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Cited by 685Dysphagia Assessment and ManagementVoice and Speech DisordersChild Nutrition and Feeding Issues

MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard

Open access
Martin-Harris, Bonnie, Brodsky, Martin B., Michel, Yvonne, Castell, Donald O., Schleicher, Melanie, Sandidge, John, Maxwell, Rebekah, Blair, Julie·2008·Dysphagia
DOI 10.1007/s00455-008-9185-9PMC PMC4217120
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Abstract

The aim of this study was to test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment. Multiple regression, confirmatory factor, and correlation analyses were used to analyze 300 in- and outpatients with heterogeneous medical and surgical diagnoses who were sequentially referred for MBS exams at a university medical center and private tertiary care community hospital. Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p < or = 0.05). Factor analysis revealed 13 significant components (loadings >/= 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity. This study reflects potential for establishment of a new standard for quantification and comparison of oropharyngeal swallowing impairment across patient diagnoses as measured on MBSS.

Integrity signals

Registry

Crossref · 10.1007/s00455-008-9185-9

Cites

64 of 64 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 32 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Interrater and intrarater agreement for blinded MBSImp scoring of modified barium swallow studies was at least 80%.

    “Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs.”
    Quote in the paperSubstantial claim
  • Findingown data

    The cookie swallow contributed only to Oral Factor OI scores (lip closure, hold position/tongue control, bolus preparation/mastication).

    “The cookie swallow contributed to only Oral Factor OI scores (lip closure, hold position/tongue control, and bolus preparation/mastication).”
    Quote in the paperNot a substantial claim
  • Findingown data

    The cup-sip thin trial contributed to one OI Oral Factor score (initiation of the pharyngeal swallow) and four OI Pharyngeal Factor scores (soft palate elevation, laryngeal elevation, laryngeal closure, and pharyngeal stripping wave).

    “The data also demonstrated that the cup-sip thin trial contributed to one OI Oral Factor score, initiation of the pharyngeal swallow, and four OI Pharyngeal Factor scores that included soft palate elevation, laryngeal elevation, laryngeal closure, and pharyngeal stripping wave.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The 5-ml pudding teaspoon swallow contributed to two Oral (bolus transport, oral residue) and three Pharyngeal (laryngeal elevation, anterior hyoid motion, PES opening) OI scores.

    “The 5-ml pudding teaspoon swallow contributed to two Oral (bolus transport, oral residue) and three Pharyngeal (laryngeal elevation, anterior hyoid motion, and PES opening) IO impairment scores.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The 5-ml thin bolus and the 5-ml nectar bolus made salient contributions to OI scores in both Oral and Pharyngeal Factors.

    “The most striking result to emerge from the data was the salient contribution of the 5-ml thin bolus and the 5-ml nectar bolus to OI scores in both Oral and Pharyngeal Factors.”
    Quote in the paperSubstantial claim
  • May combine two claims. 39
  • Classified as probably not a substantial claim. 30
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Cup-sip nectar and sequential nectar swallows each contributed to only one OI score (initiation of the pharyngeal swallow and LE, respectively).

    “Cup-sip nectar and sequential nectar swallows each contributed to only one OI score, initiation of the pharyngeal swallow and LE, respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    5-ml nectar-thick liquid barium contributed to lip closure and tongue base retraction but not to bolus preparation/mastication.

    “Boluses of 5-ml nectar-thick liquid barium, however, contributed to lip closure and tongue base retraction but, similar to 5-ml thin, did not contribute to bolus preparation/mastication scores.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Seventeen swallowing impairment components and their observational scores remained after the 8-hour consensus session.

    “Seventeen components of swallowing impairment (test items) and their observational scores remained at the conclusion of the 8-h session (Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    One factor (Oral) included OI component scores related to oral tongue function, and the other (Pharyngeal) included scores related to pharyngeal clearance and airway protection.

    “One factor (Oral, in italics) included the OI component scores that related to oral tongue function. The other factor (Pharyngeal, in bold) included the OI component scores related to pharyngeal clearance and airway protection.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Oral and Pharyngeal Impairment scores correlated significantly with Penetration-Aspiration Scale scores and with indexes of intake status, nutrition, health status, and quality of life.

    “Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Factor loadings for lip closure and soft palate elevation were below threshold and were not included.

    “Factor loadings for lip closure (1) and soft palate elevation (7) were all below threshold and were not included.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Factor analysis identified 13 significant components with loadings ≥ 0.5, grouped into oral and pharyngeal impairment groupings.

    “Factor analysis revealed 13 significant components (loadings ≥ 0.5) that formed two impairment groupings (oral and pharyngeal).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    MUSC recruited and analyzed 58% of subjects, and SJHA recruited and analyzed 42%.

    “MUSC recruited and analyzed 58% of the subjects, SJHA recruited and analyzed 42% of the subjects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The analyzed sample of 300 subjects had a demographic distribution of 59% male, 41% female, 78% Caucasian, 19% African-American, 1% Asian, and 2% unknown or unreported.

    “In the combined sample of 300 subjects between the two sites (MUSC and SJHA), there were 59% male, 41% female, 78% Caucasian, 19% African-American, 1% Asian, and 2% unknown or unreported.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingreasoning

    The Delphi consensus process reached 100% agreement or stable responses among experts.

    “The process was repeated until 100% agreement was achieved or responses became stable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The component score operational definitions each represented a unique observation of structural movement, bolus flow, or both, and were converted to Likert scales.

    “The operational definitions for the component scores represented a unique observation of either structural movement, bolus flow, or both and were converted to a set of Likert scales (Fig. 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Averaged PA Scale scores were modestly negatively skewed, with most patients scoring in the normal range (1-2) despite moderate to severe swallowing impairment.

    “Higher results revealed that the averaged PA Scale scores were modestly negatively skewed, indicating that most patients scored within the normal range (scores = 1–2) despite the presence of moderate to severe swallowing impairment scores (Fig. 4).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    PG-SGA had statistically significant, clinically modest correlations with Oral Impairment (r=0.28, R2=0.08, p<0.0005) and Pharyngeal Impairment (r=0.20, R2=0.04, p<0.008).

    “The PG-SGA demonstrated a statistically significant, clinically modest correlation with Oral Impairment (r = 0.28, R2 = 0.08, p < 0.0005) and Pharyngeal Impairment (r = 0.20, R2 = 0.04, p < 0.008).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only two of six SF-6 health concepts showed significant, clinically modest correlations: General Health Perception with Oral Impairment (r=0.17, R2=0.03, p=0.04) and Pain with both Oral and Pharyngeal Impairment (r=0.16, R2=0.03, p=0.046).

    “Only two of the six health concepts of the SF-6 survey demonstrated a statistically significant, clinically modest correlation with Oral Impairment and Pharyngeal Impairment: General Health Perception and Oral Impairment (r = 0.17, R2 = 0.03, p = 0.04) and Pain and both Oral and Pharyngeal Impairment (r = 0.16, R2 = 0.03, p = 0.046).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Oral Impairment scores (r=0.47, R2=0.22, p<0.0005) and Pharyngeal Impairment scores (r=0.54, R2=0.29, p<0.0005) significantly correlated with the examining SLP's dietary recommendation/restriction.

    “Data showed a significant correlation between Oral Impairment scores (r = 0.47, R2 = 0.22, p < 0.0005) and Pharyngeal Impairment scores (r = 0.54, R2 = 0.29, p < 0.0005) with the dietary recommendation/ restriction made by the examining SLP.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The examining SLP's recommended diet restrictions are a valid external indicator of swallowing impairment severity.

  • May combine two claims.

    Findingown data

    PA Scale scores had significant but weak correlations with Oral Impairment (r=0.27, R2=0.07, p<0.0005) and Pharyngeal Impairment (r=0.22, R2=0.05, p<0.0005), explaining less than 10% of variation.

    “While significant correlations were found between PA Scale scores and Oral Impairment (r = 0.27, R2 = 0.07, p < 0.0005) and between PA Scale scores and Pharyngeal Impairment (r = 0.22, R2 = 0.05, p < 0.0005), PA Scale scores explained less than 10% of the variation in Oral and Pharyngeal Impairment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Although correlations were statistically significant, MBSImp scores contributed only modestly to variation in external indicators.

    “Although the correlations between the indexes were statistically significant, MBSImp scores contributed only modestly to their variation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Exploratory factor analysis of physiologic impairment observations yielded a two-factor solution fitting the historically described oral and pharyngeal phases, except initiation of the pharyngeal swallow.

    “However, when subjecting physiologic observations of impairment to exploratory factor analysis, a two-factor solution resulted which fits the historically described oral and pharyngeal “phases” of swallow with one exception—initiation of the pharyngeal swallow.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    BMI had no significant correlation with Oral Impairment (r=-0.08, R2=0.02, p=0.20) but had a statistically significant, clinically modest correlation with Pharyngeal Impairment (r=-0.21, R2=0.04, p<0.0005).

    “BMI demonstrated no significant correlation with Oral Impairment (r = -0.08, R2 = 0.02, p = 0.20), but demonstrated a statistically significant, clinically modest correlation with Pharyngeal Impairment (r = −0.21, R2 = 0.04, p < 0.0005).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: BMI is a valid common clinical indicator of nutritional status.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The Penetration-Aspiration Scale is a validated and reliable aspiration index.

    “Observed aspiration, as measured by a validated and reliable aspiration index, the Penetration-Aspiration (PA) Scale [56, 57], was measured using an 8-point scale.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [56] Robbins J, Coyle J, Rosenbek J, Roecker E, Wood J. Differentiation of normal and abnormal airway protection during swallowing using the penetration-aspiration scale. Dysphagia. 1999;14(4):228–32. doi: 10.1007/PL00009610 . source

      Not checked in the free run.

    • cites [57] Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. doi: 10.1007/BF00417897 . source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The number of patients who completed the anterior-posterior view with sufficient visibility fell below the required number for factor analysis, so pharyngeal contraction and esophageal clearance were excluded.

    “The number of patients who were able to complete the anterior-posterior view with sufficient visibility, however, fell below the required number of observations necessary for factor analysis. Therefore, these two components were not included in the factor analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The measured fluoroscopic input dose and image quality values were within IEC standards.

    “These values were compared to ensure that they were within the standards of the IEC.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The MBSS permits observation of the effects of bolus volumes, textures, and compensatory strategies on swallowing physiology.

    “Furthermore, clinicians are able to observe the effects of various bolus volumes, bolus textures, and compensatory strategies on swallowing physiology [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop. 1999;51(4–5):199–212. doi: 10.1159/000021497 . source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The MBSImp showed clinical practicality, favorable inter- and intrarater reliability after standardized training, content validity, and external validity.

    “The MBSImp demonstrated clinical practicality, favorable inter- and intrarater reliability following standardized training, content, and external validity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were collected on 345 subjects, but due to missing data and transfer/analysis difficulties, 300 subjects were analyzed.

    “Data were collected on 345 subjects throughout the study. Because of missing data from incomplete forms and difficulty with transfer and analysis of the MBSS, data for 300 subjects were analyzed in the final data set.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was approved by the Institutional Review Boards of MUSC and SJHA.

    “This study was approved by the Institutional Review Boards of MUSC and SJHA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Lack of standardization in MBSS reporting leads to ambiguous reporting, potential inaccuracies in assessment and management selection, and gaps in service delivery.

    “This lack of standardization leads to ambiguous reporting of results, potential inaccuracies in assessment and selection of management strategies, and gaps in service delivery from the examining swallowing clinician, the referring SLPs, physician(s), nurses, and”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Each SF-6 single-item measure correlates significantly with its long-form parent scale (range 0.71-0.83) and takes less than 3 minutes to administer.

    “Each single-item measure correlates significantly with its long-form-parent scale (range = 0.71–0.83), and the average length of time to administer the SF-6 is less than 3 min [62].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Stewart AL, Ware JEJ. Measuring functioning and well-being: The Medical Outcomes Study approach. Durham, NC: Duke University Press; 1992. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were deidentified before scoring, and the study data did not influence patient care.

    “Data generated from this study did not influence patient care and was deidentified before scoring procedures occurred long after the examination and the surveys explained below were completed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Trained SLPs achieved at least 80% agreement with the standard MBSImp scores, which the authors treated as evidence that training was successful.

    “the MBSImp training continued until the SLPs achieved a minimum of 80% agreement which demonstrated that the training was successful.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    An expert panel reviewed the diet restriction ranking and judged it a reasonable representation of the thickness/texture and restriction gradient.

    “Then, the ranking was reviewed by an expert panel and found to be a reasonable representation of the gradient of thickness/texture and restriction.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The CD-ROM used for independent study was peer-reviewed according to ASHA Continuing Education Unit standards.

    “This CD was peer-reviewed according to the standards outlined by the Continuing Education Unit of the ASHA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The SLPs were trained to consistently and accurately score based on comparison to the standard.

    “The SLPs were trained to consistently (intrarater) and accurately (interrater) score based on comparison to the standard.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The MBSS permits detection of the presence and timing of aspiration and helps identify its physiologic and often treatable causes.

    “The MBSS also permits detection of the presence and timing of aspiration, i.e., entry of ingested material below the level of the true vocal folds into the trachea, and assists in identifying the physiologic and often treatable cause(s) of the aspiration [35–38].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [35] Dodds WJ, Logemann JA, Stewart ET. Radiologic assessment of abnormal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990;154(5):965–74. source

      Not checked in the free run.

    • cites [36] Ekberg O, Sigurjonsson SV. Movement of the epiglottis during deglutition. A cineradiographic study. Gastrointest Radiol. 1982;7(2):101–7. doi: 10.1007/BF01887619 . source

      Not checked in the free run.

    • cites [37] Martin-Harris B, Logemann JA, McMahon S, Schleicher M, Sandidge J. Clinical utility of the modified barium swallow. Dysphagia. 2000;15(3):136–41. source

      Not checked in the free run.

    • cites [38] Ramsey GH, Watson JS, Gramiak R, Weinberg SA. Cinefluorographic analysis of the mechanism of swallowing. Radiology. 1955;64(4):498–518. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Expert judgment is often based on a panel's synthesis of experimental research evidence and on clinical experience/knowledge in validating items for test tools under development in absence of a gold standard.

    “Expert judgment is often based on a panel's synthesis of evidence from experimental research described in the literature, and on the clinical experience and knowledge of panel members in the validation of selected items for test tools under development in the absence of a gold-standard set (i.e., 100% specificity/100% sensitivity) [48].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Sackman H. Delphi critique. Lexington, MA: Lexington Books; 1975.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The PG-SGA is a scored categorical and continuous measure that incorporates medical history, height, and weight to determine malnutrition risk.

    “The PG-SGA is a scored categorical and continuous measure that takes into consideration the patient's medical history in addition to height and weight to determine risk for malnutrition [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Ottery F. Patient-generated subjective global assessment. In: McCallum P, Polisena C, editors. The clinical guide to oncology nutrition. Chicago: American Dietetic Association; 2000. p. 11–23.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The SF-6 measures six of the eight generic functional health concepts from the SF-36, each with a single item.

    “The SF-6 Health Survey [62] measures six of the eight generic functional health concepts included in the SF-36: physical functioning, role functioning, pain, general health perceptions, social functioning, and general mental health.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Stewart AL, Ware JEJ. Measuring functioning and well-being: The Medical Outcomes Study approach. Durham, NC: Duke University Press; 1992. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    BMI describes relative weight for height and is significantly correlated with total body fat content.

    “BMI describes the relative weight for height and is significantly correlated with total body fat content (Table 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: BMI is a valid common clinical indicator of nutritional status.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The Delphi method encouraged exchange of ideas and equal input by preventing bias due to position, status, or dominant personalities.

    “The process encouraged the exchange of ideas and information and enabled each participant to have equal input by preventing bias due to position, status, or dominant personalities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The SWAL-QOL is a 44-item tool with ten multi-item scales, and higher scores indicate better quality of life.

    “The SWAL-QOL is a 44-item tool consisting of ten multi-item scales (food selection, burden, mental health, social functioning, fear, eating duration, eating desire, communication, sleep, and fatigue) [63, 64].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [63] McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15(3):115–21. source

      Not checked in the free run.

    • cites [64] McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21(3):141–8. doi: 10.1007/s00455-005-0026-9 . source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Previous research has linked greater thickness and higher textures to greater intake restriction.

    “This rank ordering was based on previous research that related greater thickness and higher textures to greater intake restriction [37].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Martin-Harris B, Logemann JA, McMahon S, Schleicher M, Sandidge J. Clinical utility of the modified barium swallow. Dysphagia. 2000;15(3):136–41. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    All SWAL-QOL scales exhibit internal consistency and test-retest reliability.

    “All of the SWAL-QOL scales exhibit internal consistency and test-retest reliability.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [63] McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15(3):115–21. source

      Not checked in the free run.

    • cites [64] McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21(3):141–8. doi: 10.1007/s00455-005-0026-9 . source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Adaptation of a voluntary standards system will optimize patient quality of care, safety, efficacy, and cost.

    “Adaptation of a voluntary standards system will lead to optimization of the patient's quality of care, its safety, its efficacy, and its cost [71].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Translating Research Into Practice (TRIP)-II. Fact sheet. Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Publication No. 01-P017; 2001. http://www.ahrq.gov/research/trip2fac.htm . Accessed 1 Nov 2007.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The lack of unique relation for soft palate elevation and lip closure relates to the study's heterogeneous sample, which is both a limitation and a strength.

    “This finding relates to a limitation of the study that may also be considered a strength—heterogeneity of the sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Early work by Logemann and colleagues demonstrated contributions of oral tongue movement to onset of pharyngeal swallowing dynamics.

    “This finding fits with the early work of Logemann and colleagues who demonstrated the contributions of oral tongue movement to the onset of pharyngeal swallowing dynamics [66–69].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [66] Dodds WJ, Taylor AJ, Stewart ET, Kern MK, Logemann JA, Cook IJ. Tipper and dipper types of oral swallows. AJR Am J Roentgenol. 1989;153(6):1197–9. source

      Not checked in the free run.

    • cites [67] Ergun GA, Kahrilas PJ, Lin S, Logemann JA, Harig JM. Shape, volume, and content of the deglutitive pharyngeal chamber imaged by ultrafast computerized tomography. Gastroenterology. 1993;105(5):1396–403 [see comment]. source

      Not checked in the free run.

    • cites [68] Kahrilas PJ, Lin S, Logemann JA, Ergun GA, Facchini F. Deglutitive tongue action: volume accommodation and bolus propulsion. Gastroenterology. 1993;104(1):152–62. source

      Not checked in the free run.

    • cites [69] Pauloski BR, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck. 2000;22(2):120–31. doi :10.1002/(SICI)1097-0347(200003)22:2<120::AID-HED3>3.0.CO;2-U. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Demographics may differ in specialty hospitals, skilled nursing facilities, rural regions, and Veterans' Administration medical centers.

    “Clearly, the demographics may differ in specialty hospitals, skilled nursing facilities, rural regions, and Veterans’ Administration medical centers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Thin and nectar liquids do not require substantial bolus preparation, which explains why the 5-ml liquid and nectar swallows did not contribute to bolus preparation/mastication.

    “This is not surprising given that thin and nectar liquids do not require substantial bolus preparation as defined.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Standardized practices facilitate interinstitutional exchange of patient data using electronic data collection, aggregation, and reporting systems.

    “Standardized practices facilitate interinstitutional exchange of patient data using electronic data collection, aggregation, and reporting systems [71].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Translating Research Into Practice (TRIP)-II. Fact sheet. Rockville, MD: Agency for Healthcare Research and Quality, AHRQ Publication No. 01-P017; 2001. http://www.ahrq.gov/research/trip2fac.htm . Accessed 1 Nov 2007.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Previous evidence shows that swallowing physiology varies with bolus type (volume, consistency, texture, taste).

    “The evidence is clear from previous studies that swallowing physiology does vary as a function of bolus type, taking into consideration volume, consistency, texture, and taste.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The results of this study represent a critical strategic step toward standardization of swallowing assessment.

    “The results of this study shows the achievement of a critical strategic step toward standardization of swallowing assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    41 patients with feeding tubes or parenteral feedings for nonswallowing reasons were excluded from the diet analysis.

    “A total of 41 patients who had a feeding tube or parenteral feedings for nonswallowing reasons were excluded from the diet analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Penetration and aspiration are not necessary or sufficient measures of swallowing impairment.

    “These data suggest that penetration and aspiration are not necessary or sufficient measures of swallowing impairment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This finding supports the clinical validity of the tool for making intake decisions, given that the scoring clinician was blinded to clinical patient information.

    “This finding points to the clinical validity of the tool in making intake decisions given that the scoring clinician was blinded to all clinical patient information (cognitive status, medical diagnosis, social circumstances) that usually play a role in intake recommendations made by the examining SLP.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Implementation of standardized training, protocol, contrast materials, and measurements should improve the ability to compare swallowing impairment across clinics and clinical laboratories.

    “Implementation of such standardized training, protocol, contrast materials, and measurements should improve our ability to compare across clinics and clinical laboratories the swallowing impairment exhibited by our dysphagic patients during the course of recovery or physiologic decline associated with progressive neurologic diseases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The MBSImp is a standardized evaluation tool for videofluoroscopic assessment of swallowing impairment, created and rigorously tested in a heterogeneous, representative, cross-sectional sample of patients referred for MBSS.

    “A standardized evaluation tool for the videofluoroscopic assessment of swallowing impairment (MBSImp) has been created and rigorously tested in a heterogeneous, representative, cross-sectional sample of patients referred for MBSS; it is based on scored observations of physiologic and bolus flow measures.”
    Quote in the paperSubstantial claim
55 of 55

  • The paper relies on this without support.

    Before this study, the literature lacked external validation linking the kind and severity of oropharyngeal swallowing impairment to health indicators including restricted intake, aspiration pneumonia, poor health, and reduced quality of life across patient groups.

    “Furthermore, there has been no external validation demonstrating the relationship of the type and severity of oropharyngeal swallowing impairment with health indicators such as liquid/food intake restriction, aspiration pneumonia, poor health status, and quality of life across patient groups.”

  • The paper relies on this without support.

    BMI is a valid common clinical indicator of nutritional status.

    “a common clinical indicator of nutritional status, body mass index (BMI),was calculated for each patient”

  • The paper relies on this without support.

    The examining SLP's recommended diet restrictions are a valid external indicator of swallowing impairment severity.

    “The oral intake/modification(s) recommended by the examining SLP (i.e., recommendation was not made by the SLP who participated in the blind scoring) following the MBSS was recorded.”

  • The paper relies on this without support.

    PA Scale scores validly measure the frequency and severity of penetration and aspiration.

    “To capture frequency and severity of penetration and aspiration over the nine swallow trials, PA Scale scores were summed over all nine swallow trials.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported R2 does not match correlation coefficient

    Major

    For a correlation of r = -0.028, the corresponding R2 should be about 0.0008, not 0.08. The reported R2 is therefore inconsistent with the correlation coefficient given in the same sentence.

    Reported 0.08 · recomputed 0.000784

  • Food-selection correlation does not match its reported R2

    Major

    The reported correlation of −0.028 gives an R2 of 0.000784, not 0.08. The stated correlation therefore explains far less variation than the paper reports.

    Reported 0.08 · recomputed 0.000784

  • BMI calculation specifies incompatible measurement units

    Minor

    The prose specifies pounds and inches, while the formula specifies kilograms and meters. Those unit choices require different numerical calculations.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Martin BJW. The influence of deglutition on respiration. PhD dissertation. Evanston, IL: Northwestern University; 1991.
  2. Sackman H. Delphi critique. Lexington, MA: Lexington Books; 1975.
  3. Register F. Radiology devices. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; 2002.
  4. Rosenstein M, Suleiman O, Burkhart R, Stern S. The handbook for selected tissue doses for the upper gastrointestinalfluoroscopic examination. Rockville, MD: U.S. Department of Health and Human Services, Food and Drug Administration; 1992.
  5. Martin-Harris B, McMahon S, Haynes R. Aspiration and dysphagia: pathophysiology and outcome. Phonoscope. 1998;2:125–32.

Cited by

Sorted by citations

Related

Authors
Martin-Harris, B., Brodsky, M. B., Michel, Y., Castell, D. O., Schleicher, M., Sandidge, J., Maxwell, R., & Blair, J.
Affiliations
  • Medical University of South Carolina (US)
  • Saint Joseph's Hospital (US)
ORCID
Venue
Dysphagia
Publisher
Springer Science and Business Media LLC
Published
2008-10-15
Volume
23
Issue
4
Pages
392-405
ISSN
  • 0179-051X (ISSN-L)
  • 1432-0460
DOI
10.1007/s00455-008-9185-9
PMC
PMC4217120
OpenAlex
W2100994230
Cited by
685
References
64
Citations by year
2026: 47 · 2025: 67 · 2024: 71 · 2023: 68 · 2022: 68 · 2021: 66 · 2020: 65 · 2019: 51 · 2018: 40 · 2017: 40 · 2016: 25 · 2015: 18 · 2014: 19 · 2013: 11 · 2012: 11
FWCI
15.61
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Dysphagia (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Deafness and Other Communication Disorders (K23DC005764)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Medicine › Physiology › Voice and Speech Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
modified barium swallow, swallowing impairment, swallowing assessment, inter-rater reliability, intra-rater reliability, content validity, construct validity, generalizability, penetration-aspiration, oropharyngeal dysphagia, quality of life, nutrition
MeSH terms
Data Interpretation, Statistical, Deglutition, Deglutition Disorders, Humans, Photofluorography, Regression Analysis, Statistics as Topic, United States, Reproducibility of Results

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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