Research Design

The purpose of this quantitative study is twofold: to determine (a) the inter rater reliability in interpretation of Fiber optic Endoscopic Evaluations of Swallowing (FEES) exams, and (b) the factors that influence the diet recommendations made by Speech Language Pathologists (SLP’s) in acute hospital settings.

Questions that will be explored through this study are: 

1. What is the inter rater reliability in interpretation of FEES exams by SLP's in acute hospital settings?

2. How consistent are recommendations made by SLP’s when evaluating results of a FEES exam in acute hospital settings? 

3. What are the factors that influence the diet recommendations made by SLP’s based on results of FEES exams in acute hospital settings?

4. How do SLPs' level of experience relate to their choices regarding diet recommendations based on results of FEES exams in acute hospital settings? 

Given this purpose and these research questions, my study falls under the category of a correlational design. This correlational approach is reflected in the second portion of the purpose statement, the study will attempt to find what factors influence the diet recommendations chosen by an SLP. 

Purpose Statement and Research Questions Revised

Here is my revised Purpose Statement and Research Question...

The purpose of this quantitative study is twofold: to determine (a) the inter rater reliability in interpretation of Fiber optic Endoscopic Evaluations of Swallowing (FEES) exams, and (b) the factors that influence the diet recommendations made by Speech Language Pathologists (SLP’s) in acute hospital settings.

Questions that will be explored through this study are: 

1. What is the inter rater reliability in interpretation of FEES exams by SLP's in acute hospital settings?

2. How consistent are recommendations made by SLP’s when evaluating results of a FEES exam in acute hospital settings? 

3. What are the factors that influence the diet recommendations made by SLP’s based on results of FEES exams in acute hospital settings?

4. How do SLPs' level of experience relate to their choices regarding diet recommendations based on results of FEES exams in acute hospital settings? 

Purpose Statement and Research Questions

The purpose of this quantitative study is to explore the level of inter rater reliability in interpretation of Fiber optic Endoscopic Evaluations of Swallowing (FEES) exams and the factors that influence the diet recommendations made by Speech Language Pathologists (SLP’s).

Questions that will be explored through this study are:

1) How consistent are the interpretations of results of FEES exams when evaluated by different SLP’s?

2) How consistent are recommendations made by different SLP’s evaluating results of a FEES exam?

3) How does level of experience of SLP’s relate to how conservative their recommendations are with regards to patient’s diets?

Blog Post #2

I chose to create an outline rather than a literature map...

Potential Literature Review Outline

I. Introduction

The goal for a Speech Language Pathologist is to put patients with dysphagia on the safest, least restrictive diet possible. An area in need of more research is the level of consistency between practitioners in interpreting Fiberoptic Endoscopic Evaluations of Swallowing (FEES) in acute hospital settings. Inconsistency in interpretation can potentially result in patients being placed on inappropriate diets, either too restrictive or not restrictive enough.

II. Summary of articles supporting the need for inter rater reliability in instrumental swallowing exams (both FEES and MBS)

A)   Tohara, H., Nakane, A., Murata, S., Mikushi, S., Ouchi, Y., Wakasugi, Y., Takashima, M., Chiba, Y., Uematsu, H., (2010) Inter and intra rater reliability in fiberoptic evaluation of swallowing. Journal of Oral Rehabilitation. 37, 884-891.

B)   Hey, C., Pluschinski, P., Stanschus, S., Eular, H.A., Sader, R.A., Langmore, S., Neumann, K. (2011). A documentation system to save time and proper application of the fiberoptic endoscopic evaluation of swallowing (FEES). Folia Phoniatrica et Logopaedica. 63, 201-208.

C)   Umay, E.K., Unlu, E., Saylam, G.K., Cakci, A., Korkmaz, H. (2013). Evaluation of dysphagia in early stroke patients by bedside endoscopic and electrophysiological methods. Dysphagia. 28, 395-403.

D)   Brady, S., Donzelli, J. (2013). The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngology Clinic North America 46, 1009-1022

E)   Sia, I., Carvajal, P., Carnaby-Mann, G.D., Crary, M.A. (2012) Measurement of hyoid and laryngeal displacement in video fluoroscopic swallowing studies: variability, reliability and measurement error. Dysphagia. 27, 192-197

F)    Speyer, R. (2013). Oropharyngeal dysphagia screening and assessment. Otolaryngology Clinic North America 46, 989-1008

III. Summary of articles supporting standardization of instrumental exams to encourage reliability

A)   Benadom, E.M., Potter, N.L. (2011). The use of simulation in training graduate students to perform transnasal endoscopy. Dyphagia. 26, 352-360

B)   Martin Harris, B., Brodsky, M.B., Michel, Y., Castell, D.O., Schleicher, M., Sandidge, J., Maxwell, R., Blair, J. (2008). MBS measurement tool for swallow impairment- MBSImp establishing a standard. Dysphagia. 23, 392-405

IV. Argument and support for gap in the literature for inter rater reliability for FEES exams

A)   Colodny, N. (2002) Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (FEES) using the penetration-aspiration scale. A replication study. Dysphagia. 17 (4), 308-315.

Key words: Dysphagia, endoscopy, fiberoptic, deglutition, inter rater reliability

I am really struggling with determining a theoretical framework for this topic. I don’t feel that focusing on a physiological theory fits this topic, as I am not looking at physiological improvement. Would it be appropriate to use some type of behavior theory that relates to the behavior and decision making of the SLP’s interpreting the study? I’d appreciate any feedback!

Research Problem Statement, Revised

The problem to be addressed in this study is the lack of consistency in interpretation of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) exams in acute hospital settings

Post #1: Research Problem Statement

Research problem statement:

There is a lack of consistency in interpretation of FEES (Fiberoptic Endoscopic Evaluation of Swallowing) exams in acute hospital settings

Justification for this study:

-This lack of consistency can put patients at risk of being on the wrong diet, either too conservative or too stringent.

-The connection with consistency in interpretation of Modified Barium Swallow studies has been more extensively researched, very little research has been devoted to this topic with FEES exams