Measuring mealtime performance in older adults with suspected oropharyngeal dysphagia: an updated systematic review of psychometric properties

Abstract

Purpose

To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD).

Materials and methods

Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN).

Results

Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five.

Conclusions

There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted.

Implication for rehabilitation

• Assessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information.

• Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable.

• Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments.

• Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD.

Keywords:

• Deglutition disorders
• validity
• reliability
• performance-based outcome measurements
• systematic review
• COSMIN

Acknowledgements

The authors received no financial support for the research, authorship, and/or publication of this article.

Disclosure statement

The first author has been involved in the translation and further validation of one of the included PerFOMs (MISA1-DK and MISA2-DK). Though academic and intellectual competing interests are relevant to consider, the methodology of this systematic review minimizes the risk of confirmation bias.

^aThe analyses of unidimensionality and internal consistency by the Rasch model in references 48 and 49 were applied to the same population. Reference 49 elaborated on the analysis performed in reference 48.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.