A Visuoperceptual Measure for Videofluoroscopic Swallow Studies (VMV): A Pilot Study of Validity and Reliability in Adults with Dysphagia

Katina Swan,Renée Speyer,Reinie Cordier,Daniele Farneti,Ted Brown,Martina Scharitzer

doi:10.3390/jcm11030724

Abstract

The visuoperceptual measure for videofluoroscopic swallow studies (VMV) is a new measure for analysing the recordings from videofluoroscopic swallow studies (VFSS). This study evaluated the reliability and validity of the pilot version of the VMV using classical test theory (CTT) analysis, informed by the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. Forty participants, diagnosed with oropharyngeal dysphagia by fibreoptic endoscopic evaluation of swallowing, were recruited. The VFSS and administration of bolus textures and volumes were conducted according to a standardised protocol. Recordings of the VFSS were rated by three blinded raters: a speech-language pathologist, a radiologist and a phoniatrician. Inter- and intra-rater reliability was assessed with a weighted kappa and resulted in 0.889 and 0.944 overall, respectively. Structural validity was determined using exploratory factor analyses, which found four and five factor solutions. Internal consistency was evaluated with Cronbach’s alpha coefficients, which found all but one factor scoring within an acceptable range (>0.70 and <0.95). Hypothesis testing for construct validity found the expected correlations between the severity of dysphagia and the VMV’s performance, and found no impact of gender on measure performance. These results suggest that the VMV has potential as a reliable and valid measure for VFSS. Further validation with a larger sample is required, and validation using an item response theory paradigm approach is recommended.

Highlights

A key tenet of classical test theory (CTT) is that the scores of each item are produced by a combination of the unobservable ‘true’ score, summed with the unavoidable errors and biases introduced by the use of a proxy indicator
The CTT analysis indicates that the initial psychometric properties of a pilot version of the visuoperceptual measure for videofluoroscopic swallow studies (VMV) may be adequate for analysing videofluoroscopic swallow study (VFSS) in a valid and reliable manner
Hypothesis testing for construct validity indicates that the relationship between Oropharyngeal dysphagia (OD) severity and population characteristics is as expected, with VMV severity scores increasing as functional severity on other measures increase

Summary

Introduction

As not all aspects of OD can be observed externally, investigation of OD often necessitates the use of specialised instrumental examination procedures. The videofluoroscopic swallow study (VFSS) is an instrumental exam that uses recordings of dynamic fluoroscopies in an assessment of swallowing physiology and kinematics. VFSS is recognised as a gold-standard instrumental swallowing assessment and is widely used in clinical and research settings around the world [2]. The video recordings require skilled analysis for meaningful interpretation. Clinicians typically examine the videos by visuoperceptual means to make judgments about impairments and to plan and trial interventions [3].

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