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Dysphagia
Published in: Dysphagia 4/2021

01-08-2021 | Esophagography | Original Article

Visuoperceptual Analysis of the Videofluoroscopic Study of Swallowing: An International Delphi Study

Authors: Katina Swan, Reinie Cordier, Ted Brown, Renée Speyer

Published in: Dysphagia | Issue 4/2021

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Abstract

Introduction

The Videofluoroscopic Swallow Study (VFSS) is a commonly used dysphagia assessment that is routinely analysed visuoperceptually. However, no consensus exists regarding which visuoperceptual measures should be used to analyse VFSSs. Current visuoperceptual measures for VFSSs are limited by poor quality and incomplete or indeterminate psychometric properties.

Objective

This study aimed to establish the content validity for a new visuoperceptual VFSS measure for oropharyngeal dysphagia in adults, by identifying relevant domains of the construct and generating items and corresponding response scales.

Methods

Consensus among experts in dysphagia and VFSS from over 20 countries was achieved across three rounds of anonymous online surveys, using the Delphi technique. Participants judged relevance and comprehensiveness of definitions of visuoperceptual domains of VFSS and the relevance of various domains to the overall construct. After reaching consensus on definitions of relevant domains, consensus on items were established using the same process.

Results

Participants achieved consensus on definitions of 32 domains recommended for analysis, and at least one item per domain (range 1–4). Domains selected by participants included both those which occur in existing measures and domains which have not been included in any measures to date. This study will form the basis for content validity of a new measure for VFSS.

Conclusions

This first phase of developing a visuoperceptual measure of VFSS resulted in the identification of 32 domains and 60 items for oropharyngeal dysphagia. Developers can now advance to the next phase of measure construction; prototype development and psychometric testing.
Appendix
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Literature
1.
Huckabee M-L, Macrae P, Lamvik K. Expanding instrumental options for dysphagia diagnosis and research: ultrasound and manometry. Folia Phoniatrica et Logopaedica. 2015;67(6):269–84.PubMedCrossRef
2.
Ciucci MR, et al. Dysphagia practice in 2035: Beyond fluorography, thickener, and electrical stimulation in Seminars in Speech and Language. New York: Thieme Medical Publishers; 2016.
3.
Lee JW, et al. Subjective assessment of videofluoroscopic swallow studies. Otolaryngology. 2017;156(5):901–5.CrossRef
4.
Wilcox F, Liss JM, Siegel GM. Interjudge agreement in videofluoroscopic studies of swallowing. J Speech Lang Hear Res. 1996;39(1):144–52.CrossRef
5.
McCullough GH, et al. Inter-and intrajudge reliability for videofluoroscopic swallowing evaluation measures. Dysphagia. 2001;16(2):110–8.PubMedCrossRef
6.
7.
8.
Swan K, et al. Psychometric properties of visuoperceptual measures of videofluoroscopic and fibre-endoscopic evaluations of swallowing: a systematic review. Dysphagia. 2018;34:1–32.
9.
Mokkink LB, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–49.PubMedPubMedCentralCrossRef
10.
Terwee CB, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.PubMedCrossRef
11.
Brown T. Assessing occupation: the importance of using valid tests and measures. Br J Occup Ther. 2009;72(12):519–20.CrossRef
12.
Steele CM, et al. Reference values for healthy swallowing across the range from thin to extremely thick liquids. Rockville: ASHA; 2019.CrossRef
13.
Mokkink LB, et al. COSMIN methodology for systematic reviews of patient-reported outcome measures (PROMs). User Manual. 2018;78:1.
14.
Terwee CB, et al. COSMIN methodology for assessing the content validity of PROMs–user manual. Amsterdam: VU University Medical Center; 2018.
15.
Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49–59.PubMedCrossRef
16.
Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423–8.CrossRef
17.
Hsu C-C, Sandford BA. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007;12(10):1–8.
18.
Kalaian SA, Kasim RM. Terminating sequential Delphi survey data collection. Pract Assess Res Eval. 2012;17(5):1–10.
19.
Flanagan T, et al. The Delphi method: methodological issues arising from a study examining factors influencing the publication or non-publication of mental health nursing research. Mental Health Rev J. 2016;21(2):85–94.CrossRef
20.
Miles A. Inter-rater reliability for speech–language therapists’ judgement of oesophageal abnormality during oesophageal visualization. Int J Lang Commun Disord. 2016;52(4):450–5.PubMedCrossRef
21.
Diamond IR, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014;67(4):401–9.PubMedCrossRef
22.
Miller L. Determining what could/should be: the Delphi technique and its application. in meeting of the 2006 annual meeting of the Mid-Western Educational Research Association, Columbus, Ohio (2006).
23.
Tapio P, et al. The unholy marriage? Integrating qualitative and quantitative information in Delphi processes. Technol Forecast Soc Change. 2011;78:1616–28.CrossRef
24.
IBM Corp. Released 2015. IBM SPSS statistics for windows, version 230. Armonk, NY: IBM Corp.
25.
Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
26.
Hiiemae KM, Palmer J. Food transport and bolus formation during complete feeding sequences on foods of different initial consistency. Dysphagia. 1999;14(1):31–42.PubMedCrossRef
27.
28.
Saitoh E, et al. Chewing and food consistency: effects on bolus transport and swallow initiation. Dysphagia. 2007;22(2):100–7.PubMedCrossRef
29.
Frowen JJ, Cotton SM, Perry AR. The stability, reliability, and validity of videofluoroscopy measures for patients with head and neck cancer. Dysphagia. 2008;23(4):348–63.PubMedCrossRef
30.
Miles A, et al. Comparison of cough reflex test against instrumental assessment of aspiration. Physiol Behav. 2013;118:25–31.PubMedCrossRef
31.
Veis S, Logemann JA, Colangelo L. Effects of three techniques on maximum posterior movement of the tongue base. Dysphagia. 2000;15(3):142–5.PubMedCrossRef
32.
Pauloski BR, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000;22(2):120–31.PubMedCrossRef
33.
Molfenter SM, Steele CM. The relationship between residue and aspiration on the subsequent swallow: an application of the normalized residue ratio scale. Dysphagia. 2013;28(4):494–500.PubMedCrossRef
34.
35.
Martin-Harris B, et al. Delayed initiation of the pharyngeal swallow: normal variability in adult swallows. J Speech Lang Hear Res. 2007;50(3):585–94.PubMedCrossRef
36.
Namasivayam-MacDonald AM, Barbon CE, Steele CM. A review of swallow timing in the elderly. Physiol Behav. 2018;184:12–26.PubMedCrossRef
37.
Eisenhuber E, et al. Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Am J Roentgenol. 2002;178(2):393–8.CrossRef
38.
Massey BT, Shaker R. Oral, pharyngeal and upper esophageal sphincter motility disorders. GI Motility online (2006)
39.
Belafsky PC, Kuhn MA. The clinician's guide to swallowing fluoroscopy. New York: Springer; 2014.
40.
Kendall KA, Leonard RJ, McKenzie S. Airway protection: evaluation with videofluoroscopy. Dysphagia. 2004;19(2):65–70.PubMed
41.
42.
Kim Y, McCullough GH. Maximum hyoid displacement in normal swallowing. Dysphagia. 2008;23(3):274–9.PubMedCrossRef
43.
44.
Vose A, Humbert I. “Hidden in plain sight”: a descriptive review of laryngeal vestibule closure. Dysphagia. 2018;2018:1–9.
45.
Shaker R, et al. Principles of deglutition: a multidisciplinary text for swallowing and its disorders. New York: Springer; 2012.
46.
Galluzzi F, et al. The assessment of children with suspected laryngopharyngeal reflux: an Otorhinolaringological persepective. Int J Pediatr Otorhinolaryngol. 2015;79(10):1613–9.PubMedCrossRef
47.
Logemann JA, et al. The relationship between observations and measures of oral and pharyngeal residue from videofluorography and scintigraphy. Dysphagia. 2005;20(3):226–31.PubMedPubMedCentralCrossRef
48.
Jaffer NM, et al. Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors. Am J Roentgenol. 2015;204(1):49–58.CrossRef
49.
Palmer JB, Tanaka E, Ensrud E. Motions of the posterior pharyngeal wall in human swallowing: a quantitative videofluorographic study. Arch Phys Med Rehabil. 2000;81(11):1520–6.PubMedCrossRef
50.
Jones B. Radiographic evaluation of motility of mouth and pharynx. GI Motility online (2006).
51.
Flanagan L. The validity of a three-part criteria for differentiating between delayed pharyngeal swallow and premature spillage secondary to poor oro-lingual control on videofluoroscopy (2007).
52.
53.
Kendall KA, Leonard RJ. Videofluoroscopic upper esophageal sphincter function in elderly dysphagic patients. Laryngoscope. 2002;112(2):332–7.PubMedCrossRef
54.
55.
Perry JL, Bae Y, Kuehn DP. Effect of posture on deglutitive biomechanics in healthy individuals. Dysphagia. 2012;27(1):70–80.PubMedCrossRef
56.
57.
Logemann JA. Manual for the videofluorographic study of swallowing. (1993).
58.
Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):953–63.PubMedCrossRef
59.
Logemann J. Evaluation and treatment of swallowing disorders. London: College Hill Press; 1983. p. 214–227.
60.
Linden P, et al. Bolus position at swallow onset in normal adults: preliminary observations. Dysphagia. 1989;4(3):146–50.PubMedCrossRef
61.
Daniels SK, et al. Mechanism of sequential swallowing during straw drinking in healthy young and older adults. J Speech Lang Hear Res. 2004;47(1):33–45.PubMedCrossRef
62.
Park J-W, et al. Increased bolus volume effect on delayed pharyngeal swallowing response in post-stroke oropharyngeal dysphagia: a Pilot study. Ann Rehabil Med. 2016;40(6):1018.PubMedPubMedCentralCrossRef
63.
Daniels SK, et al. Effects of verbal cue on bolus flow during swallowing. Am J Speech Lang Pathol. 2007;16(2):140–7.PubMedCrossRef
64.
Nagy A, et al. Timing differences between cued and noncued swallows in healthy young adults. Dysphagia. 2013;28(3):428–34.PubMedCrossRef
65.
Bryant KN, Finnegan E, Berbaum K. VFS interjudge reliability using a free and directed search. Dysphagia. 2012;27(1):53–63.PubMedCrossRef
66.
Han TR, Paik N-J, Park JW. Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil. 2001;82(5):677–82.PubMedCrossRef
67.
Han TR, et al. The prediction of persistent dysphagia beyond six months after stroke. Dysphagia. 2008;23(1):59–64.PubMedCrossRef
68.
Scott AG. The development of a scale to assess swallowing function in motor neuron disease using videofluoroscopic techniques. Bundoora: La Trobe University; 1999.
69.
Stoeckli SJ, et al. Interrater reliability of videofluoroscopic swallow evaluation. Dysphagia. 2003;18(1):53–7.PubMedCrossRef
70.
Miles A, et al. Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing. Otolaryngology. 2015;152(3):488–93.CrossRef
71.
Rofes L, Muriana D, Palomeras E, Vilardell N, Palomera E, Alvarez-Berdugo D, Casado V, Clavé P. Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: a cohort study. Neurogastroenterol Motil. 2018;30(8):e13338.CrossRef
Metadata
Title
Visuoperceptual Analysis of the Videofluoroscopic Study of Swallowing: An International Delphi Study
Authors
Katina Swan
Reinie Cordier
Ted Brown
Renée Speyer
Publication date
01-08-2021
Publisher
Springer US
Published in
Dysphagia / Issue 4/2021
Print ISSN: 0179-051X
Electronic ISSN: 1432-0460
DOI
https://doi.org/10.1007/s00455-020-10174-3

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