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Measuring Competency Development in Objective Evaluation of Videofluoroscopic Swallowing Studies

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Abstract

Clinical interpretation of videofluoroscopic swallow study (VFSS) has often been criticized for its poor objectivity and inter-rater agreement. In order to address this, objective VFSS measures have been developed, reported and demonstrated to be valid and reliable. However, widespread clinical implementation is lacking. Reasons cited include lack of training and excessive time taken to perform measures. This study investigated competency development in selected standardized objective VFSS measures among speech-language pathologists (SLPs) naive to quantitative measurement. Six novice (no VFSS experience) and four experienced (2–10 years of VFSS experience) SLPs participated in 4 h of training in how to perform selected objective VFSS measures including pharyngeal constriction ratio, maximum pharyngoesophageal opening, pharyngoesophageal opening duration, airway closure duration and total pharyngeal transit time. Each week for eight weeks, participants were asked to independently measure and report three VFSS of patients affected by stroke. By week 8, all SLPs, irrespective of prior experience level, were able to achieve 80% accuracy in measures in comparison to the consensus of three expert clinicians. SLPs’ mean time for completion reduced from 50 min in week 1–25 min in week 8. Inter-rater agreement for measures improved across the eight-week period (range ICC = −31.05 to .60 in week 1 to ICC = .71 to .98 in week 8). There was high agreement in location of impairment and consequent management recommendations by week 8. In conclusion, SLPs can reliably learn and incorporate objective VFSS measures within a reasonable time frame. Level of experience has limited influence on the learning curve.

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Acknowledgements

Thank you to all the speech-language pathologists who participated in the research. The authors would like to acknowledge Dr. Rebecca Leonard and thank her for providing guidance and the videos for this study.

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Authors and Affiliations

  1. Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand

    Natrah Ahmad Nordin, Anna Miles & Jacqui Allen

  2. Otorhinolaryngology, Waitemata District Health Board, Auckland, New Zealand

    Jacqui Allen

Authors
  1. Natrah Ahmad Nordin
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  2. Anna Miles
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  3. Jacqui Allen
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Corresponding author

Correspondence to Anna Miles.

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The authors have nothing to declare. This work has not been published elsewhere. All authors have contributed to the study and are accountable for accuracy and integrity. The authors agree to the copyright conditions of this journal.

Appendices

Appendix 1

See Table 5.

Table 5 VFSS objective measures
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Appendix 2

See Table 6.

Table 6 Standardized interpretation sheet
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Nordin, N.A., Miles, A. & Allen, J. Measuring Competency Development in Objective Evaluation of Videofluoroscopic Swallowing Studies. Dysphagia 32, 427–436 (2017). https://doi.org/10.1007/s00455-016-9776-9

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