Inter- and intrajudge reliability for videofluoroscopic swallowing evaluation measures

Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations h as been investigated, and results have, for the most part, indicated that r eliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are avail able for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and i ntrajudge reliability of VFS examination measures commonly used to assess s wallowing functions. No training to criteria occurred. VFS examinations wer e conducted on 20 patients who had suffered a stroke within six weeks and h ad no structural abnormalities or tracheostomies. Three clinical judges ser ved as subjects and rated the VFS examinations from videotape using frame-b y-frame analysis. A clinician's repeated re-view of measures employed in th e 20 examinations indicated high intrajudge reliability for a number of mea sures, suggesting that an experienced clinician may employ consistent stand ards for rating certain VFS measures across patients and time. These standa rds appear to vary among clinicians and yield unacceptable interjudge relia bility. The need to train clinicians to criteria to improve interjudge reli ability is discussed.