VFS interjudge reliability using a free and directed search.

Reports in the literature suggest that clinicians demonstrate poor reliability in rating videofluoroscopic swallow (VFS) variables. Contemporary perception theories suggest that the methods used in VFS reliability studies constrain subjects to make judgments in an abnormal way. The purpose of this study was to determine whether a directed search or a free search approach to rating swallow studies results in better interjudge reliability. Ten speech pathologists served as judges. Five clinical judges were assigned to the directed search group (use checklist) and five to the free search group (unguided observations). Clinical judges interpreted 20 VFS examinations of swallowing. Interjudge reliability of ratings of dysphagia severity, affected stage of swallow, dysphagia symptoms, and attributes identified by clinical judges using a directed search was compared with that using a free search approach. Interjudge reliability for rating the presence of aspiration and penetration was significantly better using a free search ("substantial" to "almost perfect" agreement) compared to a directed search ("moderate" agreement). Reliability of dysphagia severity ratings ranged from "moderate" to "almost perfect" agreement for both methods of search. Reliability for reporting all other symptoms and attributes of dysphagia was variable and was not significantly different between the groups.