ABSTRACT
BACKGROUND: Accumulation of secretions in the hypopharynx, aditus laryngis and trachea constitute a cardinal trait of oropharyngeal dysphagia. For the evaluation of the degree of severity a 4-point secretion scale by Murray et al. is used internationally in a long and a short version. However, a validated German translation of the long version of this scale does not yet exist. Also, it has not yet been scientifically proven that both versions of the scale are equally valid. OBJECTIVES: This study aimed at the validation of the German translation of the long version of the secretion scale by Murray et al. and at a comparison of reliability and validity of the short and long versions. MATERIAL AND METHODS: A total of 40 videos of fiberoptic endoscopic evaluation of swallowing (FEES(®)), 10 for each severity level, were rated by 4 otorhinolaryngologists (ENT specialists) independently and with different randomizations for examination of the reliability and validity. Two rating sessions for each of the scale versions were conducted. Intrarater and interrater reliability as well as the agreement of the ratings with a reference standard were analyzed. RESULTS: Both the intrarater reliability (Spearman correlations: ρs > 0.840***) and the interrater reliability (Krippendorff's alpha: α > 0.850) yielded very good results and the concurrent validity was highly significant (ρs > 0.981***). DISCUSSION: The German translation of the secretion scale by Murray et al. can be considered reliable and valid, with comparable test accuracy of the short and long versions. Hence, the scale can be recommend for the graduation of pharyngolaryngotracheal secretions and should be integrated into the standardized evaluation of FEES(®) diagnostics for clinical and scientific purposes.
Subject(s)
Deglutition Disorders/diagnosis , Esophagoscopy/methods , Severity of Illness Index , Surveys and Questionnaires , Aged , Aged, 80 and over , Female , Germany , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , Sensitivity and Specificity , TranslatingABSTRACT
BACKGROUND: The Penetration-Aspiration Scale was developed by Rosenbek et al. to enable standardized documentation of this cardinal symptom of a swallowing disorder. OBJECTIVES: The objective was to create and validate a German version of the Penetration-Aspiration Scale according to the guidelines governing the translation of foreign language measurement tools. MATERIALS AND METHODS: Both reliability and validity were examined based on the ratings of 80 randomized endoscopically evaluated swallows, 10 for each severity level. Ratings were carried out by four independent raters: two with more than 3 years' experience with dysphagia and a further two with less than 3 years' experience. The swallows were rerated after 4 weeks. RESULTS: Both intrarater (Kendall's Tau: τs > 0.643; median 0.773; ps < 0.001) and interrater reliability were highly significant (two-way mixed single ICC coefficient of 0.799 for the first rating session and 0.728 for the second session; ps < 0.001). Results from the raters with less than 3 years' experience were significantly different from the reference standard in three out of four cases, whereas this was not the case for the more experienced raters. However, for each film, the median of the individual ratings from all four raters correlated almost perfectly with the reference standard (first rating session: τ = 0.894; second rating session: τ = 0.843; ps < 0.001). CONCLUSION: The German version of the Penetration-Aspiration Scale according to Rosenbek presented here was demonstrated to be both reliable and valid. Despite its dependency on the raters' experience, it can therefore be used as a graduation instrument for swallowing disorders in German-speaking countries and make an important contribution to evidence-based medicine in dysphagiology for both clinical and scientific use.
