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.
Key Words
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Article info
Footnotes
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.
Identification
Copyright
© 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
