Session Information
Date: Wednesday, June 22, 2016
Session Title: Rating scales
Session Time: 12:00pm-1:30pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: A new FEES protocol specified for dysphagia diagnosis among Parkinson’s disease (PD) patients was recently developed in a prior two-phased study¹, which is now aimed to be investigated for interrater reliability.
Background: Dysphagia as a frequent and clinically relevant symptom of PD is leading to various threats to health and reduction in quality of life. Although the penetration-aspiration scale has become a standard for FEES, it fails to identify beginning oropharyngeal symptoms.
Methods: FEES video recordings from 77 PD patients at a Munich Movement Disorder Center (aged 70.47 +/- 8.40 (mean, SD), disease duration 11.19 +/- 6.27 y., median Hoehn & Yahr stage 3) previously evaluated with the new PARK-FEES protocol were reevaluated independently from 2 experts. PARK-FEES contains 10 ordinal parameters to describe early and advanced dysphagia symptoms typically occurring in PD. Examination order was performed in a standardized procedure incl. anatomic-physiological exam, nutrition ingestion of 3 diff. consistencies, and medication samples. Score assessment was done twice in order to distinguish typical swallowing performance from possible outliners (maximum values).
| PARAMETERS (inspection of structure, sensory-reflex-analyses, functional exam, swallowing tests)* | SCALE **1 |
|---|---|
| 1. Secretion management | 0-4 (0=normal) |
| 2. Vocal cord motility ([i:] phonation) | 0-2 (0=normal) |
| 3. Glottal closure (tightly breath-holding) | 0-2 (0=normal) |
| 4. Voluntary cough impact | 0-2 (0=normal) |
| 5. Bolus leakage (H2O, BREAD, COOKIE) | 0-4 (0=normal) each |
| 6. Residues (H2O, BREAD, COOKIE, 2 PILLS) | 0-3 (0=normal) each |
| 7. Clearance effectiveness (H2O, BREAD, COOKIE, TABLET, PILL) | 0-4 (0=normal) each |
| 8. Leakage afterwards (H2O, BREAD, COOKIE) | 0-4 (0=normal) each |
| 9. Penetration aspiration scale (PAS) (H2O, BREAD, COOKIE) | 1-8 (1=normal) each |
| 10. Type of penetration/aspiration: pre-, intra-, postdeglutitive (H2O, BREAD, COOKIE) | 0-3 (0=normal) each |
Results: 73% of patients presented with swallowing disabilities (44% oropharyngeal, 29% penetration/aspiration). 11 of the 26 estimations achieved a Kalpha above the threshold of .60 indicating good inter-coder agreements when tested in all 3 observers’ evaluations (original examination situation and both posteriori ratings). Highest values resulted for “Clearance effectiveness PILL” (Kalpha= .89, CI .78-97), “Residues PILL” (.88; .73-1.00), and “Leakage afterwards BREADmax” (.81, .64-.96). Even more parameters can be outlined with excellent interrater reliability by comparing both posteriori observed evaluations pairwise.
Conclusions: Using PARK-FEES enables clinicians to accurately characterize dysphagia symptoms and supports to differentiate early oropharyngeal from clinically advanced stages. Furthermore, it demonstrates a high level of interrater reliability. The next step is to define a score classification algorithm for overall assessment of dysphagia severity in order to facilitate interprofessional communication and appropriate treatment strategies.
To cite this abstract in AMA style:
J.A. Simons, S. von Clarmann, T. Warnecke. Reliability of a newly developed protocol for fiberoptic endoscopic evaluation of swallowing in Parkinson’s patients (PARK-FEES) [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/reliability-of-a-newly-developed-protocol-for-fiberoptic-endoscopic-evaluation-of-swallowing-in-parkinsons-patients-park-fees/. Accessed June 6, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/reliability-of-a-newly-developed-protocol-for-fiberoptic-endoscopic-evaluation-of-swallowing-in-parkinsons-patients-park-fees/