Competency Development in Objective Measures of Videofluoroscopic Study of Swallowing

Abstract

The Videofluoroscopic Study of Swallowing (VFSS) has been criticised for its poor objectivity and inter-rater reliability. The validity and reliability of objective VFSS measures have been demonstrated in research settings but not widely implemented clinically. Study 1 investigated the up-take of objective VFSS measures in New Zealand. An online survey was completed by nine speech-language therapists (SLTs) previously trained in objective VFSS measures. The survey explored current usage and barriers to use of objective VFSS measures. Two significant barriers described by respondents were lack of resources and follow-up training. With this information in mind, Study 2 investigated competency development among novice and experienced SLTs in utilising objective VFSS measures. Six novice (no VFSS experience) and four experienced (2-10 years of VFSS experience) SLTs participated in four hours of training in objective VFSS measurement. Each week, they were asked to independently measure and report on three VFSS videos of patients following stroke, for eight weeks. Participants received email feedback weekly. Competency was measured by speed of completion, measurement and interpretation accuracy. In addition, ratings of perceived competence and perceived pressure were collected each week. All SLTs, irrespective of experience level, were able to achieve 80% accuracy and completion within 30 minutes. SLTs mean speed reduced from 50 minutes in Week 1 to 25 minutes in Week 8. The inter-rater reliability for pharyngeal constriction ratio, maximum pharyngoesophageal opening, pharyngoesophageal opening duration and total pharyngeal transit time improved across the eight-week period (range ICC = -31.05 - .597 in week 1 to ICC = .708 - .977 in week 8). Only airway closure duration did not improve during the study (ICC = .511 in week 1 and ICC = .222 in week 8). Perceived competence increased over time (p<.01); while perceived pressure reduced (p<.01). Both novice and experienced SLTs were capable of achieving competency in objective VFSS measurement within 8 weeks. Level of experience has limited influence on the learning curve. As one becomes familiar with the measures, perceived competence improves and pressure recedes. SLTs can learn and incorporate this new technique reasonably within a standard work service requirement.