Use of training to improve the reliability in rating Videofluoroscopic Swallowing Studies (VFSS) using two analysis protocols

Abstract

Introduction: Videofluoroscopic Swallowing Study (VFSS) has been commonly used in clinics and research as an instrumental assessment of swallowing functions. However, the reliabilities of VFSS analysis have been questioned in some studies. Training has been proposed to be one possible method to improve the reliability [1, 2]. A recently developed Coordinate Mapping protocol for analyzing VFSS has also been suggested to improve raters' reliabilities [2]. The protocol makes use of imaging software to mark and track the movement of key landmarks during VFSS. The current study aimed to compare the effect of training on improving inexperienced clinicians' reliabilities in using subjective clinical evaluation and the Coordinate Mapping protocols for VFSS analysis. Material & Methods: Forty undergraduate Speech-Language-Pathology students were randomly assigned to two training groups: a Clinical Evaluation (CE) and a Coordinate Mapping (CM) group. The CE group rated VFSS based on their subjective judgment and the CM group rated with the Coordinate Mapping protocol. All participated in a pre-training, training, and 1-day post-training rating sessions. Results: Results showed that both groups significantly improved after training when compared with their pre-training intra- and inter-rater reliabilities. In addition, the CE group had significantly higher intra- and inter-rater reliabilities in rating pharyngeal shortening than the CM group after training. Conclusions: Training is an effective method to improve the reliability in VFSS analysis. It is recommended that training protocols could be developed for each VFSS analysis protocol. In addition, the current study supports the use of the Coordinate Mapping protocol to analyze VFSS reliably but more extensive training on the use of the protocol may be needed.