Optimizing Dysphagia Evaluation in Chile: Development of a Non-Nutritive Clinical Swallowing Examination for Adult Inpatients

Although robust screening protocols exist for the early detection of swallowing disorders, a detailed Clinical Swallow Examination (CSE) remains essential for guiding timely and effective intervention. The Mann Assessment of Swallowing Ability is a widely referenced tool, yet it omits several components critical to clinical practice. Following initial screening, Speech and Language Therapists (SLTs) often rely on non-standardized assessments developed locally. This lack of standardized tools with established psychometric properties hinders consistent clinical evaluation and the development of equitable treatment guidelines. Aim: To develop a standardized Spanish-language CSE focused on the non-nutritive component of oropharyngeal swallowing in adults, tailored for use by SLTs. Methods: The study was conducted in two phases. Phase 1 established content validity through expert consensus. Phase 2 evaluated psychometric properties, including internal consistency, inter-rater reliability, and construct and content validity. The instrument was tested with 132 participants (79 healthy individuals and 53 patients). Exploratory and confirmatory factor analyses initially supported the inclusion of 18 items. However, Cronbach's alpha indicated that three items—dentition, saliva accumulation, and odynophagia—did not significantly contribute to internal consistency. While two of these items were excluded, saliva accumulation was retained due to its positive contribution to model fit. The final version of the CSE included 16 items. Results: Two scoring approaches were explored: a standardized, factor-derived score and a clinically oriented score based on the percentage of total item scores. Both performed similarly, although the clinically oriented score proved more practical for real-world application due to its ease of interpretation. Conclusions: This standardized CSE provides SLTs with a reliable and validated tool for assessing oropharyngeal dysphagia, especially in low- and middle-income countries with limited access to instrumental assessments. Its use supports more equitable, consistent, and effective patient care.