Development of a Remote Examination of Deglutition Based on Consensus Surveys of Clinicians (Part I): Selection of Examination Items

Abstract

In order to ensure appropriateness and feasibility of examination items for remote evaluation for deglutition disorders, a questionnaire based on the Delphi method was administered to 122 speech–language–hearing therapists (STs), and a set of examination items was selected. The participants were instructed to view a video recording of a remote assessment situation and answer a 30-item questionnaire. Of 19 items ensuring the appropriateness for deglutition disorders detection, 13 items ultimately met the consensus criteria for remote feasibility. Factor analysis extracted three factors: ‘oral observation,’ ‘overall evaluation,’ and ‘perceptual voice judgment.’ In free-text responses, “quality and stability of the voice that may be heard through the device” were the most common concerns, followed by “the need to correct of the camera angle, magnification, and targets that should be projected,” “concerns about the technical aspects of the assistants and their role in relation with the examiner/ST,” and “the need for palpation as well as visual confirmation.” The proposed 13-item examination is considered to capture the characteristics of deglutition disorders, while items that appeared difficult to implement remotely were excluded. The fact that some items could be influenced by the video calling experience when judging the feasibility of remote implementation, the acceptability of such items, is likely to increase in the future.

Development of a Remote Examination of Deglutition Based on Consensus Surveys of Clinicians (Part II): Reliability and Validity in Healthy Elderly Individuals and Oral Cancer Patients

“…In the questionnaire surveys of SLHTs in Part I of our study, the most common comments were "concerns about the quality and stability of the voice that may be heard through the device. [ 22 ]" However, there was also a high level of agreement in the items that included assessment of voice quality: "sustained phonation and voice quality," "water intake (3 ml, 10 ml)," and "staple food intake (pharyngeal response)." Ward et al [ 16 ] found a high degree of agreement between remote and face-to-face comparisons in their evaluation of wet voice.…”

“…There are two major differences between RED and other existing tests. First, RED consists only of items that were judged to be remotely feasible in our Part I study [ 22 ]. In contrast, other standardized tests developed for face-to-face conditions have been directly adapted for remote evaluation.…”

“…In this study, we created a simulated remote scene by connecting a training room and another room in the hospital via a web conference system [ 22 ]. Specifically, the SLHT and the participant were in separate rooms in the facility, with an assistant present on the participant's side.…”

“…In Part I of our study [ 22 ], we extracted items that were appropriate for detecting deglutition disorders and for remote administration, using questionnaire surveys of Japan’s nationally licensed speech-language-hearing therapists (SLHTs). In addition, we sought to obtain professional consensus on the type and amount of test materials (food), role of an assistant, and components of visualization, etc.…”