doss swallowing scale pdf
The Dysphagia Outcome Severity Scale (DOSS) is a seven-point scale designed to systematically assess the functional severity of swallowing difficulties based on objective evaluation. Created at Hartford Hospital, DOSS aims to improve rating consistency and guide treatment plans.
What is the DOSS?
The Dysphagia Outcome Severity Scale, or DOSS, is a straightforward, seven-level rating system created to assess the severity of dysphagia, or swallowing difficulties. It provides a structured method for healthcare professionals to evaluate a patient’s swallowing function following objective assessments, such as videofluoroscopy or a clinical swallowing evaluation. The DOSS is not a patient self-report scale; instead, it is completed by clinicians based on their observations and findings. This tool serves as a standardized way to describe the patient’s current swallowing ability, ranging from normal to severe impairment, facilitating clear communication among healthcare teams. The scale takes into account the safety and efficiency of the swallow, considering aspects like bolus transport and airway protection. Its main goal is to streamline the evaluation and to ensure consistent recommendations for diet modifications, level of feeding independence, and appropriate nutrition.
Purpose of the DOSS
The primary purpose of the Dysphagia Outcome Severity Scale (DOSS) is to offer a consistent and reliable method for rating the severity of dysphagia, moving beyond subjective descriptions to a standardized, objective assessment. This allows for a clearer picture of a patient’s swallowing function. The DOSS is designed to aid clinicians in making well-informed decisions regarding diet modifications, levels of feeding independence, and the most suitable types of nutritional support. By using a seven-level scale, the DOSS aims to standardize the terminology and recommendations surrounding dysphagia management. It helps to improve communication among members of the care team by creating a common language. This ultimately enhances patient care by ensuring that recommendations are tailored to an individual’s specific swallowing needs and abilities, leading to better outcomes and reduced risk of complications.
DOSS Structure and Levels
The DOSS employs a 7-point scale, ranging from level 1, indicating severe dysphagia, to level 7, denoting normal swallowing function. This structure allows for nuanced assessment of swallowing abilities and difficulties.
The 7-Point Scale
The Dysphagia Outcome Severity Scale (DOSS) utilizes a 7-point ordinal scale to categorize the severity of swallowing dysfunction. This scale is structured to provide a systematic method for clinicians to rate a patient’s swallowing abilities, ranging from the most severe impairment to normal function. Each level on the scale is defined by specific characteristics relating to oral and pharyngeal function, bolus transport, airway protection, and pharyngeal retention. The scale is designed to be easy to use and helps establish consistency in recommendations for diet, independence level, and nutritional support. The 7-point scale was developed to systematically rate the functional severity of dysphagia based on objective assessment and make recommendations for diet, independence, and nutrition. The scale’s points allow clinicians to easily assess and rate patients’ swallowing function in a simple manner.
DOSS Levels of Severity
The DOSS levels range from 1 to 7, with Level 1 indicating the most severe dysphagia, where the individual is unable to swallow anything orally, and Level 7 representing normal swallowing function across all situations. Intermediate levels describe varying degrees of swallowing impairment. For instance, a patient at Level 2 might demonstrate severe dysphagia, requiring non-oral feeding and strict precautions. Level 3 might involve moderate dysphagia where the person needs a modified diet and assistance, while Level 4 could indicate mild to moderate dysphagia. Levels 5 and 6 then represent mild forms, potentially with some limitations. The levels of severity systematically rate functional severity of dysphagia, with each level reflecting the person’s ability to safely and efficiently swallow, considering factors like bolus control and airway protection.
DOSS Assessment and Application
The DOSS is applied following objective swallowing evaluations, such as videofluoroscopy. It helps determine diet levels, independence in feeding, and the necessity of non-oral nutrition, based on the observed swallowing abilities.
How DOSS is Used in Dysphagia Assessment
The Dysphagia Outcome Severity Scale (DOSS) serves as a structured method for clinicians to evaluate the functional impact of dysphagia following an objective swallowing assessment. Typically, this involves procedures like videofluoroscopy (VFSS) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The DOSS is not a diagnostic tool, but rather a means to quantify the severity of observed swallowing impairments. It allows clinicians to systematically translate findings into a numerical score, reflecting the individual’s ability to safely and effectively swallow. This score incorporates factors such as oral and pharyngeal phase function, bolus transport, airway protection, and any signs of pharyngeal residue. Using DOSS, clinicians can consistently document and communicate the severity of dysphagia which can aid in developing appropriate treatment strategies.
DOSS and Diet Level Recommendations
The Dysphagia Outcome Severity Scale (DOSS) plays a crucial role in guiding diet level recommendations for individuals with swallowing difficulties. The seven-point scale directly links specific DOSS scores to appropriate diet textures and liquid viscosities, ensuring safe and effective oral intake. A lower DOSS score, indicating more severe dysphagia, will typically correspond to a more restrictive diet. This might include pureed foods and thickened liquids to minimize aspiration risk. Conversely, a higher DOSS score, indicative of mild or no dysphagia, allows for a less restricted diet, possibly including regular foods and thin liquids. The DOSS helps clinicians make consistent and evidence-based decisions about diet modifications, ensuring the patient’s nutritional needs are met while minimizing risks associated with swallowing impairment. This structured approach helps avoid guesswork in diet prescription.
DOSS and Independence Level Evaluation
The Dysphagia Outcome Severity Scale (DOSS) is not only useful for determining diet levels but also for evaluating the level of independence a patient has during mealtimes. The DOSS considers a person’s ability to self-feed and manage their swallowing without needing assistance. A low DOSS score suggests a significant need for assistance and monitoring during meals, possibly requiring complete feeding or supervision to ensure safety. As the DOSS score increases, it indicates a greater level of independence in eating, and a decreased need for support. A higher DOSS score suggests the patient can eat independently with minimal or no supervision. The DOSS, therefore, provides a standardized method for assessing and documenting the level of assistance required by patients with dysphagia. This information helps to create an individualized plan for each patient.
DOSS Reliability and Validity
The DOSS demonstrates strong intra- and interjudge reliability, meaning that different clinicians consistently rate swallowing severity similarly. Studies also confirm DOSS validity when used with objective methods like FEES.
Intra- and Interjudge Reliability of DOSS
The Dysphagia Outcome Severity Scale (DOSS) has been rigorously examined for its reliability, a crucial factor in any assessment tool used in clinical practice. Intra-rater reliability, which refers to the consistency of ratings made by the same clinician over time, has been shown to be high for the DOSS, indicating that a single professional will consistently evaluate a patient’s swallowing abilities. This consistency is vital for tracking a patient’s progress or decline. Inter-rater reliability, which examines the level of agreement between different clinicians, has also been reported to be robust for the DOSS, ensuring that different professionals will arrive at similar conclusions when evaluating the same patient, which is vital for consistent patient care. The high level of agreement among different clinicians using the DOSS further validates its reliability as a clinical tool. These findings support the DOSS’s value in ensuring that assessments are both consistent and reliable across different clinical settings and clinicians.
DOSS Validity in Different Assessment Methods (e.g., FEES)
The validity of the Dysphagia Outcome Severity Scale (DOSS) has been investigated across various assessment methods, particularly with Flexible Endoscopic Evaluation of Swallowing (FEES). Studies have shown a strong criterion validity for DOSS when used in conjunction with FEES, demonstrating its effectiveness in accurately reflecting swallowing function. This means that the DOSS scores obtained from FEES assessments correlate well with actual swallowing abilities. The DOSS’s ability to maintain its validity across different assessment methods like FEES strengthens its role as a versatile tool. This ensures that the scale can be reliably used regardless of the evaluation method used, contributing to consistency in dysphagia assessment. The DOSS’s consistent validation across different assessment techniques underscores its value as a dependable and adaptable tool for healthcare professionals evaluating swallowing disorders. The DOSS’s consistent performance enhances its utility for making accurate clinical judgments about swallowing function.
Related Scales and Tools
Several scales and tools exist for dysphagia assessment, including the EAT-10 and Dysphagia NRS. These instruments offer different perspectives on swallowing difficulties, complementing the DOSS in clinical practice.
Comparison with Other Dysphagia Scales (e.g., EAT-10, Dysphagia NRS)
The Dysphagia Outcome Severity Scale (DOSS) is often compared to other dysphagia scales like the Eating Assessment Tool-10 (EAT-10) and the Dysphagia Numeric Rating Scale (NRS). The EAT-10 is a patient-reported outcome measure, focusing on the patient’s perception of their swallowing difficulties, while the DOSS relies on objective clinical evaluations. The Dysphagia NRS, on the other hand, is a 10-point scale where patients rate the severity of their symptoms over a specific period, typically the past 24 hours or seven days. Unlike the DOSS, which assigns a severity level and makes recommendations for diet and independence, the NRS primarily focuses on symptom severity. These differences highlight how these tools serve distinct but complementary purposes in dysphagia assessment. The DOSS is a tool for clinicians to rate the severity of dysphagia based on objective assessments, whereas EAT-10 is a patient-reported outcome measure for patients to rate the severity of their symptoms. Unlike these, the Dysphagia NRS allows patients to rate their symptoms over a period of time.
The Swallowing Disturbance Questionnaire (SDQ)
The Swallowing Disturbance Questionnaire (SDQ) is another tool used in the assessment of swallowing difficulties, providing a different perspective compared to the Dysphagia Outcome Severity Scale (DOSS). While the DOSS is a clinician-administered scale based on objective findings, the SDQ is a questionnaire designed to capture the patient’s subjective experience of swallowing problems. It aims to detect symptoms and clinical abnormalities related to swallowing, offering valuable insights into the functional impact of dysphagia from the patient’s point of view. An SDQ score exceeding 12.5 is considered a strong predictor of swallowing disturbances, both diagnosed and undiagnosed. This makes the SDQ a useful screening tool and a valuable complement to objective assessments like those used in the DOSS. The SDQ can provide key information on the patient’s subjective experience of their swallowing difficulties and may be used to help guide treatment. It is a good predictor of swallowing difficulties and can serve as a screening tool.