Inter-rater reliability for judgment of cough following citric acid inhalation after training

Abstract

Diminished cough strength is prevalent in many neurological disorders and has been linked with the development of aspiration pneumonia. Subjective judgments of cough strength are common in clinical practice but the reliability of such judgments is unknown. This study investigated the inter-rater reliability of subjective judgments of cough in trained speech-language therapists (SLTs). Fifty-eight SLTs were trained in cough physiology and cough strength judgment. Participants were then asked to provide a rating of present or absent to 10 video segments of cough responses elicited by inhalation of nebulized citric acid in hospitalized patients. If coughing was present, they were then asked to provide a rating of strong or weak. Participants' inter-rater reliability for cough presence was calculated with a Fleiss' generalized kappa of 0.71 and cough strength was calculated at 0.52. SLTs demonstrated substantial agreement in subjectively judging the presence of cough. However, agreement in cough strength was only moderate. Years of dysphagia management experience did not improve inter-rater reliability significantly.

Keywords:

• Dysphagia
• Cough judgment
• Reliability
• Cough reflex testing
• Speech-language pathologist
• Speech-language therapist

Acknowledgements

The authors appreciate the contributions of all the SLTs who participated in this study.