Validation and Inter-rater Reliability of the Modified Videofluoroscopic Dysphagia Scale (mVDS) in Dysphagic Patients with Multiple Etiologies.

Min Cheol Chang,Donghwi Park,Changbae Lee

doi:10.3390/jcm10132990

Abstract

Background: the Videofluoroscopic Dysphagia Scale (VDS) is used to interpret and predict the long-term prognosis of patients with dysphagia. However, the inter-rater agreement of the VDS was shown to be lower in a previous study. To overcome the mentioned limitation of the VDS, a modified version (mVDS) was created and applied clinically. We aimed to validate its usefulness in determining the appropriate feeding method and predicting the prognosis of dysphagia. Methods: the videofluroscopic swallowing study (VFSS) data of 50 patients with dysphagia were collected retrospectively. The VFSS data were evaluated using the mVDS, and the inter-rater reliability was calculated. We also evaluated the association between the mVDS and type of feeding method selected, and between the mVDS and presence of aspiration pneumonia in patients with dysphagia. Results: among the different parameters of mVDS, “aspiration” showed the highest reliability (k = 0.767), followed by “mastication” and “lip closure” (k = 0.648 and k = 0.634, respectively). Conversely, “triggering pharyngeal swallow” and “pyriformis residue” demonstrated the lowest reliabilities (k = 0.312 and k = 0.324, respectively). The intraclass correlation coefficient (ICC), which is used as a measure of the reliability of the total mVDS score, was 0.876. In all patients with dysphagia, the mVDS score correlated significantly with the type of feeding method selected (p < 0.05), and the presence of aspiration pneumonia (p < 0.05). Conclusion: the ICC of the total mVDS score was 0.876. Therefore, the mVDS could be a useful tool for quantifying the severity of dysphagia. It could be helpful in the analysis of the VFSS findings among patients with dysphagia in clinical settings and research.

Highlights

Swallowing is a complex sensorimotor process that includes a coordinated contraction and inhibition of the muscles located in the mouth, including the tongue, pharynx, larynx, and esophagus, by different levels of the central nervous system, from the cerebral cortex to the medulla oblongata [1,2,3]
We reviewed the data for the presence of aspiration pneumonia 1 month before and after the videofluoroscopic swallowing study (VFSS) [9,10]
To verify the clinical usefulness of modified VDS (mVDS), we evaluated the associations between the total mVDS score and the various feeding methods selected, and the mVDS and the presence of aspiration pneumonia, using univariate logistic regression analysis with enter methods

Summary

Introduction

Swallowing is a complex sensorimotor process that includes a coordinated contraction and inhibition of the muscles located in the mouth, including the tongue, pharynx, larynx, and esophagus, by different levels of the central nervous system, from the cerebral cortex to the medulla oblongata [1,2,3]. In the instrumental assessment of dysphagia, several clinical tools, such as videofluoroscopic, endoscopic, manometric, and electromyographic (EMG) studies are used currently [2,3,4]. The videofluoroscopic swallowing study (VFSS) is a primary instrumental measurement tool in clinical practice [5]. The VDS has 14 parameters and shows good correlation with aspiration or symptoms of penetration that develop six months after the initial onset of dysphagia [6,7]. The 14 parameters in the VDS (Table 1) represent the oral (lip closure, mastication, bolus formation, premature bolus loss, apraxia, and oral transit time) and pharyngeal (pharyngeal triggering, laryngeal elevation, epiglottic closure, pharyngeal transit time, pharyngeal coating, vallecular and pyriform sinus residues, and aspiration) functions that can be obtained from VFSS videos [6,7]

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Discussion

Conclusion