Content Validity and Intra-Inter Reliability of the Turkish Version of the Murray Secretion Scale

Area of Science:

• Clinical Medicine
• Speech-Language Pathology
• Otolaryngology

Background:

• Impaired airway protection can lead to secretion accumulation and dysphagia.
• Standardized assessment of pharyngolaryngeal secretions is crucial for effective dysphagia management.
• A validated Turkish version of the Murray Secretion Scale (MSS-TR) was lacking for clinical use.

Purpose of the Study:

• To translate the Murray Secretion Scale (MSS) into Turkish (MSS-TR).
• To evaluate the content validity and inter- and intra-rater reliability of the MSS-TR.
• To establish MSS-TR as a reliable tool for assessing secretion severity during fiberoptic endoscopic evaluation of swallowing (FEES) in Turkish clinical settings.

Main Methods:

• Translation and back-translation of the original MSS.
• Content validity assessment using the Content Validity Index (CVI).
• Reliability testing on 40 FEES recordings by four speech-language therapists using statistical analyses (Wilcoxon signed-rank test, Kendall's τb, Fleiss' Kappa).

Main Results:

• The MSS-TR demonstrated strong content validity (CVI = 0.86).
• High intra-rater reliability (Kendall's τb: 0.933-1.000) and substantial to almost perfect inter-rater reliability (Fleiss' Kappa: 0.634-0.862) were observed.
• Overall inter-rater agreement was 94.4%, though grade 2 showed potential clinical uncertainty.

Conclusions:

• The MSS-TR is a valid and reliable instrument for assessing secretion severity in Turkish clinical practice.
• The validated scale supports consistent dysphagia evaluation, clinical decision-making, and research.
• Further research is recommended to explore its application across diverse patient populations and clinical settings.