Revista CEFAC
https://www.revistacefac.org.br/article/doi/10.1590/1982-0216/202628411525
Revista CEFAC
Original Articles

Validity and reliability of the Protocol for Functional Evaluation of Swallowing by Nasal Endoscopy

Validez y confiabilidad del protocolo de evaluación funcional de la deglución por nasofibroscopía

Belkis David Parra-Reyes; Helen Angulo-Luna

http://dx.doi.org/10.1590/1982-0216/202628411525 Revista CEFAC, vol.28, n4, e11525, 2026
PDF English
PDF Español
SciELO
Downloads: 0
Views: 130

Abstract

Purpose: to evaluate the validity and reliability of the Protocol for Functional Evaluation of Swallowing by Nasal Endoscopy as a multidisciplinary assessment tool for dysphagia.

Methods: a protocol including six items related to structural and functional aspects of the pharyngeal phase with an instrumental study conducted in two phases. In the first phase, content validity was assessed using the Content Validity Index (CVI), based on the judgment of seven dysphagia experts. In the second phase, the instrument's reliability was analyzed through a pilot test applied to 120 patients diagnosed with oropharyngeal dysphagia, calculating Cronbach's alpha coefficient and item-total correlations.

Results: the protocol demonstrated adequate content validity, with item CVI values greater than 0.78 and an overall CVI of 0.94. Internal consistency was good (α = 0.86), with item-total correlations greater than 0.65 (p < 0.001). The sample consisted primarily of patients with neurological dysphagia (64.2%), predominantly due to stroke sequelae, and with moderate severity (73.3%). Pharyngeal residue (71.7%) was the most frequent finding in the functional assessment.

Conclusion: the Protocol for Functional Evaluation of Swallowing by Nasal Endoscopy demonstrated adequate content validity and reliability. It allows for a structured clinical evaluation, contributing to the detection of functional alterations and to therapeutic decision-making.

Keywords

Swallowing; Dysphagia; Nasofibroscopy; Reliability; Validation Study

Resumen

Objetivo: evaluar la validez y confiabilidad del Protocolo de evaluación funcional de la deglución por nasofibroscopía, como un instrumento de evaluación multidisciplinar para la disfagia.

Metodos: el protocolo incluye 6 ítems relacionados con aspectos estructurales y funcionales de la fase faríngea. Se realizó un estudio instrumental en dos fases. En la primera, se evaluó la validez de contenido mediante el Índice de Validez de Contenido (IVC), a partir del juicio de 7 expertos en disfagia. En la segunda, se analizó la confiabilidad del instrumento mediante una prueba piloto aplicada a 120 pacientes con diagnóstico de disfagia orofaríngea, calculando el coeficiente alfa de Cronbach y las correlaciones ítem-total.

Resultados: el protocolo mostró una adecuada validez de contenido, con valores de IVC por ítem superiores a 0,78 y un IVC global de 0,94. La consistencia interna fue buena (α = 0,86), con correlaciones ítem-total superiores a 0,65 (p < 0,001). La muestra estuvo conformada principalmente por pacientes con disfagia de origen neurológico (64,2%), predominando las secuelas de accidente cerebrovascular, y con severidad moderada (73,3%). En la evaluación funcional, el hallazgo más frecuente fue la presencia de residuos faríngeos (71,7%).

Conclusión: el protocolo de evaluación funcional de la deglución por nasofibroscopía, ha mostrado una adecuada validez de contenido y confiabilidad; y permite una valoración clínica estructurada, contribuyendo a la detección de alteraciones funcionales y a la toma de decisiones terapéuticas.

Palabras clave

Deglución; Disfagia; Nasofibroscopía; Confiabilidad; Estudios de Validación

Referencias

1. Wegner DA, Steidl EM, Pasqualoto AS, Mancopes R. Oropharyngeal deglutition, nutrition, and quality of life in individuals with chronic pulmonary disease. CoDAS. 2018;30(3):e20170088. https://doi.org/10.1590/2317-1782/20182017088 PMID: 29898054.

2. Borges ALDF, Velasco LC, Ramos HVL, Imamura R, Roldão PMAD, Petrillo MVB et al. Association between dysphagia and tongue strength in patients with amyotrophic lateral sclerosis. Braz J Otorhinolaryngol. 2022;88(05):752-7. https://doi.org/10.1016/j.bjorl.2020.10.015 PMID: 33461912.

3. De Brito MMOS, De Paula BH, Moreira VBF, De Lima VSH, De Almeida GCM, Junior HVM et al. Analysis of the deglutition parameters in patients with dysphagia after speech therapy and nutritional support. Research, Society and Development. 2020;9(10):e6809109081-e6809109081. https://doi.org/10.33448/rsd-v9i10.9081

4. D'Netto P, Rumbach A, Dunn K, Finch E. Clinical predictors of dysphagia recovery after stroke: A systematic review. Dysphagia. 2023;38(1):1-22. https://doi.org/10.1007/s00455-022-10443-3 PMID: 35445366.

5. Miller CK, Schroeder JW, Langmore S. Fiberoptic endoscopic evaluation of swallowing across the age spectrum. Am J Speech Lang Pathol. 2020;29(2S):967-78. https://doi.org/10.1044/2019_AJSLP-19-00072 PMID: 32650653.

6. Wilson T, Checklin M, Lawson N, Burnett AJ, Lombardo T, Freeman-Sanderson A. Understanding user experience and normative data in pharyngeal residue rating scales used in flexible endoscopic evaluation of swallowing (FEES): A scoping review. Int J Speech Lang Pathol. 2024:1-14. https://doi.org/10.1080/17549507.2024.2420606 PMID: 39529356.

7. Parra DR, Angulo HL. Nasofibroscopy of swallowing: Proposal for a cooperative protocol in speech therapy and otorrhinolaryngology. Revista Areté. 2021;21(1):43-54. https://doi.org/10.33881/1657-2513.art21104

8. Hyrkäs K, Appelqvist-Schmidlechner K, Oksa L. Validating an instrument for clinical supervision using an expert panel. Int J Nurs Stud. 2003;40(6):619-25. https://doi.org/10.1016/S0020-7489(03)00036-1 PMID: 12834927.

9. Halain AA, Yoong TL, Chan CM, Ibrahim NA, Abdullah KL. Development and validation of an educational information web page for family members with relatives in the Intensive Care Unit (ICU). Nurse Educ Pract. 2022;61:103324. https://doi.org/10.1016/j.nepr.2022.103324 PMID: 35299010.

10. Souza ACD, Alexandre NMC, Guirardello EDB. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude. 2017;26(3):649-59. https://doi.org/10.5123/S1679-49742017000300022 PMID: 28977189.

11. Bolarinwa OA. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J. 2015;22(4):195-201. https://doi.org/10.4103/1117-1936.173959 PMID: 26776330.

12. Taber KS. The use of Cronbach's alpha when developing and reporting research instruments in science education. Res Sci Educ. 2018;48:1273-96. https://doi.org/10.1007/s11165-016-9602-2

13. Alexandre NMC, Coluci MZO. Content validity in the development and adaptation processes of measurement instruments. Cien Saude Colet. 2011;16(7):3061. https://doi.org/10.1590/S1413-81232011000800006 PMID: 21808894.

14. Koller I, Levenson MR, Glück J. What do you think you are measuring? A mixed-methods procedure for assessing the content validity of test items and theory-based scaling. Front Psychol. 2017;21(8):126. https://doi.org/10.3389/fpsyg.2017.00126 PMID: 28270777.

15. Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: Evaluation and collaborative management. Am Fam Physician. 2021;103(2):97-106. PMID: 33448766.

16. Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E et al. Expert consensus statement: Management of dysphagia in head and neck cancer patients. Otolaryngol Head Neck Surg. 2023;168(4):571-92. https://doi.org/10.1002/ohn.302 PMID: 36965195.

17. Waters A, Patterson J, Bhat P, Phillips A. Investigating dysphagia in adults. BMJ. 2022;379:e067347. https://doi.org/10.1136/bmj-2021-067347 PMID: 36252961.

18. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C et al. ESPEN guideline on home enteral nutrition. Clinical Nutrition. 2020;39(1):5-22. https://doi.org/10.1016/j.clnu.2019.04.022 PMID: 31255350.

19. Bock JM, Varadarajan V, Brawley MC, Blumin JH. Evaluation of the natural history of patients who aspirate. Laryngoscope. 2017;127(Suppl. 8):S1-S10. https://doi.org/10.1002/lary.26854 PMID: 28884823.

20. Ji EK, Wang HH, Jung SJ, Lee KB, Kim JS, Hong BY et al. Is the modified Mann Assessment of Swallowing Ability useful for assessing dysphagia in patients with mild to moderate dementia? Journal of Clinical Neuroscience. 2019;70:169-72. https://doi.org/10.1016/j.jocn.2019.08.031 PMID: 31416733.

21. Johnson KL, Speirs L, Mitchell A, Przybyl H, Anderson D, Manos B et al. Validation of a postextubation dysphagia screening tool for patients after prolonged endotracheal intubation. Am J Crit Care. 2018;27(2):89-96. https://doi.org/10.4037/ajcc2018483 PMID: 29496764.

22. Warnecke T, Im S, Kaiser C, Hamacher C, Oelenberg S, Dziewas R. Aspiration and dysphagia screening in acute stroke-the Gugging Swallowing Screen revisited. Eur J Neurol. 2017;24(4):594-601. https://doi.org/10.1111/ene.13251 PMID: 28322006.

23. Ko HY, Huh S, Ko HY, Huh S. Respiratory dysfunction in spinal cord injuries. Handbook of spinal cord injuries and related disorders: A guide to evaluation and management. Singapore: Springer, 2021.

24. Curtis JA, Borders JC, Dakin AE, Troche MS. Normative reference values for FEES and VASES: Preliminary data from 39 nondysphagic, community-dwelling adults. J Speech Lang Hear Res. 2023;66(7):2260-77. https://doi.org/10.1044/2023_JSLHR-23-00132 PMID: 37343540.

25. Bahia MM, Lowell SY. A systematic review of the physiological effects of the effortful swallow maneuver in adults with normal and disordered swallowing. Am J Speech Lang Pathol. 2020;29(3):1655-73. https://doi.org/10.1044/2020_AJSLP-19-00132 PMID: 32463714.

26. Moon IY, Yi CH, Park IW, Yong JH. Effects of sitting posture and bolus volume on activation of swallowing-related muscles. J Oral Rehabil. 2020;47(5):577-83. https://doi.org/10.1111/joor.12934 PMID: 31926028.

27. Helliwell K, Hughes VJ, Bennion CM, Manning-Stanley A. The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: A narrative review. Radiography. 2023;29(2):284-90. https://doi.org/10.1016/j.radi.2022.12.007 PMID: 36640583.

28. Everton LF, Benfield JK, Hedstrom A, Wilkinson G, Michou E, England TJ et al. Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients. Scientific reports. 2020;10(1):7268. https://doi.org/10.1038/s41598-020-64208-9 PMID: 32350338.

29. Steele CM, Grace-Martin K. Reflections on clinical and statistical use of the penetration-aspiration scale. Dysphagia. 2017;32(5):601-16. https://doi.org/10.1007/s00455-017-9809-z PMID: 28534064.

30. Miller S, Ptok M, Jungheim M. Influence of acid swallows on the dynamics of the upper esophageal sphincter. Dysphagia. 2021;36(3):443-55. https://doi.org/10.1007/s00455-020-10159-2 PMID: 32886255.

31. Zimmerman E, Carnaby G, Lazarus CL, Malandraki GA. Motor learning, neuroplasticity, and strength and skill training: Moving from compensation to retraining in behavioral management of dysphagia. Am J Speech Lang Pathol. 2020;29(2S):1065-77. https://doi.org/10.1044/2019_AJSLP-19-00088 PMID: 32650656.

32. Mavrea S, Regan J. The diagnostic accuracy of the pitch glide to identify aspiration in patients with respiratory diseases: A pilot study. Folia Phoniatr Logop. 2020;72(5):331-40. https://doi.org/10.1159/000501451 PMID: 31514185.

33. McHutchison L, Miles A, Spriggs D, Jayathissa S. Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia. Australas J Ageing. 2018;37(4):E120-E126. https://doi.org/10.1111/ajag.12562 PMID: 30069993.
 

Submitted date:
07/10/2025

Accepted date:
15/04/2026

6a7c7affa953950dce4a0ba6 cefac Articles
1982-0216 (Electrónico) 1516-1846 (Impreso)
Revista CEFAC ©2026 Todos los derechos reservados sobre el contenido de este sitio web. Los artículos siguen sus propias licencias.

Revista CEFAC

Share this page
Page Sections