Videofluoroscopy, as a tool that assesses the process of swallowing, has transformed our understanding of dysphagia. Clinicians can observe the biomechanics of a bolus moving from the oral cavity through the pharynx and oesophagus and into the stomach. Over the last two decades, criterion-referenced analysis tools such as the Modified Barium Swallow Impairment Profile and the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) have improved inter-rater reliability of the subjective observations made by clinicians. More recently, quantitative protocols such as the Dynamic Swallow Study (DSS) and Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) have been developed but are slower to enter the clinical domain. The authors of this paper investigate whether clinical interpretation and recommendations made by clinicians using a traditional observation approach differ from those who employ a quantitative approach. The videofluoroscopy results of 100 patients were analysed via three approaches: 1) traditional observation by clinicians, 2) quantitative analysis by two independent raters, 3) binary subjective analysis by 11 raters (normal vs. disordered) for the same three metrics used in the quantitative analysis. Each group was asked to provide a treatment plan based on their analysis. Overall results showed that the traditional observation analysis demonstrated the least impairment, meaning that more subtle and nuanced impairment was often missed, with fewer recommendations for rehabilitation made. In contrast, quantitative analysis showed high intra and inter-rater reliability and better accuracy through comparisons with normative data. More treatment recommendations were suggested that were linked to the quantitative findings. The authors conclude that traditional clinical observation of videofluroscopy may possibly under-diagnose swallowing impairments resulting in patients not receiving the full array of rehabilitation exercises that may be appropriate to target their dysphagia.
Analysing videofluroscopy: does it matter how it’s done?
Reviewed by Roganie Govender
Impact of Quantitative Videofluoroscopic Swallowing Measures on Clinical Interpretation and Recommendations by Speech-Language Pathologists.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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