Min Ingi, Woo Hyeonseong, Kim Jae Yoon, Kim Tae-Lim, Lee Yookyung, Chang Won Kee, Jung Se Hee, Lee Woo Hyung, Oh Byung-Mo, Han Tai Ryoon, Seo Han Gil
Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
National Traffic Injury Rehabilitation Hospital, 260, Jungang-ro, Yangpyeong-gun, Gyeonggi-do, Republic of Korea.
Dysphagia. 2024 Feb;39(1):43-51. doi: 10.1007/s00455-023-10590-1. Epub 2023 May 19.
This study aimed to develop a standardized protocol for the assessment of videofluoroscopic dysphagia scale (VDS) and to demonstrate the inter-rater and intra-rater reliability of the VDS by applying the new standard protocol. A standardized protocol for the VDS was developed by dysphagia experts, including the original developer. To identify the reliability of the VDS using the protocol, 60 patients who underwent videofluoroscopic swallowing study (VFSS) for various etiologies were recruited retrospectively from three tertiary medical centers. Ten randomly selected cases were duplicated to evaluate the intra-rater reliability. Six physicians evaluated the VFSS data sets. Intraclass correlation coefficients were calculated for inter-rater and intra-rater reliability of the VDS score, and Gwet's kappa values for each VDS item were calculated. The inter-rater and intra-rater reliability of the total VDS score was 0.966 and 0.896, respectively. Notably, the evaluators' experience did not appear to have a significant impact on the reliability (physiatrists: 0.933/0.869, residents: 0.922/0.922). The reliability was consistent across different centers and dysphagia etiologies. The inter-rater and intra-rater reliability of the oral and pharyngeal sub-scores were 0.953/0.861 and 0.958/0.907, respectively. The inter-rater agreement of individual items ranged from 0.456 to 0.929, and nine items demonstrated good to very good level of agreement. Assessment of dysphagia using the VDS with the standard protocol showed excellent inter-rater and intra-rater reliabilities regardless of the evaluator's experience, VFSS equipment, and dysphagia etiologies. The VDS can be a useful assessment scale in the quantitative analysis of dysphagia based on VFSS findings.
本研究旨在制定一项用于评估视频荧光吞咽造影量表（VDS）的标准化方案，并通过应用新的标准方案来证明VDS的评分者间信度和评分者内信度。吞咽障碍专家，包括该量表的原开发者，共同制定了VDS的标准化方案。为了使用该方案确定VDS的信度，我们从三家三级医疗中心回顾性招募了60例因各种病因接受视频荧光吞咽造影检查（VFSS）的患者。随机选取10例病例进行重复评估以评估评分者内信度。由6名医生对VFSS数据集进行评估。计算VDS评分的评分者间信度和评分者内信度的组内相关系数，并计算每个VDS项目的Gwet卡帕值。VDS总分的评分者间信度和评分者内信度分别为0.966和0.896。值得注意的是，评估者的经验似乎对信度没有显著影响（物理治疗师：0.933/0.869，住院医师：0.922/0.922）。信度在不同中心和吞咽障碍病因之间保持一致。口腔和咽部子评分的评分者间信度和评分者内信度分别为0.953/0.861和0.958/0.907。各个项目的评分者间一致性范围为0.456至0.929，9个项目显示出良好至非常好的一致性水平。使用标准方案的VDS评估吞咽障碍显示出出色的评分者间信度和评分者内信度，无论评估者的经验、VFSS设备和吞咽障碍病因如何。基于VFSS结果，VDS在吞咽障碍的定量分析中可能是一种有用的评估量表。
