Swallowing may be assessed by a comprehensive battery of tools including instrumental/objective assessments, clinician-rated measures and patient-reported measures. The authors of this paper use secondary analysis to explore concordance between videofluoroscopy and a patient-reported dysphagia quality of life (QOL) measure. The data was pooled from a three-arm RCT investigating service delivery modes (clinician-directed F2F, telehealth via swallow IT and patient self-directed treatment) when completing an intensive swallowing exercise programme. As no significant differences were found between the groups in the original study, the authors elected to analyse the data as a single cohort for this secondary analysis. They compared the Modified Barium Swallow Impairment Profile (MBSImP) scores with the MD Anderson Dysphagia Inventory (MDADI) – both validated measures widely in use. On multivariable analysis, they found that the MBSImP pharyngeal stage composite score was significantly associated with the MDADI global scores (p=0.001) and the MDADI emotional subscale (p=0.044), with a positive trend for the MDADI physical subscale (p=0.06). No associations were seen with the functional subscale or between the MBSImP Oral stage composite scores and the MDADI domains. The authors reflect that their findings differ from other reports in the literature. They acknowledge that there may be greater concordance at baseline and up to three months, and that these measures may become more divergent as patients adjust and adapt. An interesting paper that raises important considerations about choice of swallowing tools, timing of use and the nature of exactly what is being measured by swallowing instruments.