title: Speech Pathology Reliability for Stroke Swallowing Screening Items.
abstract: Swallowing screening is critical in rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Accuracy in judgments is vital for the success of the screening. This study examined speech-language pathologists' (SLPs) reliability in interpreting screening items. Swallowing screening was completed in 75 individuals admitted with stroke symptoms. Screening items evaluated were lethargy, dysarthria, wet voice unrelated to swallowing, abnormal volitional cough, and cough, throat clear, wet voice after swallowing, and inability to continuously drink with ingestion of 5 and 90 ml water. Two SLPs, each with more than 10 years of experience, made simultaneous independent judgments of the same observations obtained from the screening. Overall, generally high agreement was identified between the SLPs (k[SE] = 0.83[0.03]). Individual kappas ranged from 0.38 (fair) for non-swallowing wet voice to 0.95 (almost perfect) for cough after swallow, with one item omitted due to minimal variation. SLPs demonstrate high reliability in swallowing screening. Results, however, indicate some potential variability. Items associated with trial swallows had the highest reliability, whereas items related to judgments of speech and voice quality had the lowest. Although SLPs have dedicated training and ample opportunity to practice, differences in agreement are evident. Routine practice in hospital departments is recommended to establish and maintain sensitive perceptual discrimination. If other professionals are to provide swallowing screening, knowledge of SLPs' reliability levels must be considered when identifying screening items, creating education modules, and determining acceptable levels of agreement.
authors.affiliation: Research Service, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA. stephanie.daniels@va.gov.|Department of Communication Sciences and Disorders, University of Houston, 100 Clinical Research Services, Houston, TX, 77204, USA. stephanie.daniels@va.gov.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Daniels
authors.affiliation: School of Public Health, University of Texas Health Sciences Center, 1200 Herman Pressler Blvd, Houston, TX, 77030, USA.
authors.forename: Shweta
authors.initials: S
authors.lastname: Pathak
authors.affiliation: Speech Pathology Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Carol B
authors.initials: CB
authors.lastname: Stach
authors.affiliation: Speech Pathology Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Tiffany M
authors.initials: TM
authors.lastname: Mohr
authors.affiliation: School of Public Health, University of Texas Health Sciences Center, 1200 Herman Pressler Blvd, Houston, TX, 77030, USA.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.affiliation: Neurology Care Line, Medicine Service, Michael E. DeBakey VA Medical Center, Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013066:Speech-Language Pathology / Q000379:methods*; D020521:Stroke / Q000150:complications*
keywords: Deglutition; Deglutition disorders; Reliability; Stroke; Swallowing screening