Intra- and interrater variation in the evaluation of videofluorographic swallowing studies

The objective of this study was to determine the inter- and intrarater reliability in evaluating videofluoroscopic swallowing studies (VFSS). Participants included 4 physicians (3 physiatrists and 1 internist) and 5 speech-language pathologists with at least 5 years experience in evaluating VFSS. The main outcomes of the study were reliability ratios of positive and negative tests in inter- and intrarater evaluations. Raters independently rated each of 20 VFSS on two separate occasions. Traits evaluated included oral stage impairment, aspiration, pharyngeal retention, and several functional components: timing of swallow onset, adequacy of velopharyngeal apposition, laryngeal elevation, epiglottic tilt, pharyngeal contraction, and pharyngoesophageal (PE) segment opening. Reliability varied widely depending on food type and the trait under evaluation. Inter- and intrarater reliability ratios did not differ widely. Reliability ratios values typically were highest (greater than 90%) for aspiration, especially with solid food, and lowest for the functional components. It was concluded that inter- and intrarater reliability in VFSS are adequate for evaluating oral stage, laryngeal penetration, and aspiration and pharyngeal retention, but questionable for functional components.