Diagnostic Validity of Clinical Observations for Detecting Physiologic Swallowing Impairment

Abstract

The act of swallowing is characterized as a complex synergy of coordinated movements that serve to protect the airway, generate pressures on and propel a bolus (liquids and foods) through the upper aerodigestive tract from mouth to stomach. Dysphagia, or swallowing problem(s) commonly occur in diseases and conditions that involve the central or peripheral control of swallowing function, or when there is direct injury to the muscles and structures involved in swallowing movement. The incidence of dysphagia in hospitalized patients is high and has shown to be a critical factor in the duration of hospital length of stay and patient survival (Attrill et al., 2018; D. A. Patel et al., 2018). The importance of early identification through timely, accurate and reliable assessment is highly significant to the overall health and well-being of patients who suffer from dysphagia. The clinical assessment of swallowing function involves observational measures of swallowing behavior used as surrogate markers of swallowing impairment. Information obtained from swallowing assessments are life changing for patients. It is essential that we have assessment tools with rigorous methodological quality to optimize the accuracy of our clinical judgement. The results obtained from these tools in combination with medical, social, and environmental factors allow clinicians to make critical decisions about patients’ health and quality of life. Thus, it is crucial that the tools assess what they propose to assess (validity) in a reproducible and consistent manner (reliability) to avoid reporting ambiguity, potential inaccuracies in assessment and selection of treatment and management plans, and gaps in service delivery.