Visual Analysis of Swallowing Efficiency and Safety (VASES): Establishing Criterion-Referenced Validity and Concurrent Validity

Abstract

Purpose: The primary aim of this study was to examine the criterion-referenced validity of the Visual Analysis of Swallowing Efficiency and Safety (VASES). As a secondary aim, we examined the concurrent validity of using verbal numerical ratings for VASES as a potential substitute for visual analog scale ratings. Method: Fifty-seven novice raters were prospectively recruited to rate 26 flexible endoscopic evaluations of swallowing (FEES) images (2 times each, randomized)—once using VASES and once using a criterion-referenced scale. Ratings were made for the valleculae, piriforms, epiglottis, laryngeal vestibule, vocal folds, and subglottis. Criterion validity was determined by examining the correlation between VASES and the criterion-referenced scales. The novice raters also provided visual analog scale ratings following verbal numerical ratings. Concurrent validity of using verbal numerical ratings as a potential substitute for visual analog scale ratings was determined by examining the correlation and absolute agreement between both rating methods. Results: Three thousand five hundred eighty-seven ratings were analyzed. Spearman's correlation revealed strong correlations between VASES ratings and criterion-referenced ratings across all anatomic landmarks (ρ = .882–.915). Lin's concordance revealed substantial agreement between numerical ratings and visual analog scale ratings (ρ c = .986). Conclusions: The strong correlations between VASES and the criterion-referenced scales suggest that VASES is a valid method for interpreting pharyngeal residue, penetration, and aspiration during FEES. Furthermore, numerical ratings exhibited substantial agreement with visual analog scales. This suggests that clinicians could provide verbal numerical ratings in lieu of visual analog scale ratings as a potential way to enhance the ease and feasibility of implementing VASES into clinical practice. Supplemental Material: https://doi.org/10.23641/asha.18737072