Original article
Initial Psychometric Assessment of a Functional Oral Intake Scale for Dysphagia in Stroke Patients

https://doi.org/10.1016/j.apmr.2004.11.049Get rights and content

Abstract

Crary MA, Carnaby Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients.

Objective

To report on the development and psychometric evaluation of a clinical scale to document change in functional oral intake of food and liquid in stroke patients.

Design

Validity and reliability study.

Setting

Tertiary care, academic medical center, metropolitan stroke unit.

Participants

Acute stroke patients (N=302).

Interventions

Not applicable.

Main Outcome Measures

Interrater reliability, validity, and sensitivity to change assessments were completed on a 7-point ordinal scale—the Functional Oral Intake Scale (FOIS)—developed to document the functional level of oral intake of food and liquid in stroke patients. Interrater reliability was drawn from FOIS ratings applied to dietary information from patient medical charts. Consensual validity was estimated by rankings from judges against predefined scale scores. Criterion validity was evaluated by comparison to the Modified Rankin Scale, the Modified Barthel Index, and Mann Assessment of Swallowing Ability. Cross-validation was assessed via comparison to 2 physiologic measures of swallowing function. Change in functional oral intake over time was assessed descriptively by applying the scale to dietary information from a cohort of 302 acute stroke patients followed up for 6 months.

Results

Interrater reliability was high, with perfect agreement on 85% of ratings. Kappa statistics ranged from .86 to .91. Consensual validity was high (.90). Criterion validity was high at onset and 1 month poststroke. Significant associations were identified between the FOIS and stroke handicap scales. The FOIS was significantly associated with 2 physiologic measures of swallowing. Scores on the FOIS from the cohort of stroke patients showed a shift toward increased oral intake over a 6-month period.

Conclusions

The FOIS had adequate reliability, validity, and sensitivity to change in functional oral intake. These findings suggest that the FOIS may be appropriate for estimating and documenting change in the functional eating abilities of stroke patients over time.

Section snippets

Development of the FOIS for Stroke Patients

Development of the FOIS for stroke patients has proceeded through 2 stages: (1) initial scale development and item selection, face validity, interrater reliability, and consensual validity and (2) criterion validity, cross-validation, and evaluation of sensitivity to expected change in functional performance.

We selected items for the initial scale based on a review of dysphagia literature and chose items with the intent of describing the type and amount of oral intake of food and liquid that a

Interrater Reliability

Agreement between paired judges ranged from 85% to 95%. Perfect agreement was observed across all judges on 85% of all patient records. Rank correlations ranged between .98 and .99. Average κ values ranged from .86 to .91.

Consensual Validity

Agreement with the predefined scale scores ranged from 81% to 98%. The Kendall concordance was .90.

Criterion Validity

All stroke measures (MRS, MBI, MASA) were significantly associated with the FOIS score on admission to a stroke unit and at 1 month poststroke (table 2). The strongest

Discussion

Collectively, these data indicate adequate interrater reliability in addition to adequate consensual and criterion validity and cross-validation with other swallowing measures. The FOIS has been shown to reflect change in oral intake of food and liquid over time in a cohort of acute stroke patients who were expected to have improved oral intake. These preliminary studies indicate that the FOIS may be an appropriate tool to clinically document change in functional oral intake of food and liquid

Conclusions

The FOIS is an ordinal scale that reflects the functional oral intake of patients with dysphagia. Results of this study indicate that the FOIS is robust in terms of interrater reliability and consensual validity. Compared with standard clinical measures of stroke outcome, the FOIS shows strong criterion validity and cross-validation. Finally, in a cohort of acute stroke patients, the FOIS showed an expected increase in functional oral intake over a 6-month recovery period. Collectively, the

Acknowledgment

We acknowledge the contributions to data analysis of Julia Pizzi, MA, Research Associate at the Royal Perth Hospital, Perth, Western Australia.

References (16)

  • H.M. Finestone et al.

    Quantifying fluid intake in dysphagic stroke patientsa preliminary comparison of oral and nonoral strategies

    Arch Phys Med Rehabil

    (2001)
  • G. Mann et al.

    Swallowing disorders following acute strokeprevalence and diagnostic accuracy

    Cerebrovasc Dis

    (2000)
  • G. Mann et al.

    Swallowing function after strokeprognosis and prognostic factors at 6 months

    Stroke

    (1999)
  • D.G. Smithard et al.

    The natural history of dysphagia following a stroke

    Dysphagia

    (1997)
  • R. Sala et al.

    Swallowing changes in cerebrovascular accidentsincidence, natural history, and repercussions on the nutritional status, morbidity, and mortality

    Rev Neurol

    (1998)
  • K.L. DePippo et al.

    Validation of the 3-oz water swallow test for aspiration following stroke

    Arch Neurol

    (1992)
  • G.D. Mann

    The Mann Assessment of Swallowing Ability

    (2001)
  • M.A. List et al.

    A performance status scale for head and neck cancer patients

    Cancer

    (1990)
There are more references available in the full text version of this article.

Cited by (1096)

  • Dysphagia and Enteral Feeding After Stroke in the Rehabilitation Setting

    2024, Physical Medicine and Rehabilitation Clinics of North America
View all citing articles on Scopus

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

View full text