We commend DePippo and colleagues1 for studying the 3-oz water swallow test, a simple but potentially useful bedside test for aspiration after stroke. Before being of use to clinicians, however, it is essential to provide more details about the test procedures such as the patient's position (upright position was recommended in the "Comments" section) and the rapidity with which patients were instructed to swallow. What proportion of patients with stroke at risk for aspiration were unable to do the test (because they could not hold a cup, for example)?
When evaluating subjective assessments such as the water swallow test and the modified barium swallow, it is important that the person doing the test not be aware of the results of the neurologic examination, or the other test. Was this the case? Interpretation of a wet hoarse voice and cough might vary from observer to observer. Was the interobserver variability
Biem HJ, Laupacis A. Hard to Swallow Test. Arch Neurol. 1994;51(2):119. doi:10.1001/archneur.1994.00540140021006
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