2005 Volume 9 Issue 2 Pages 139-147
【Purpose】Videofluorography（VF）is known to be the best way of evaluating dysphagia so far，but the interpretation of such assessment depends on subjective judgment．This study measured inter-rater and intra-rater reliability of VF for swallowing function．
【Subjects and Methods】Participants included 5 dentists，1 speech language pathologist，and 1 nurse．They evaluated VF images of 6 dysphagic patients repeatedly 4 times using an evaluation sheet and criteria of our own．The kappa coefficient was calculated to estimate inter-and intra-rater reliability．
【Results】The average kappa coefficient of all evaluation items between raters was low，0.24-0.34．Items that have some relation to aspiration such as amount of aspiration or Penetration-Aspiration Scale showed relatively high reliability，however，each of the other items generally yielded low reliability．In addition，repeating the appraisal did not improve inter-rater reliability．On the other hand，the average kappa coefficient of intra-rater reliability showed high reliability，0.53-0.67．In addition，each item generally showed high reliability．
【Discussion】Evaluation of aspiration did not differ from raters who were expected to have passable knowledge and clinical experience of dysphagia．However，the protocol of VF was altered in order to tailor the examination to each patient's needs．In brief，the incidence of aspiration differs according to the protocol．Therefore，to improve the reliability of VF，VF by well-experienced raters as well as practice evaluation of VF must be performed． Evaluation of oral and pharyngeal motor function differed among raters， in other words， selection of swallowing therapy depends on the rater．Therefore，we have to decide swallowing therapy by mutual consent to avoid misapplication of the therapy．
