Liza Bergström1,2,3, Julie Ay Cichero4,5. 1. Institute of Neuroscience & Physiology, Department of Health & Rehabilitation, Speech and Language Pathology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg 405 30, Sweden. 2. Speech Therapy Clinic, Danderyd Hospital, Stockholm, Sweden. 3. REMEO Stockholm, Sköndal, Sweden. 4. School of Pharmacy, PACE, The University of Queensland, Woolloongabba, Australia. 5. Mater Research, South Brisbane, Australia.
Abstract
Purpose: Cervical auscultation (CA) uses a stethoscope or microphone to complement the clinical swallow examination by interpreting swallowing sounds and swallow-respiratory coordination. This study investigated the effects of structured CA training on CA-rating agreement with Flexible Endoscopic Evaluation of Swallowing (FEES) and CA rater reliability.Method: Thirty-nine speech-language pathologists participated in a structured CA training course at Gothenburg University. They rated nine swallow-respiratory sound recordings which were simultaneously recorded during FEES. Swallow sounds were rated six weeks prior to the CA-workshop using two binary yes/no questions, (1) Safe, (2) Dysphagia, and a third Dysphagia Severity rating. Swallow sounds were rated again (re-randomised) one month post CA-workshop.Result: Agreement with FEES (validity) improved significantly (p < 0.05) pre-post training for the Safe and Dysphagia questions, with post training sensitivities >90% and specificities at 76% and 85% respectively. Dysphagia severity rating improved non-significantly. Intra-rater reliability improved significantly with kappa statistics >0.90 post training. Improvements for inter-rater reliability were noted, though non-significant. Conclusion: Results demonstrate that with structured training, the validity of CA (to detect a Safe/Dysphagic swallow) significantly improves, as does intra-rater reliability. This is congruent with literature identifying the positive effects of structured training improving instrumental dysphagia assessment.
Purpose: Cervical auscultation (CA) uses a stethoscope or microphone to complement the clinical swallow examination by interpreting swallowing sounds and swallow-respiratory coordination. This study investigated the effects of structured CA training on CA-rating agreement with Flexible Endoscopic Evaluation of Swallowing (FEES) and CA rater reliability.Method: Thirty-nine speech-language pathologists participated in a structured CA training course at Gothenburg University. They rated nine swallow-respiratory sound recordings which were simultaneously recorded during FEES. Swallow sounds were rated six weeks prior to the CA-workshop using two binary yes/no questions, (1) Safe, (2) Dysphagia, and a third Dysphagia Severity rating. Swallow sounds were rated again (re-randomised) one month post CA-workshop.Result: Agreement with FEES (validity) improved significantly (p < 0.05) pre-post training for the Safe and Dysphagia questions, with post training sensitivities >90% and specificities at 76% and 85% respectively. Dysphagia severity rating improved non-significantly. Intra-rater reliability improved significantly with kappa statistics >0.90 post training. Improvements for inter-rater reliability were noted, though non-significant. Conclusion: Results demonstrate that with structured training, the validity of CA (to detect a Safe/Dysphagic swallow) significantly improves, as does intra-rater reliability. This is congruent with literature identifying the positive effects of structured training improving instrumental dysphagia assessment.
Authors: Dora Praczko; Amanda K Tinkle; Crystal R Arkenberg; Robyn L McClelland; Kate E Creevy; M Katherine Tolbert; Brian G Barnett; Lucy Chou; Jeremy Evans; Kellyn E McNulty; Jonathan M Levine Journal: Front Vet Sci Date: 2022-08-05