Walmari Pilz

Reliability and validity of student peer assessment in medical education: a systematic review.

Background: Peer assessment has been demonstrated to be an effective educational intervention for health science students. Aims: This study aims to give an overview of all instruments or questionnaires for peer assessments used in medical and allied health professional educational settings and their psychometric characteristics as described in literature. Methods: A systematic literature search was carried out using the electronic databases Pubmed, Embase, ERIC, PsycINFO and Web of Science, including all available inclusion dates up to May 2010. Results: Out of 2899 hits, 28 studies were included, describing 22 different instruments for peer assessment in mainly medical educational settings. Although most studies considered professional behaviour as a main subject of assessment and described peer assessment usually as an assessment tool, great diversity was found in educational settings and application of peer assessment, dimensions or constructs as well as number of items and scoring system per questionnaire, and in psychometric characteristics. Conclusions: Although quite a few instruments of peer assessment have been identified, many questionnaires did not provide sufficient psychometric data. Still, the final choice of an instrument for educational purposes can only be justified by its sufficient reliability and validity as well as the discriminative and evaluative purposes of the assessment.

Surface electrical stimulation in dysphagic parkinson patients: A randomized clinical trial

A new treatment for oropharyngeal dysphagia in Parkinsons disease was evaluated in the present study.

Swallowing in Parkinson Patients versus Healthy Controls: Reliability of Measurements in Videofluoroscopy

Objective. To determine and describe the pathophysiological aspects of oropharyngeal swallowing in patients with Parkinsons disease more accurately, a pilot study of qualitative as well as quantitative parameters of swallowing was performed using videofluoroscopy (VFS). Methods. Ten patients with a diagnosis of idiopathic Parkinsons disease having dysphagic complaints and ten healthy age- and gender-matched control subjects underwent a standardized videofluoroscopic swallowing protocol. Information on the swallowing function was derived from temporal, spatial, and descriptive visuoperceptual parameters. Intra- and interrater reliability was calculated. Results. No significant differences were found between Parkinson patients and healthy control subjects for the majority of the reliable variables. Conclusions. It was concluded that swallowing function seemed to be preserved in the early stages of Parkinsons disease. Furthermore, the reliability of many quantitative as well as qualitative swallowing parameters proved insufficient, raising questions about the interpretation of study outcomes in videofluoroscopy.

Intrarater and interrater reliability for measurements in videofluoroscopy of swallowing

OBJECTIVE Intrarater and interrater reliability is crucial to the quality of diagnostic and therapy-effect studies. This paper reports on a systematic review of studies on intrarater and interrater reliability for measurements in videofluoroscopy of swallowing. The aim of this review was to summarize and qualitatively analyze published studies on that topic. MATERIALS AND METHODS Those published up to March 2013 were found through a comprehensive electronic database search using PubMed, Embase, and The Cochrane Library. Two reviewers independently assessed the studies using strict inclusion criteria. RESULTS Nineteen studies were included and then qualitatively analyzed. In several of these, methodological problems were found. Moreover, intrarater and interrater reliability varied with the measure applied. A meta-analysis was not carried out as studies were not of sufficient quality to warrant doing so. CONCLUSION In order to achieve reliable measurements in videofluoroscopy of swallowing, it is recommended that raters use well-defined guidelines for the levels of ordinal visuoperceptual variables. Furthermore, in order to make the measurements reliable (intrarater and interrater) it is recommended that, following protocolled pre-experimental training, the raters should have maximum consensus about the definition of the measured variables.

Swallowing assessment in myotonic dystrophy type 1 using fiberoptic endoscopic evaluation of swallowing (FEES)

This study describes the swallowing function of patients with myotonic dystrophy type 1 (DM1) and the effect of bolus consistency on swallowing in this group. The aim of the study is twofold: (a) to identify which (and to what extent) swallowing variables change for DM1 patients relative to healthy control subjects and (b) to examine whether the degree of oropharyngeal dysphagia is associated with disease severity. Forty-five consecutive DM1 patients and ten healthy subjects underwent a swallowing assessment, at Maastricht University medical Center in the Netherlands. The assessment included a standardized fiberoptic endoscopic evaluation of swallowing (FEES) protocol using different bolus consistencies. Clinical severity of the disease was assessed using the muscular impairment rating scale (MIRS). Significant differences were found between patients and controls for all FEES variables. The magnitude of these differences depended on the bolus consistency. The odds of a more pathological swallowing outcome increased significantly with higher MIRS levels. In conclusion, swallowing function is found to be significantly altered in DM1 patients. The results emphasize the importance of conducting a detailed swallowing assessment in all patients, even those with mild muscle weakness.

Diagnosis and Treatment of Phagophobia: A Review

This narrative review summarizes published studies on diagnostic examinations and therapeutic interventions for phagophobia. The electronic databases Embase, PubMed, PsycINFO®, and The Cochrane Library were used. The literature search was limited to publications in the English, German, French, Spanish, or Dutch language. The original articles are summarized in the present narrative review. The body of literature on phagophobia and swallowing fear remains very limited; only 12 studies were found. The present narrative review discovered heterogeneity in the definitions of phagophobia or similar syndromes. A systematic review, including a qualitative analysis, was planned but not carried out as studies were not of sufficient quality to warrant doing so. All the studies had severe methodological shortcomings. In general, the conclusions could not be compared across the studies because of the different study designs, small populations, different ways of evaluating and treating phagophobia, and complex combinations of treatments. A general conclusion is provided.

Observers’ Agreement on Measurements in Fiberoptic Endoscopic Evaluation of Swallowing

This study analyzed the effect that dysphagia etiology, different observers, and bolus consistency might have on the level of agreement for measurements in FEES images reached by independent versus consensus panel rating. Sixty patients were included and divided into two groups according to dysphagia etiology: neurological or head and neck oncological. All patients underwent standardized FEES examination using thin and thick liquid consistencies. Two observers scored the same exams, first independently and then in a consensus panel. Four ordinal FEES variables were analyzed. Statistical analysis was performed using a linear weighted kappa coefficient and Bayesian multilevel model. Intra- and interobserver agreement on FEES measurements ranged from 0.76 to 0.93 and from 0.61 to 0.88, respectively. Dysphagia etiology did not influence observers’ agreement level. However, bolus consistency resulted in decreased interobserver agreement for all measured FEES variables during thin liquid swallows. When rating on the consensus panel, the observers deviated considerably from the scores they had previously given on the independent rating task. Observer agreement on measurements in FEES exams was influenced by bolus consistency, not by dysphagia etiology. Therefore, observer agreement on FEES measurements should be analyzed by taking bolus consistency into account, as it might affect the interpretation of the outcome. Identifying factors that might influence agreement levels could lead to better understanding of the rating process and assist in developing a more precise measurement scale that would ensure higher levels of observer agreement for measurements in FEES exams.

Oropharyngeal Dysphagia in Myotonic Dystrophy Type 1: A Systematic Review

A systematic review was conducted to investigate the pathophysiology of and diagnostic procedures for oropharyngeal dysphagia in myotonic dystrophy (MD). The electronic databases Embase, PubMed, and The Cochrane Library were used. The search was limited to English, Dutch, French, German, Spanish, and Portuguese publications. Sixteen studies met the inclusion criteria. Two independent reviewers assessed the methodological quality of the included articles. Swallowing assessment tools, the corresponding protocols, the studies’ outcome measurements, and main findings are summarized and presented. The body of literature on pathophysiology of swallowing in dysphagic patients with MD type 1 remains scant. The included studies are heterogeneous with respect to design and outcome measures and hence are not directly comparable. More importantly, most studies had methodological problems. These are discussed in detail and recommendations for further research on diagnostic examinations for swallowing disorders in patients with MD type 1 are provided.

Identifying patterns of FEES-derived swallowing trajectories using group-based trajectory model

The present study delineates and visualizes swallowing trajectories along seven swallow trials in dysphagic patients using group-based trajectory modeling (GBTM). This model facilitates the recognition of swallowing functional categories, estimates their frequency of occurrence, and enhances the understanding of swallowing dynamics. Two hundred and five dysphagic patients underwent a standardized FEES examination protocol. Five ordinal variables were blindly assessed for each swallow by two observers independently. GBTM analysis was conducted to find and characterize trajectories of FEES responses. For most FEES outcome variables, trajectories were qualitatively distinct in degree and kind (level of impairment and how this changed over the seven swallow trials). Two FEES outcome variables—delayed initiation of the pharyngeal reflex and postswallow pyriform sinus pooling—showed the highest prevalence of severe swallowing impairment. Highly impaired categories were more stable throughout the different swallow trials. Intermediate trajectories, by contrast, were erratic, responding more sensitively to shifts in bolus consistency. GBTM can identify distinct developmental trajectories of measured FEES variables in patients with oropharyngeal dysphagia. In clinical practice, classification into distinct groups would help to identify the subgroup of dysphagic patients who may need specific medical attention.