Abstract：
The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs = 0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study\'s results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.
摘要：
吞咽困难结果和严重程度量表在临床和吞咽困难研究中使用，国际上。尽管它是使用视频透视吞咽研究开发的，它经常用于评估吞咽的柔性内窥镜评估。DOSS使用费用的有效性和可靠性，然而,以前没有评估过。这项研究调查了使用DOSS对费用进行评分的临床医生的有效性和评分者可靠性。招募了11名具有不同吞咽困难经验的言语语言病理学家（SLP）进行审查，并对11名异源性吞咽困难患者（2例重复FEES）和4名健康成年人记录的17个无声FEES（198个食团吞下）进行了DOSS评估。将SLPsDOSS评分与初始综合吞咽困难评估(包括患者诊断,采访,颅神经和完整的FEES评估）与功能性口腔摄入量表（FOIS）和DOSS结果测量。SLP不了解患者的详细信息和全面的吞咽困难检查。两周后对FEES病例进行了重新随机评级（评估者内部可靠性）。DOSS评分的标准有效性（与FOIS和DOSS的综合吞咽困难评估相比）很强-非常强（rs分别为0.858和0.936；p<0.001）。评价员间可靠性表现出很高的一致性(α=0.891)，评分员内部的可靠性也表现出几乎完美的一致性(Kw=0.945)。这项研究的结果，SLP具有很强-非常强的标准效度和较高的评分者信度，增加了DOSS与费用一起使用的证据。建议将来进行有效性研究，将DOSS同时与FEES和VFSS进行比较。
