Reliability and Validity of Non-Instrumental Clinical Assessments for Adults with Oropharyngeal Dysphagia: A Systematic Review

Abstract

This systematic review on non-instrumental clinical assessment in adult oropharyngeal dysphagia (OD) provides an overview of published measures with reported reliability and validity. In alignment with PRISMA, four databases (CINAHL, Embase, PsycINFO, and PubMed) were searched, resulting in a total of 16 measures and 32 psychometric studies included. The included measures assessed any aspect of swallowing, consisted of at least one specific subscale relating to swallowing, were developed by clinical observation, targeted adults, and were developed in English. The included psychometric studies focused on adults, reported on measures for OD-related conditions, described non-instrumental clinical assessments, reported on validity or reliability, and were published in English. Methodological quality was assessed using the standard quality assessment QualSyst. Most measures targeted only restricted subdomains within the conceptual framework of non-instrumental clinical assessments. Across the 16 measures, hypothesis testing and reliability were the most reported psychometrics, whilst structural validity and content validity were the least reported. Overall, data on the reliability and validity of the included measures proved incomplete and frequently did not meet current psychometric standards. Future research should focus on the development of comprehensive non-instrumental clinical assessments for adults with OD using contemporary psychometric research methods.

Keywords: content validity; deglutition; hypothesis testing; instrument development; internal consistency; measurement; psychometrics; structural validity; swallowing disorders.

Figure 1

Flow diagram of the review process based on PRISMA.

Figure 2

Conceptual mapping of non-instrumental clinical measure items. Note. Legend background colours. Green = Skills related to eating and drinking; Blue = Making adjustment to facilitate eating and drinking; Yellow = Swallowing act. ● = Item, but not part of scoring; ASHA-NOMS DS = ASHA-NOMS Dysphagia Scale; DDS = Dysphagia Disorders Survey; DMSS = Dysphagia Management Staging Scale; DSRS = Dysphagia Severity Rating Scale; EDACS = Eating and Drinking Ability Classification System; EDSQ = Easy Dysphagia Symptom Questionnaire; FOIS = Functional Oral Intake Scale; IDDSI-FDS = International Dysphagia Diet Standardisation Initiative Functional Diet Scale; MASA = Mann Assessment of Swallowing Ability; MASA-C = Mann Assessment of Wallowing Ability-Cancer; MISA = McGill Ingestive Skills Assessment; M-MASA/mMASA = Modified Mann Assessment of Swallowing Ability; SPEAD = Swallowing Proficiency for Eating and Drinking; TOMASS = Test of Masticating and Swallowing Solids.