Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study

This study used Fiberoptic Endoscopic Evaluation of Swallowing (FEES(R)) to assess the reliability of the Penetration-Aspiration Scale (PAS) using 79 swallows and four judges in a replication of a study using videofluoroscopy (VFSS). The swallows were diagnosed using FEES, which allowed for comparison between the two techniques. The findings indicated that all categories of the PAS achieved adequate reliability, both on intrajudge and interjudge assessments. Reliabilities, with the exception of Scale Score 7, were higher in this study than in the original study by Rosenbek and associates. Data analysis indicated that judges were more highly consistent on second ratings compared with their original ratings, indicating a learning curve on the PAS. In addition, findings suggested that the FEES was more reliable on assessing penetration than VFSS, but that VFSS was more reliable on the assessment of the various severities of aspiration. The two techniques were equally effective in discriminating between penetration and aspiration. This study found that FEES was just as reliable as VFSS when using the PAS.