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.


METHODS
Validity and reliability study.


METHODS
Tertiary care, academic medical center, metropolitan stroke unit.


METHODS
Acute stroke patients (N=302).


METHODS
Not applicable.


METHODS
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.
Crary
Michael A
MA
Department of Communicative Disorders, College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, FL 32610-0174, USA. mcrary@phhp.ufl.edu
Mann
Giselle D Carnaby
GD
Groher
Michael E
ME
D000368:Aged; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications / Q000503:physiopathology*