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Rethinking Residue: Determining the Perceptual Continuum of Residue on FEES to Enable Better Measurement

Abstract

The goal of this work was to better understand perceptual judgments of pharyngeal residue on flexible endoscopic evaluation of swallowing (FEES) and the influence of a visual analog scale (VAS) versus an ordinal scale on clinician ratings. The intent was to determine if perceptual judgments of residue were more accurately described by equal or unequal intervals. Thirty-three speech language pathologists rated pharyngeal residue from 75 FEES videos representing a wide range of residue severities for thin liquid, applesauce, and cracker boluses. Clinicians rated their impression of the overall residue amount in each video on a VAS and, in a different session, on a five-point ordinal scale. Residue ratings were made in two separate sessions separated by several weeks. Statistical correlations of the two rating methods were carried out and best-fit models were determined for each bolus type. A total of 2475 VAS ratings and 2473 ordinal ratings were collected. Residue ratings from both methods (VAS and ordinal) were strongly correlated for all bolus types. The best fit for the data was a quadratic model representing unequal intervals, which significantly improved the r 2 values for each bolus type (cracker r 2 = 0.98, applesauce r 2 = 0.99, thin liquid r 2 = 0.98, all p < 0.0001). Perceptual ratings of pharyngeal residue demonstrated a statistical relationship consistent with unequal intervals. The present findings support the use of a VAS to rate residue on FEES, allowing for greater precision as compared to traditional ordinal rating scales. Perceptual judgments of pharyngeal residue reflected unequal intervals, an important concept that should be considered in future rating scales.

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Acknowledgements

The lead author would like to thank Dr. Elizabeth Hoover and Dr. Wendy Coster for their input and guidance in the development of this research. We are also grateful for the participation in this investigation by speech pathologists across the United States.

Funding

Salary and tuition support was provided to the first and last authors from National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under Award Number R01DC012584 (PI: Kumar). The Department of Speech, Language, and Hearing of Sargent College (Boston University) also provided financial support for this research via the Dudley Allen Sargent Research Fund.

Author information

Correspondence to Jessica M. Pisegna.

Additional information

Portions of this manuscript were presented at the Dysphagia Research Society in Portland, Oregon on Saturday, March 4, 2017.

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Supplementary material 3 (MP4 37266 kb)

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Pisegna, J.M., Kaneoka, A., Leonard, R. et al. Rethinking Residue: Determining the Perceptual Continuum of Residue on FEES to Enable Better Measurement. Dysphagia 33, 100–108 (2018). https://doi.org/10.1007/s00455-017-9838-7

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Keywords

  • Deglutition
  • FEES
  • Pharyngeal residue
  • Ratings
  • Visual analog scale
  • Prothetic continuum