Original articleInitial Psychometric Assessment of a Functional Oral Intake Scale for Dysphagia in Stroke Patients
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.
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