How well do different assessments of swallowing correlate with one another?
Reviewed by Roganie Govender

Swallowing (dys)function may be assessed by three key measures: 1. instrumental swallowing techniques such as the modified barium swallow (MBS) or videofluoroscopy; 2. functional measures of diet texture that patients can eat comfortably (usually rated by the clinician); and 3. patient self-reported questionnaires that consider the impact of dysphagia on quality of life. Should these measures all correlate and, if not, which should we rely on in clinical practice and research? The authors conducted an analysis of results from 312 consecutive patients referred for MBS at one institution over a two-year period. In addition to the MBS, they also examined the data for functional oral intake scale (FOIS) and the Dysphagia Handicap Index (DHI) for this patient cohort. They were able to compare overall scores for oral stage and pharyngeal stage dysphagia rated on the MBS with the corresponding FOIS and DHI scores for each patient. The broad findings demonstrated only a modest clinical correlation amongst these measures, confirming that each of these different types of assessments contribute uniquely to the complexity of dysphagia. The authors highlight that functional ratings of diet texture and dysphagia QoL questionnaires cannot therefore replace instrumental assessments, but instead should be used in addition to tools that provide important information about swallow physiology and biomechanics. In clinical decision-making about managing dysphagia and/or need for tube feeding, for example, it is helpful to consider the entire battery of tests to provide a comprehensive picture. Reliance on findings from one type of assessment alone is less likely to achieve optimal patient-centred care. Deciding the most relevant measure for research should be guided by determining which measure relates best to the research question and how changes in outcomes can be satisfactorily explained by any research interventions.

Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow‑Specific Quality of Life.
Hazelwood RJ, Armeson KE, Hill EG, et al.
DYSPHAGIA
2023;38(4):1106-16.