Design and Content Validation of an Ultrasound Swallowing Assessment Protocol

Abstract

Although evidence suggests that ultrasound can be used to evaluate and quantify various dynamic aspects of swallowing, no validated protocol currently exists for exploring the swallowing process specifically. This cross-sectional descriptive study aimed to design a swallowing assessment protocol with diagnostic utility for dysphagia and to validate its content through expert judgment. Seven national and international specialists participated in a survey, where Lawshe’s statistical test was used, requiring a content validity index (CVI) of 0.99. In addition to this, a method for resolving controversies was used. The resulting items included: tongue characteristics, hyoid-thyroid approximation, vocal fold adduction, assessment of the upper esophageal sphincter, and hyoid bone movement. The experts also provided input on the type of transducer to use for the evaluation and the type of examination to perform for each item. The protocol was subsequently applied to three healthy subjects to determine measurement possibilities and establish technical conditions for the examination. The results were validated by a sonographer and an international specialist. Based on the findings of this study, future directions include proceeding to the criterion validity phase by piloting the protocol in a healthy population, as well as conducting studies to establish standard and normative values.