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

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

Research output: Contribution to journalArticlepeer-review

84 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)49-57
Number of pages9
JournalJournal of Stroke and Cerebrovascular Diseases
Volume19
Issue number1
DOIs
StatePublished - Jan 2010
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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