Analysis of a Physician Tool for Evaluating Dysphagia on an Inpatient Stroke Unit: The Modified Mann Assessment of Swallowing Ability

Antonios, Nader; Carnaby-Mann, Giselle; Crary, Michael; Miller, Leslie; Hubbard, Holly; Hood, Kelly; Sambandam, Raam; Xavier, Andrew; Silliman, Scott

doi:10.1016/j.jstrokecerebrovasdis.2009.03.007

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 19, Issue 1 , Pages 49-57, January 2010

Analysis of a Physician Tool for Evaluating Dysphagia on an Inpatient Stroke Unit: The Modified Mann Assessment of Swallowing Ability

Nader Antonios, MD
- Department of Neurology, College of Medicine, University of Florida, Jacksonville, Florida
Giselle Carnaby-Mann, MPH, PhD
- Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
- Address correspondence to Giselle Carnaby-Mann, MPH, PhD, Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, PO Box 100175, Gainesville, FL 32610-0175.
Michael Crary, PhD
- Department of Communicative Disorders, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
Leslie Miller, MS
- Department of Rehabilitation Service, Shands Hospital, Jacksonville, Florida
Holly Hubbard, MA
- Department of Rehabilitation Service, Shands Hospital, Jacksonville, Florida
Kelly Hood, MS
- Department of Rehabilitation Service, Shands Hospital, Jacksonville, Florida
Raam Sambandam, MD
- Department of Neurology, College of Medicine, University of Florida, Jacksonville, Florida
Andrew Xavier, MD
- Department of Neurology, College of Medicine, University of Florida, Jacksonville, Florida
Scott Silliman, MD
- Department of Neurology, College of Medicine, University of Florida, Jacksonville, Florida

Received 30 July 2008; received in revised form 18 March 2009; accepted 26 March 2009.

Background

Although many dysphagia screening protocols have been introduced in recent years, no validated, physician-administered dysphagia screening tool exists for acute stroke that can be performed at the bedside. Based on the psychometrically validated Mann Assessment of Swallowing Ability (MASA), we developed the Modified MASA (MMASA) as a physician-administered screening tool for dysphagia in acute stroke.

Objective

The purpose of this study was to complete initial validation of this new screening tool for dysphagia in acute ischemic stroke.

Methods

Two stroke neurologists independently performed the MMASA on 150 patients with ischemic stroke. Speech-language pathologists performed the standard MASA on all patients. All examiners were blinded to the results of the other assessments. Interjudge reliability was evaluated between the neurologists. Validity between the screening tool (MMASA) and the clinical evaluation (MASA) was assessed with sensitivity/specificity and predictive value assessment.

Results

Interobserver agreement between the neurologists using the MMASA was good (k=0.76; SE=0.082). Based on the comprehensive clinical evaluation (MASA), 36.2% of patients demonstrated dysphagia. Screening results from the neurologists (N1 and N2) identified 38% and 36.7% prevalence of dysphagia, respectively. Sensitivity (N1: 92%, N2: 87%), specificity (N1: 86.3%, N2: 84.2%), positive predictive value (N1: 79.4%, N2: 75.8%), and negative predictive value (N1: 95.3%, N2: 92%) were high between the screen and the comprehensive clinical evaluation.

Conclusions

This preliminary study suggests that the MMASA is a potentially valid and reliable physician-administered screening tool for dysphagia in acute ischemic stroke. Use of this tool may facilitate earlier identification of dysphagia in patients with stroke prompting more rapid comprehensive evaluation and intervention.

Key Words: Stroke, swallowing, screening