Brage Louise, Nylén Fredrik, Hägglund Patricia, Holmlund Thorbjörn
Speech and Language Pathology Department of Clinical Sciences, Umeå University, 90187, Umeå, Sweden.
Otorhinolaryngology, Department of Clinical Sciences, Umeå University, 90187, Umeå, Sweden.
Dysphagia. 2024 Nov 9. doi: 10.1007/s00455-024-10778-z.
We aimed to fine-tuning the Timed Water Swallow Test (TWST) screening procedure to provide the most reliable prediction of the Flexible Endoscopic Evaluation of Swallowing (FEES) assessment outcomes, with age, sex, and the presence of clinical signs of dysphagia being considered in the assessment. Participants were healthy people and patients with suspected dysphagia. TWST performance and participants' reported dysphagia symptoms were assessed in terms of their utility in predicting the outcome of a FEES assessment the same day. The FEES assessors were blinded to the nature of the TWST performance. The water swallowing capacity levels and clinical observations during a screening performance that were indicative of dysphagia/no symptoms in FEES were determined. Convergent validity was assessed as the agreement with the Functional Oral Intake Scale (FOIS) in the FEES assessment. TWST predicted FEES findings (aspiration and dysphagia) with a sensitivity of 72 and 45% and a specificity of 75% and 80%, respectively. Extended analysis of the TWST procedure (eTWST) identified aspiration (sensitivity = 92%, specificity = 62%) and dysphagia (sensitivity = 70%, and specificity = 72%) more accurately and showed a high correlation with FOIS (ɸ = 0.37). Excellent inter-rater reliability was further observed (Kw = 0.83). The extended evaluation of TWST performance has superior criterion validity to that of TWST. eTWST displayed high convergent validity and excellent interrater reliability. We therefore believe that eTWST can be highly relevant for clinical dysphagia screening.
我们旨在对定时饮水吞咽测试（TWST）筛查程序进行微调，以最可靠地预测吞咽功能的纤维内镜评估（FEES）结果，评估时考虑年龄、性别以及吞咽困难的临床体征。参与者为健康人群和疑似吞咽困难患者。根据TWST表现及参与者报告的吞咽困难症状在预测同一天FEES评估结果中的效用进行评估。FEES评估人员对TWST表现的性质不知情。确定了筛查过程中提示FEES中有吞咽困难/无症状的饮水能力水平和临床观察结果。在FEES评估中，将与功能性经口摄食量表（FOIS）的一致性作为收敛效度进行评估。TWST预测FEES结果（误吸和吞咽困难）的敏感性分别为72%和45%，特异性分别为75%和80%。对TWST程序的扩展分析（eTWST）更准确地识别出误吸（敏感性=92%，特异性=62%）和吞咽困难（敏感性=70%，特异性=72%），并与FOIS显示出高度相关性（ɸ=0.37）。进一步观察到了出色的评分者间信度（Kw=0.83）。TWST表现的扩展评估具有优于TWST的标准效度。eTWST显示出高收敛效度和出色的评分者间信度。因此，我们认为eTWST与临床吞咽困难筛查高度相关。
