Validation and Inter-rater Reliability of the Modified Videofluoroscopic Dysphagia Scale (mVDS) in Dysphagic Patients with Multiple Etiologies

Background: the Videofluoroscopic Dysphagia Scale (VDS) is used to interpret and predict the long-term prognosis of patients with dysphagia. However, the inter-rater agreement of the VDS was shown to be lower in a previous study. To overcome the mentioned limitation of the VDS, a modified version (mVDS) was created and applied clinically. We aimed to validate its usefulness in determining the appropriate feeding method and predicting the prognosis of dysphagia. Methods: the videofluroscopic swallowing study (VFSS) data of 50 patients with dysphagia were collected retrospectively. The VFSS data were evaluated using the mVDS, and the inter-rater reliability was calculated. We also evaluated the association between the mVDS and type of feeding method selected, and between the mVDS and presence of aspiration pneumonia in patients with dysphagia. Results: among the different parameters of mVDS, “aspiration” showed the highest reliability (k = 0.767), followed by “mastication” and “lip closure” (k = 0.648 and k = 0.634, respectively). Conversely, “triggering pharyngeal swallow” and “pyriformis residue” demonstrated the lowest reliabilities (k = 0.312 and k = 0.324, respectively). The intraclass correlation coefficient (ICC), which is used as a measure of the reliability of the total mVDS score, was 0.876. In all patients with dysphagia, the mVDS score correlated significantly with the type of feeding method selected (p < 0.05), and the presence of aspiration pneumonia (p < 0.05). Conclusion: the ICC of the total mVDS score was 0.876. Therefore, the mVDS could be a useful tool for quantifying the severity of dysphagia. It could be helpful in the analysis of the VFSS findings among patients with dysphagia in clinical settings and research.

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Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia

Healthcare ◽

10.3390/healthcare9060632 ◽

2021 ◽

Vol 9 (6) ◽

pp. 632

Author(s):

Byung-Joo Lee ◽

Hyoshin Eo ◽

Chang-Bae Lee ◽

Donghwi Park

Keyword(s):

Logistic Regression ◽

Aspiration Pneumonia ◽

Operating Characteristic ◽

Stroke Patients ◽

Rater Reliability ◽

Feeding Method ◽

Videofluoroscopic Swallowing Study ◽

Number Of Patients ◽

Long Term Prognosis

Introduction: The Videofluoroscopic Dysphagia Scale (VDS) is used to predict the long-term prognosis of dysphagia in patients with strokes. However, the inter-rater reliability of the VDS was low in a previous study. To overcome the mentioned limitations of the VDS, the modified version of the VDS (mVDS) was created and clinically applied to evaluate its usefulness in choosing the feeding method for stroke patients with dysphagia. Methods: The videofluoroscopic swallowing study (VFSS) data of 56 stroke patients with dysphagia were collected retrospectively. We investigated the presence of aspiration pneumonia and the selected feeding method. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia after stroke. Univariate logistic regression and receiver operating characteristic analyses were used in the data analysis. Results: The inter-rater reliability (Cronbach α value) of the total score of the mVDS was 0.886, which was consistent with very good inter-rater reliability. In all patients with dysphagia, the supratentorial stroke subgroup, and the infratentorial stroke subgroup, the mVDS scores were statistically correlated with the feeding method selected (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). Conclusions: The mVDS can be a useful scale for quantifying the severity of dysphagia, and it can be a useful tool in the clinical setting and in studies for interpreting the VFSS findings in stroke patients with dysphagia. Further studies with a greater number of patients and various stroke etiologies are required for more generalized applications of the mVDS.

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Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia

10.21203/rs.3.rs-155745/v1 ◽

2021 ◽

Author(s):

Byung Joo Lee ◽

Hyoshin Eo ◽

Changbae Lee ◽

Donghwi Park

Keyword(s):

Logistic Regression ◽

Aspiration Pneumonia ◽

Operating Characteristic ◽

Stroke Patients ◽

Rater Reliability ◽

Feeding Method ◽

Videofluoroscopic Swallowing Study ◽

Number Of Patients ◽

Long Term Prognosis

Abstract Introduction: The Videofluoroscopic Dysphagia Scale (VDS) is used to predict the long-term prognosis of dysphagia in patients with stroke. However, the inter-rater reliability of the VDS was low in a previous study. To overcome the mentioned limitations of the VDS, the modified version of the VDS (mVDS) was created and clinically applied to evaluate its usefulness in choosing the feeding method for stroke patients with dysphagia.Methods: The videofluoroscopic swallowing study (VFSS) data of 56 stroke patients with dysphagia were collected retrospectively. We investigated the presence of aspiration pneumonia and the selected feeding method. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia after stroke. Univariate logistic regression and receiver operating characteristic analyses were used in the data analysis.Results: The inter-rater reliability (Cronbach α value) of the total score of the mVDS was 0.886, which was consistent with very good inter-rater reliability. In all patients, the supratentorial stroke subgroup, and the infratentorial stroke subgroup, the mVDS scores were statistically correlated with the feeding method selected (p<0.05) and the presence of aspiration pneumonia (p<0.05).Conclusions: The mVDS can be a useful scale for quantifying the severity of dysphagia, and it can be a useful tool in the clinical setting and in studies for interpreting the VFSS findings in stroke patients with dysphagia. Further studies with a greater number of patients and various stroke etiologies are required for more generalized application of the mVDS.

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Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Evaluating Swallowing Function among Patients with Amyotrophic Lateral Sclerosis and Dysphagia

Journal of Clinical Medicine ◽

10.3390/jcm10194300 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4300

Author(s):

Byung Joo Lee ◽

Hyoshin Eo ◽

Donghwi Park

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Aspiration Pneumonia ◽

Roc Curve ◽

Oral Feeding ◽

Roc Curve Analysis ◽

Swallowing Function ◽

Feeding Method ◽

Long Term Prognosis ◽

Lateral Sclerosis

Introduction: The videofluoroscopic dysphagia scale (VDS) is used to predict the long-term prognosis of dysphagia among patients with the condition. Previously, a modified version of the VDS (mVDS) was established to overcome the relatively low inter-rater reliability of VDS, and was verified in patients with dysphagia, such as stroke patients. However, the validity of mVDS in patients with amyotrophic lateral sclerosis (ALS) has never been proved. Therefore, in this study, we attempted to seek the validity of the mVDS score in patients with ALS suffering from dysphagia. Method: Data from the videofluoroscopic swallowing study (VFSS) of 34 patients with ALS and dysphagia were retrospectively collected. We investigated the presence of aspiration pneumonia and the selected feeding method based on the VFSS. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed during the data analysis. Results: In patients with ALS and dysphagia, the mVDS scores were statistically correlated with the selected feeding method (p < 0.05) and the presence of aspiration pneumonia (p < 0.05). In the ROC curve analysis, the area under the ROC curve values for the selected feeding method and the presence of aspiration pneumonia were 0.886 (95% confidence interval (CI), 0.730–0.969; p < 0.0001) and 0.886 (95% CI, 0.730–0.969; p < 0.0001), respectively. Conclusion: The mVDS can be a useful tool for quantifying the severity of dysphagia and interpreting the VFSS findings in patients with ALS and dysphagia. However, further studies involving a more general population of patients with ALS are needed to elucidate a more accurate cut-off value for the allowance of oral feeding and the presence of aspiration pneumonia.

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Development and assessment of the inter-rater and intra-rater reproducibility of a self-administration version of the ALSFRS-R

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-321138 ◽

2019 ◽

Vol 91 (1) ◽

pp. 75-81 ◽

Cited By ~ 7

Author(s):

Leonhard A Bakker ◽

Carin D Schröder ◽

Harold H G Tan ◽

Simone M A G Vugts ◽

Ruben P A van Eijk ◽

...

Keyword(s):

Rating Scale ◽

Clinical Care ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

The Self ◽

Coefficient Alpha ◽

Rater Agreement ◽

Self Administration ◽

Limits Of Agreement ◽

Rater Reliability

ObjectiveThe Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is widely applied to assess disease severity and progression in patients with motor neuron disease (MND). The objective of the study is to assess the inter-rater and intra-rater reproducibility, i.e., the inter-rater and intra-rater reliability and agreement, of a self-administration version of the ALSFRS-R for use in apps, online platforms, clinical care and trials.MethodsThe self-administration version of the ALSFRS-R was developed based on both patient and expert feedback. To assess the inter-rater reproducibility, 59 patients with MND filled out the ALSFRS-R online and were subsequently assessed on the ALSFRS-R by three raters. To assess the intra-rater reproducibility, patients were invited on two occasions to complete the ALSFRS-R online. Reliability was assessed with intraclass correlation coefficients, agreement was assessed with Bland-Altman plots and paired samples t-tests, and internal consistency was examined with Cronbach’s coefficient alpha.ResultsThe self-administration version of the ALSFRS-R demonstrated excellent inter-rater and intra-rater reliability. The assessment of inter-rater agreement demonstrated small systematic differences between patients and raters and acceptable limits of agreement. The assessment of intra-rater agreement demonstrated no systematic changes between time points; limits of agreement were 4.3 points for the total score and ranged from 1.6 to 2.4 points for the domain scores. Coefficient alpha values were acceptable.DiscussionThe self-administration version of the ALSFRS-R demonstrates high reproducibility and can be used in apps and online portals for both individual comparisons, facilitating the management of clinical care and group comparisons in clinical trials.

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The Identification and Management of Malingering in Clinical Settings

10.2310/psych.13073 ◽

2020 ◽

Author(s):

Lauren Dent ◽

Scott Simpson

Keyword(s):

Psychological Symptoms ◽

Neuropsychological Testing ◽

Clinical Settings ◽

Factitious Disorder ◽

Financial Gain ◽

Adaptive Choice ◽

Psychiatric Conditions ◽

Long Term Prognosis ◽

External Incentives

Malingering is the “intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.” Malingering is difficult to identify and a challenge for physicians to manage. There are innumerable incentives for malingering, including financial gain, housing, and controlled substances. Although there is no definitive way to identify malingering, clues that suggest malingering include inconsistencies in history and exam, discrepancies among collateral informants, and the results of neuropsychological testing. By recognizing how malingering may be a rational, adaptive choice for patients to address their needs, psychiatrists can preserve the doctor-patient relationship and build an alliance to achieve the patient’s goals in a more productive manner. Pitfalls for clinicians treating malingering patients include burnout, aversive countertransference reactions, and inadequate treatment of comorbid medical or psychiatric conditions. Psychiatrists must also be attentive to appropriate documentation and personal safety. The long-term prognosis of malingering patients is not well understood. This review contains 5 figures, 7 tables, and 95 references. Key words: malingering, external incentive, forensic psychiatry, factitious disorder, antisocial personality disorder, countertransference, confrontation

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Development and reliability of the AOSpine CROST (Clinician Reported Outcome Spine Trauma): a tool to evaluate and predict outcomes from clinician’s perspective

European Spine Journal ◽

10.1007/s00586-020-06518-0 ◽

2020 ◽

Vol 29 (10) ◽

pp. 2550-2559

Author(s):

Said Sadiqi ◽

Sander P. J. Muijs ◽

Jeroen J. M. Renkens ◽

Marcel W. Post ◽

Lorin M. Benneker ◽

...

Keyword(s):

Internal Consistency ◽

Developmental Process ◽

Intraclass Correlation ◽

Kappa Statistics ◽

Spine Trauma ◽

Rater Agreement ◽

Reliability Study ◽

Rater Reliability ◽

Dichotomous Scoring ◽

Outcome Tool

Abstract Purpose To report on the development of AOSpine CROST (Clinician Reported Outcome Spine Trauma) and results of an initial reliability study. Methods The AOSpine CROST was developed using an iterative approach of multiple cycles of development, review, and revision including an expert clinician panel. Subsequently, a reliability study was performed among an expert panel who were provided with 20 spine trauma cases, administered twice with 4-week interval. The results of the developmental process were analyzed using descriptive statistics, the reliability per parameter using Kappa statistics, inter-rater rater agreement using intraclass correlation coefficient (ICC), and internal consistency using Cronbach’s α. Results The AOSpine CROST was developed and consisted of 10 parameters, 2 of which are only applicable for surgically treated patents (‘Wound healing’ and ‘Implants’). A dichotomous scoring system (‘yes’ or ‘no’ response) was incorporated to express expected problems for the short term and long term. In the reliability study, 16 (84.2%) participated in the first round and 14 (73.7%) in the second. Intra-rater reliability was fair to good for both time points (κ = 0.40–0.80 and κ = 0.31–0.67). Results of inter-rater reliability were lower (κ = 0.18–0.60 and κ = 0.16–0.46). Inter-rater agreement for total scores showed moderate results (ICC = 0.52–0.60), and the internal consistency was acceptable (α = 0.76–0.82). Conclusions The AOSpine CROST, an outcome tool for the surgeons, was developed using an iterative process. An initial reliability analysis showed fair to moderate results and acceptable internal consistency. Further clinical validation studies will be performed to further validate the tool.

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Investigating the feasibility and reliability of the Pictorial Fit-Frail Scale

Age and Ageing ◽

10.1093/ageing/afz111 ◽

2019 ◽

Vol 48 (6) ◽

pp. 832-837 ◽

Cited By ~ 1

Author(s):

Lisa McGarrigle ◽

Emma Squires ◽

Lindsay M K Wallace ◽

Judith Godin ◽

Mary Gorman ◽

...

Keyword(s):

Healthcare Professionals ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Visual Image ◽

Clinical Settings ◽

Rater Reliability ◽

Intraclass Correlation Coefficients ◽

Healthcare Settings ◽

Test Retest Reliability ◽

Mean Time

Abstract Background the Pictorial Fit-Frail Scale (PFFS) was designed as a simple and practical approach to the identification of frailty. Objectives To investigate the feasibility and reliability of this visual image-based tool, when used by patients, caregivers and healthcare professionals (HCPs) in clinical settings. Design observational study. Setting three outpatient geriatric healthcare settings. Subjects patients (n = 132), caregivers (n = 84), clinic nurses (n = 7) and physicians (n = 10). Methods the PFFS was administered to all patients. Where available, HCPs and caregivers completed the scale based on the patients’ health. In the geriatric day hospital, the PFFS was completed on admission and administered again within 7–14 days. Time and level of assistance needed to complete the scale were recorded. Intraclass correlation coefficients (ICCs) and 95% confidence intervals (CIs) were used to assess test−retest and inter-rater reliability. Results mean time to complete the scale (minutes:seconds ± SD) was 4:30 ± 1:54 for patients, 3:13 ± 1:34 for caregivers, 1:28 ± 0:57 for nurses and 1:32 ± 1:40 for physicians. Most patients were able to complete the scale unassisted (64%). Mean patient PFFS score was 11.1 ± 5.3, mean caregiver score was 13.2 ± 6.3, mean nurse score was 10.7 ± 4.5 and mean physician score was 11.1 ± 5.6; caregiver scores were significantly higher than patient (P < 0.01), nurse (P < 0.001) and physician (P < 0.01) scores. Test−retest reliability was good for patients (ICC = 0.78, [95%CI = 0.67–0.86]) and nurses (ICC = 0.88 [0.80–0.93]). Inter-rater reliability between HCPs was also good (ICC = 0.75 [0.63–0.83]). Conclusion the PFFS is a feasible and reliable tool for use with patients, caregivers and HCPs in clinical settings. Further research on the validity and responsiveness of the tool is necessary.

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Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013231 ◽

2017 ◽

Vol 10 (5) ◽

pp. 462-466 ◽

Cited By ~ 3

Author(s):

Scott L Zuckerman ◽

Nikita Lakomkin ◽

Jordan A Magarik ◽

Jan Vargas ◽

Marcus Stephens ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Weighted Kappa ◽

Years Of Experience ◽

Rater Agreement ◽

Rater Reliability ◽

Intraclass Correlation Coefficients ◽

Level Of Agreement ◽

Strong Agreement

BackgroundThe angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment.ObjectiveThe main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms.MethodsA panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0–100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization.Results10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58).ConclusionsIdentifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population.

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