Inter-rater reliability for speech-language therapists' judgement of oesophageal abnormality during oesophageal visualization

Int J Lang Commun Disord. 2017 Jul;52(4):450-455. doi: 10.1111/1460-6984.12283. Epub 2016 Sep 13.


Background: Oesophageal abnormalities are common findings in a speech-language therapy videofluoroscopy clinic. Fluoroscopic screening involving oropharynx alone fails to identify these patients. Oesophageal screening as an adjunct to videofluoroscopy is gaining popularity. Yet currently, little is known about the reliability of speech and language therapists' judgement of the oesophageal phase.

Aim: To measure the inter-rater reliability of oesophageal abnormality judgement in speech and language therapists during upright videofluoroscopy.

Methods & procedures: Seventy-four speech and language therapists were trained in oesophageal physiology and oesophageal visualization. Participants were asked to provide a rating of bolus transit (> or <15 s) for 10 segments of videofluoroscopy with oesophageal visualization showing ingestion of one 20 ml fluid barium bolus. Participants then provided a binary judgement of (1) the presence of stasis, (2) the presence of redirection and (3) the need for referral for further investigation. If stasis were present, they then rated the level of stasis as cervical, aortic or thoracic.

Outcomes & results: Participants achieved substantial agreement for bolus transit time, presence of stasis, presence of redirection and need for referral (K = and .61 respectively). The level of stasis achieved only fair agreement (K = .22) with disagreement primarily between aortic, thoracic or aortic/thoracic across clinicians.

Conclusions & implications: Speech and language therapists demonstrated substantial agreement in judging oesophageal abnormality during videofluoroscopy. Oesophageal screening as an adjunct to videofluoroscopy can be used reliably in trained clinicians.

Keywords: deglutition; dysphagia; inter-rater reliability, speech-language therapy; oesophagus; videofluoroscopy.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Deglutition Disorders / diagnostic imaging*
  • Deglutition Disorders / etiology
  • Deglutition Disorders / physiopathology
  • Deglutition*
  • Esophagus / diagnostic imaging*
  • Esophagus / physiopathology
  • Female
  • Fluoroscopy
  • Humans
  • Judgment*
  • Male
  • Middle Aged
  • Observer Variation
  • Predictive Value of Tests
  • Reproducibility of Results
  • Speech-Language Pathology / methods*
  • Time Factors
  • Video Recording*