Barbon C E A, Warneke C L, Ledger B, Rogus-Pulia N, Cunningham L, Coyle J L, Levesque-Boissonneault C, Alvarez C, Valencia D, Hutcheson K A
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Dysphagia. 2025 Apr;40(2):353-362. doi: 10.1007/s00455-024-10733-y. Epub 2024 Aug 24.
DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training. Thirty-two SLPs from 5 sites participated in a blinded longitudinal DIGEST rating study. Raters were provided a standardized training set of MBS (n = 19). Initial SLP ratings (round 1, R1) were followed by a 2-4 week break before raters rated a re-keyed MBS set (round 2, R2). A minimum 4-8 week wash-out period then preceded self-study of the DIGEST training manual which was followed by a final rating (round 3, R3) and a post-manual survey afterwards. Baseline reliability (R1) of overall DIGEST was on average k = 0.70, reflecting agreement in the substantial range. Seventy-five percent of raters (24/32) demonstrated reliability ≥ 0.61 in the substantial to almost perfect range prior to training. Inter-rater reliability significantly improved from R1 to R3 after review of the DIGEST manual, with the largest change in DIGEST-Efficiency (mean change: DIGEST k = .04, p = .009, DIGEST-Safety k = .07, p = 0.03, and DIGEST-Efficiency k = .14, p = 0.009). Although DIGEST reliability at baseline was adequate in the majority of raters, self-study of the DIGEST training manual significantly improved inter-rater reliability and rater confidence using the DIGEST method, particularly when assigning DIGEST-Efficiency grade. These early data show promise that provider training may be useful to aid in fidelity of DIGEST implementation among SLP clinical users with varying DIGEST experience.
DIGEST是一种经过验证的开源方法，用于根据改良钡餐吞咽（MBS）研究对咽部吞咽困难的严重程度进行分级。DIGEST的传播和应用正在增加，因此了解用户准确应用该方法的可靠性和促进因素至关重要。目的是评估在审阅DIGEST培训手册前后，多个机构的言语语言病理学（SLP）评估者使用该工具的可靠性，并评估培训前后使用DIGEST的信心。来自5个机构的32名SLP参与了一项双盲纵向DIGEST评级研究。为评估者提供了一组标准化的MBS（n = 19）。最初的SLP评级（第1轮，R1）之后有2至4周的间隔，然后评估者对重新录入的MBS进行评级（第2轮，R2）。然后在进行至少4至8周的洗脱期后，进行DIGEST培训手册的自学，随后进行最终评级（第3轮，R3）以及之后的手册后调查。总体DIGEST的基线可靠性（R1）平均k = 0.70，反映出在相当大的范围内具有一致性。75%的评估者（24/32）在培训前的一致性范围从实质性到几乎完美，可靠性≥0.61。在审阅DIGEST手册后，评估者间的可靠性从R1到R3有显著提高，其中DIGEST-效率的变化最大（平均变化：DIGEST k = 0.04，p = 0.009，DIGEST-安全性k = 0.07，p = 0.03，DIGEST-效率k = 0.14，p = 0.009）。尽管大多数评估者在基线时DIGEST的可靠性足够，但DIGEST培训手册的自学显著提高了评估者间的可靠性以及评估者使用DIGEST方法的信心，特别是在评定DIGEST-效率等级时。这些早期数据表明，对于不同DIGEST经验的SLP临床用户，提供培训可能有助于提高DIGEST实施的保真度。
