Improvement of Intra-Rater Reliability in a Videofluoroscopic Swallowing Study

Abstract

Objectives: Videofluorography (VF) is regarded as the gold standard for evaluationof dysphagia. Interpretation of VF studies is highly subjective, however, resulting in inconsistent therapeuticrecommendations. This study aimed to improve the inter-rater reliability in the interpretation of VF studies by modifying the evaluation criteria.
Methods: Seven dentists were asked to evaluate a series of VF images three times each, using our evaluation criteria and forms. Images included oral stage impairment, pharyngeal retention, aspiration before swallowing, aspiration at swallowing and aspiration after swallowing. Cohen's Kappa coefficient was calculated to estimate inter-rater agreement.
Results: The Cohen's Kappa coefficient increased with repeated viewing; the coefficient for all images was 0.28±0.26 for the first viewing, 0.37±0.26 for the second, and 0.43±0.28 for the third.
Discussion: The inter-rater coefficient improved using our modified evaluation criteria. To achieve higher rates of inter-rater agreement at our hospital, we have also initiated weekly conferences to discuss VF study interpretation. While development of consistent evaluation criteria is critical for reliable diagnosis and treatment protocols, professional discussions may also play an important role in ensuring that VF is interpreted appropriately.