Rater Reliability of the Modified Barium Swallow

Although videofluoroscopy is widely used in the assessment and management of dysphagia, there are scant data on rater reliability. The measurement of rater reliability is crucial to quality control. The inter-rater and intra-rater reliability of the modified barium swallow was analyzed in order to determine if acceptable levels of reliability were being achieved in the clinic. The secondary aims were to identify the most reliable raters and to determine clinical training needs for videofluoroscopy.Four speech pathologists analyzed 20 swallows of selected dysphagic patients, twice. Six variables were measured: aspiration, swallow time, number of swallows, number of tongue elevations, place of initiation, and vallecula pooling. Rating was performed using videos in store. Reliability scores were good for all variables except vallecula/e pooling. Repeatability of vallecula pooling ratings over time was particularly problematic. The implications of these findings for the evaluation of dysphagia are discussed.