Validation of the Fleming Index of Dysphagia Using Videofluoroscopy

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Abstract
The Fleming Index of Dysphagia is a questionnaire incorporating information from empirical investigation, patient observation and report. It is designed to determine prevalence and severity of oral, pharyngeal and oesophageal dysphagia. The index was validated using videofluoroscopy with 26 patients referred for videofluoroscopy or barium swallow/meal radiological investigation. There was a significant, moderate positive correlation between prevalence and severity of dysphagia identified using the Fleming Index of Dysphagia and that was determined from evaluation of videofluoroscopy. The index accurately allocated severity levels in 69% of cases and was conservative, overestimating dysphagia severity in 27% of cases. Modification of the index by removing radiographic, endoscopic or manometric data resulted in loss of validity and underestimation of severity levels. Changed impact score cutoff points did not increase the correlation between the Fleming Index of Dysphagia and videofluoroscopy or increase accuracy of allocation into severity levels. Item profiles could not be distinguished on the basis of dysphagia in severity.