The visuoperceptual measure for videofluoroscopic swallow studies (VMV) is a new measure for analysing the recordings from videofluoroscopic swallow studies (VFSS). This study evaluated the reliability and validity of the pilot version of the VMV using classical test theory (CTT) analysis, informed by the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. Forty participants, diagnosed with oropharyngeal dysphagia by fibreoptic endoscopic evaluation of swallowing, were recruited. The VFSS and administration of bolus textures and volumes were conducted according to a standardised protocol. Recordings of the VFSS were rated by three blinded raters: a speech-language pathologist, a radiologist and a phoniatrician. Inter- and intra-rater reliability was assessed with a weighted kappa and resulted in 0.889 and 0.944 overall, respectively. Structural validity was determined using exploratory factor analyses, which found four and five factor solutions. Internal consistency was evaluated with Cronbach’s alpha coefficients, which found all but one factor scoring within an acceptable range (>0.70 and <0.95). Hypothesis testing for construct validity found the expected correlations between the severity of dysphagia and the VMV’s performance, and found no impact of gender on measure performance. These results suggest that the VMV has potential as a reliable and valid measure for VFSS. Further validation with a larger sample is required, and validation using an item response theory paradigm approach is recommended.

Background: People with aphasia (PWA) may have difficulty accessing information in their environment, including the hospital setting. Prior research has recommended the use of aphasia-friendly text-formatting principles, including using graphics when providing information to PWA. There is limited research into the impact of using such principles for hospital menus. Aims: To evaluate the impact of an aphasia-friendly menu with assistance from a Speech Pathology Therapy Assistant (SPTA) compared with usual hospital menus in PWA on 1) oral intake, 2) self-reported involvement and 3) ease in meal ordering and 4) meal preference. The secondary aim was to investigate the feasibility of implementing the aphasia-friendly menu by exploring staff and caregiver experiences regarding the perceived barriers and facilitators to its implementation, along with time required to assist PWA to order meals. Methods and procedures: This embedded mixed-methods design study was piloted at two hospitals in Queensland, Australia. Hospital inpatients with aphasia due to non-progressive neurological damage, their caregivers and SPTAs participated. Each day PWA received either the 1) aphasia-friendly menu: professional photos of menu items on an iPad with SPTA support, or 2) usual hospital menus provided in random order for up to 15 days during their inpatient stay. Each day, oral intake was measured and PWA rated their perceived involvement and ease with ordering from the menu provided on a 10-point Likert scale. SPTAs recorded time assisted using the menus and reported barriers and facilitators to the use of the menus daily. At the completion of the pilot, the PWA’s preferred menu type was recorded, SPTAs participated in a focus group and caregivers completed a questionnaire. Outcomes and results: There was no significant difference in oral intake between menu types. PWA rated the aphasia-friendly menu more favourably for involvement (p = 0.004) and ease (p = 0.015) when ordering. Nineteen out of 20 PWA who provided a response preferred the aphasia-friendly menu (p = 4 × 10⁻⁵). SPTA comments were analysed using qualitative content analysis and outlined their perceived barriers and facilitators to the use of aphasia-friendly menus, experience with usual menus and recommendations for future directions. Meal ordering was approximately 4.4 minutes longer with PWA using the aphasia-friendly menus. Conclusions: The aphasia-friendly menu was positively perceived by PWA, caregivers and SPTAs and may be a viable and preferred option for PWA when ordering food in hospitals. Staff are encouraged to consider the contextual barriers and facilitators identified in the pilot, prior to implementation of such aphasia-friendly menus.

Visuoperceptual evaluation of fiberoptic endoscopic evaluation of swallowing (FEES) is a commonly used assessment in dysphagia or swallowing disorders. Currently, no international consensus exists regarding which visuoperceptual measures to use for the analysis of FEES recordings. Moreover, existing visuoperceptual FEES measures are limited by poor and incomplete psychometric data, identifying an urgent need for developing a visuoperceptual measure to interpret FEES recordings. Following the COSMIN group’s (COnsensus-based Standards for the selection of health Measurement INstruments) psychometric taxonomy and guidelines, this study aimed to establish the content validity of a new visuoperceptual FEES (V-FEES) measure in adults with oropharyngeal dysphagia. Using the Delphi technique, international consensus was achieved among dysphagia experts across 21 countries, resulting in a new prototype measure for V-FEES, comprising 30 items, 8 function testing items (i.e., specific tasks performed by patients while observing and rating items), and 36 unique operationalisations (i.e., defining items into measurable factors that could be measured empirically using visuoperceptual observation). This study supports good content validity for V-FEES, including participants’ feedback on the relevance, comprehensiveness, and comprehensibility of the included items. Future studies will continue the instrument development process and determine the remaining psychometric properties using both the classic test theory (CTT) and item response theory (IRT) models.