Speech-Language Pathologists Ratings of the Yale 3-Ounce Water Swallow Challenge: Accuracy, Reliability, and Clinician Demographics

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Authors

Morrissey, Amanda

Issue Date

2022

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Dissertation

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aspiration , dysphagia , reliablity , swallow screening , Water Swallow Testing , Yale Swallow Protocol

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Objective: Examine Speech-Language Pathologists (SLP) water swallow challenge (WSC) ratings across different clinical scenario videos (CSVs). Method: A non-experimental cross-sectional correlational design included eight expert and 150 non-expert SLPs who participated in an online rating task. Participants rated 11CSVs illustrating a standardized patient performing the 3-ounce WSC. Non-expert participants received training, feedback on their performance, on-demand definitions, and unlimited CSV reviews. Expert participants received training with no feedback on their performance and unlimited CSV reviews. On-demand definitions were not available. Non-expert participants completed eight demographic questions related to work setting, experience, and clinical practices. Results: Non-expert mean accuracy (M= 90.06, SD = 8.45) was significantly higher than expert mean accuracy by a mean difference of 9.59, 95% CI [8.23 to 10.95], t(149) = 13.89, p <.001. Non-expert and expert intra-rater reliability revealed 91% and 98% overall proportion of agreement, respectively. Non-expert interrater reliability revealed “good” agreement (κ = .69, 95% CI [.692, .703], p < .001). Expert interrater reliability revealed “good” agreement (κ = .65, 95% CI [.570, .727], p =.000). Non-expert demographics were not statistically significant predictors for CSV accuracy. Conclusions: Expertise did not influence rating accuracy or reliability. Training with knowledge of performance and on-demand definitions review improved CSV rating accuracy. Demographics did not predict rater performance as reported by previous investigations. Updated WSC interpretation guidelines, including training with feedback and expanded definitions, should be considered. Keywords: dysphagia, aspiration, swallow screening, reliability, Yale Swallow Protocol, Water Swallow Testing

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