Reliability of swallowing outcomes via telehealth (Borders et al., 2021)

Purpose: The COVID-19 pandemic has drastically increased the use of telehealth. Prior studies of telehealth clinical swallowing evaluations provide positive evidence for telemanagement of swallowing. However, the reliability of these measures in clinical practice, as opposed to well-controlled research conditions, remains unknown. This study aimed to investigate the reliability of outcome measures derived from clinical swallowing tele-evaluations in real-world clinical practice (e.g., variability in devices and Internet connectivity, lack of in-person clinician assistance, or remote patient/caregiver training).Method: Seven raters asynchronously judged clinical swallowing tele-evaluations of 12 movement disorders patients. Outcomes included the Timed Water Swallow Test (TWST), Test of Masticating and Swallowing Solids (TOMASS), and common observations of oral intake. Statistical analyses were performed to examine inter- and intrarater reliability, as well as qualitative analyses exploring patient and clinician-specific factors impacting reliability.Results: Forty-four trials were included for reliability analyses. All rater dyads demonstrated “good” to “excellent” interrater reliability for measures of the TWST (intraclass correlation coefficients [ICCs] ≥ .93) and observations of oral intake (≥ 77% agreement). The majority of TOMASS outcomes demonstrated “good” to “excellent” interrater reliability (ICCs ≥ .84), with the exception of the number of bites (ICCs = .43–.99) and swallows (ICCs = .21–.85). Immediate and delayed intrarater reliability were “excellent” for most raters across all tasks, ranging between ICCs of .63 and 1.00. Exploratory factors potentially impacting reliability included infrequent instances of suboptimal video quality, reduced camera stability, camera distance, and obstruction of the patient’s mouth during tasks.Conclusions: Subjective observations of oral intake and objective measures taken from the TWST and the TOMASS can be reliably measured via telehealth in clinical practice. Our results provide support for the feasibility and reliability of telehealth for outpatient clinical swallowing evaluations during COVID-19 and beyond.Supplemental Material S1. TWST and TOMASS interrater reliability across all dyads. Supplemental Material S2. Observations of oral intake interrater reliability across all dyads.Supplemental Material S3. TWST Intrarater reliability. Supplemental Material S4. TOMASS intrarater reliability. Supplemental Material S5. Observations of oral intake intrarater reliability. Borders, J. C., Sevitz, J. S., Malandraki, J. B., Malandraki, G. A., & Troche, M. S. (2021). Objective and subjective clinical swallowing outcomes via telehealth: Reliability in outpatient clinical practice. American Journal of Speech-Language Pathology. https://doi.org/10.1044/2020_AJSLP-20-00234

目的：COVID-19大流行极大地提升了远程医疗的使用率。先前关于远程医疗临床吞咽评估的研究为远程管理吞咽提供了积极的证据。然而，这些措施在临床实践中的可靠性，与严格控制的研究条件相比，尚属未知。本研究旨在调查从临床吞咽远程评估中得出的结果指标的可靠性，特别是在现实世界的临床实践中（例如，设备与互联网连接的变异性、缺乏现场临床医师协助或远程患者/护理者培训）。方法：七名评审员异步评估了12名运动障碍患者的临床吞咽远程评估。结果包括计时水吞咽测试（TWST）、咀嚼和吞咽固体测试（TOMASS）以及口腔摄入的常见观察。进行了统计分析，以检验评审员之间的以及评审员内部的可靠性，以及定性分析，探讨影响可靠性的患者和临床医师特定因素。结果：纳入了44次试验进行可靠性分析。所有评审员对TWST（组内相关系数[ICCs]≥.93）和口腔摄入观察（≥77%一致性）的评估均表现出“良好”至“优秀”的评审员之间可靠性。TOMASS的大多数结果也表现出“良好”至“优秀”的评审员之间可靠性（ICCs≥.84），但咀嚼次数（ICCs=.43-.99）和吞咽次数（ICCs=.21-.85）除外。对于大多数评审员来说，所有任务的即时和延迟的评审员内部可靠性均为“优秀”，ICCs范围在.63至1.00之间。可能影响可靠性的探索性因素包括视频质量不佳的罕见情况、相机稳定性降低、相机距离以及任务过程中患者口腔的阻塞。结论：通过远程医疗在临床实践中对口腔摄入的主观观察以及从TWST和TOMASS中获取的客观措施可以进行可靠的测量。我们的结果为COVID-19期间及以后的远程医疗门诊临床吞咽评估的可行性和可靠性提供了支持。补充材料S1：所有配对中TWST和TOMASS的评审员之间可靠性。补充材料S2：所有配对中口腔摄入观察的评审员之间可靠性。补充材料S3：TWST的评审员内部可靠性。补充材料S4：TOMASS的评审员内部可靠性。补充材料S5：口腔摄入观察的评审员内部可靠性。Borders, J. C.，Sevitz, J. S.，Malandraki, J. B.，Malandraki, G. A.，& Troche, M. S.（2021）。通过远程医疗进行的客观和主观临床吞咽结果：门诊临床实践中的可靠性。美国言语-语言病理学杂志。https://doi.org/10.1044/2020_AJSLP-20-00234