Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale

Catriona M Steele,Ashwini M Namasivayam-Macdonald,Brittany T Guida,Julie A Cichero,Janice Duivestein,Ben Hanson,Peter Lam,Luis F Riquelme

doi:10.1016/j.apmr.2018.01.012

Abstract

ObjectiveTo assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. DesignParticipants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. SettingWeb-based survey. ParticipantsRespondents (N=170) from 29 countries. InterventionsNot applicable. Main Outcome MeasuresConsensual validity (percent agreement and Kendall τ), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). ResultsThe International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (>70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. ConclusionsThis initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians to capture diet texture restriction and progression in people with dysphagia.

Highlights

MethodsA Google Surveya was developed and launched on September 1, 2016. Ethics approval was obtained from the local institutional www.archives-pmr.org Scale NameNo of Target Population Levels DirectionFunctional Status Scale[3 ] Pediatrics1 (normative function) to 5(severe dysfunction)Swallowing Performance Status Scale[4]Dysphagia Outcome and Severity Scale[5]American Speech-LanguageHearing Association National
For case scenarios with Functional Oral Intake Scale (FOIS) scores of 4 and 5, corresponding International Dysphagia Diet Standardisation Initiative (IDDSI) Functional Diet Scale scores spanned a larger range from 2 to 6, suggesting that the IDDSI Functional Diet Scale was better able to capture gradations of diet texture restriction. The participants in this survey found it straightforward to assign IDDSI Functional Diet Scale scores to most of the case scenarios developed for the validation study
Based on the survey responses received in the survey, it has been decided that IDDSI Functional Diet Scale scores will reflect the main diet prescription and that therapeutic diet advances should be annotated using a þ diacritic

Summary

Methods

A Google Surveya was developed and launched on September 1, 2016. Ethics approval was obtained from the local institutional www.archives-pmr.org Scale NameNo of Target Population Levels DirectionFunctional Status Scale[3 ] Pediatrics1 (normative function) to 5(severe dysfunction)Swallowing Performance Status Scale[4]Dysphagia Outcome and Severity Scale[5]American Speech-LanguageHearing Association National. A Google Surveya was developed and launched on September 1, 2016. Ethics approval was obtained from the local institutional www.archives-pmr.org Scale Name. Functional Status Scale[3 ] Pediatrics. Swallowing Performance Status Scale[4]. Dysphagia Outcome and Severity Scale[5]

Results

Discussion

Conclusion