Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES).
Johanna Fransson, Sofia Thorén, Jenny Selg and 2 others
PMID 39046477WHAT IT FOUND
Experienced speech pathologists using the Swedish Dysphagia Outcome Severity Scale to rate silent endoscopic videos agreed strongly with each other and with the gold standard assessment.
The scale appears valid and reliable for use with FEES, even without audio or patient history.
Key findings
01Inter-rater agreement among 11 speech pathologists was high (Krippendorff's alpha = 0.891), and intra-rater agreement was almost perfect (weighted Kappa = 0.945).
02Ratings made on silent, edited FEES videos showed strong to very strong correlation with scores from a comprehensive gold-standard evaluation that included patient history and audio.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The FEES videos were silent, which prevented raters from hearing coughs or voice changes, yet agreement remained high. In real clinical practice, you usually have this audio information. The raters were blinded to patient history and diagnosis, which is not how the scale is typically used in a full clinical evaluation. The study used a small sample of 17 videos from 15 patients, selected to represent a range of severity, which may not capture the complexity of all clinical cases. Validity was compared against the Functional Oral Intake Scale and the original DOSS score, but not against other instrumental measures like VFSS.
Declared interests
The study was funded by Umea University. No other conflicts of interest were declared.
The easy way to misread this
Do not assume the DOSS-S is equally reliable when used on unedited, full-length FEES with audio and patient history, as this study specifically tested its performance on silent, blinded videos.