title: New scoring system improves inter-rater reliability of the Neonatal Oral-Motor Assessment Scale.
abstract: OBJECTIVE
  The Neonatal Oral-Motor Assessment Scale (NOMAS) is a standardised tool to assess sucking patterns in infants to 48 weeks of postmenstrual age (PMA). In the Netherlands, the interpretation of specific NOMAS items has evolved, leading to a new scoring system. Recent research using the NOMAS describes a way of clustering the most frequent items, and the aim of this study was to determine whether those changes improved the inter-rater reliability.
  
  
  METHODS
  The inter-rater reliability was tested by two NOMAS-certified therapists who scored 120 video recordings of 40 preterm infants, admitted to the University Hospital of Düsseldorf, Germany, at 34, 37 and 44 weeks PMA, for normal, disorganised and dysfunctional diagnosis. The NOMAS comprised 28 items and five clusters of items.
  
  
  RESULTS
  The therapists agreed on the level of diagnoses for 116 of 120 recordings (Cohen's Κ 0.90), on an item level for 107 of 120 recordings (Cohen's Κ 0.78) and on a cluster level for 108 of 120 recordings (Cohen's K 0.90).
  
  
  CONCLUSIONS
  The new scoring system improved the inter-rater reliability of the NOMAS on all levels, highlighting the importance of NOMAS user having a clear understanding on how to interpret and score each item.
authors.affiliation: Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
authors.forename: Saakje P
authors.initials: SP
authors.lastname: da Costa
authors.affiliation: Department of General Pediatrics, University Hospital of Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Hübl
authors.affiliation: Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kaufman
authors.affiliation: Department of Pediatrics, Neonatology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
mesh_terms: D000067290:Behavior Rating Scale / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009426:Netherlands; D015588:Observer Variation; D013391:Sucking Behavior
keywords: Neonatal Oral-Motor Assessment Scale; Oral feeding performances; Oral-motor problems; Sucking and swallowing; Sucking patterns