A STUDY OF INTERRATER RELIABILITY WHEN USING VIDEOFLUOROSCOPY AS AN ASSESSMENT OF SWALLOWING

Videofluoroscopic assessment of swallowing is widely used in clinical settings. The interpretation of such assessments depends on subjective visual judgments but the reliability of these judgments has been poor ly researched. This study measured interrater reliability of judgments , made by speech pathologists, of videofluoroscopic images of subjects swallowing liquid and semisolid boluses. A 5-point rating scale was u sed in three conditions: individually after careful reading; together with other speech pathologists in group discussion; and individually a fter the group discussion. Analysis of the ratings for the three condi tions revealed that the level of agreement among raters was generally higher for semisolid swallows than for liquid swallows. The highest le vels of agreement occurred for ratings made after group discussions. T he levels of agreement were lowest when raters worked alone, relying o nly on reading the scale. Individual rating after group discussion res ulted in higher levels of agreement than sole reliance on reading the scale. Factors influencing the levels of interrater agreement, includi ng the timing of observations, bolus consistency, the quality of the i mage, and the complexity of the task, are discussed.