Page 78 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

Chapter 3
No relevant differences in reliability were observed between male and female participants and participants with a BMI below or higher than 25.
Table 4 Intra-class Correlation Coefficients for test-retest, intra-rater and inter-rater reliability.
Test-retest reliability (ICC with 95%CI)
Intra-rater reliability (ICC with 95%CI)
Inter-rater reliability (ICC with 95%CI)
Thin liquid
Duration
Number of swallows
Duration
Number of swallows
Duration
Number of swallows
Number of chews
0.90 (0.86-0.94) 0.84 (0.77-0.90)
0.88 (0.83-0.92) 0.68 (0.56-0.78)
0.89 (0.83-0.93) 0.60 (0.46-0.73) 0.89 (0.83-0.93)
1.00 (1.00-1.00) 0.99 (0.99-1.00)
0.98 (0.97-0.99) 0.96 (0.95-0.97)
0.98 (0.96-0.98) 0.96 (0.94-0.97) 1.00 (0.99-1.00)
0.98 (0.97-0.99) 0.93 (0.90-0.95)
0.97 (0.96-0.98) 0.74 (0.65-0.81)
0.95 (0.93-0.97) 0.75 (0.65-0.82) 0.98 (0.98-0.99)
Thick liquid
Solid
76
Abbreviations: CI = confidence interval, ICC = intraclass correlation coefficient.
Known groups validity
Patients had a significantly lower SPEAD-rate as well as a lower speed on the individual consistencies, compared to healthy participants (see Table 3). As hypothesized, patients had a median SPEAD-rate of 2 g/s (range 0-10), compared to 6 g/s (range 2-11) for healthy participants corresponding to a large effect size of 0.56 (see also Figure 2). Adjusted for age, dental prosthesis, and spoon use, the effect size was moderate (0.33) with an estimated difference between patients and healthy participants of 3 g/s. For thin liquid, median ingestion speed in the patient group was 6 g/s (range 1-25 g/s) versus 11 g/s (range 3-20 g/s) in the healthy group which corresponds to a moderate effect size of 0.44. For thick liquid, this was 2 g/s (range 0-11 g/s) versus 6 g/s (range 2-14 g/s) corresponding to a large effect size of 0.57 and for solid 0.04 g/s (range 0.01-0.15 g/s) versus 0.11 g/s (range 0.05-0.24 g/s) corresponding to a large effect size of 0.65. Moreover, patients were unable to finish the consistency more often, their average swallow volume was lower, and they had to cough more often compared to healthy participants.
When dividing participants into four groups based on degree of dysphagia rated by the SLP (no, mild, moderate and severe, with the healthy participants rated as no), SPEAD-rate decreases with increasing degree of dysphagia (p < .001) (see Figure 3). Also, although not statistically significant, SPEAD-rate decreased with increasing median DIGEST-scores (p = .054). However, SPEAD-rates of patients with DIGEST scores of 1 and 2 largely overlapped.
The difference in ingestion speed of thin-liquid only between patients and healthy participants, as comparable to the outcome of the WST, had an effect size of 0.44. The difference in ingestion speed of only solids, as comparable to the outcome of the TOMASS, had an effect size of 0.65. Both were somewhat comparable to the effect size of the SPEAD-test with all consistencies combined of 0.56.