and within raters concerning the sixth respiratory variable was improved substantially when the charts were examined in an enlarged form that provided improved resolution. We conclude that the majority of variables monitored by the Exeter Dysphagia Assessment Technique can be evaluated very reliably.