A systematic review of ordinal scales used to classify the eating and drinking abilities of individuals with cerebral palsy

Abstract

AIM The aim of this review was to examine systematically the scope, validity, and reliability of ordinal scales used to classify the eating and drinking ability of people with cerebral palsy (CP).METHOD Six electronic databases were searched to identify measures used to classify eating and drinking ability; in addition, two databases were used to track citations of key texts. The constructs assessed by each measure were examined in relation to the World Health Organization International Classification of Functioning, Disability and Health. Evidence of validity and reliability of the identified scales was appraised from peer-reviewed studies using standard criteria.RESULTS Fifteen scales were identified in 23 papers. Clinician or researcher assessment was required for 13 scales; nine scales made use of information from parents and carers through interviews or questionnaires. Eight scales used the terms mild, moderate, and severe (with varying definitions) to describe different aspects of eating and drinking impairment. There was an assessment of either content validity and/or reliability for five scales; however, none met the recommended psychometric quality standards. Individuals with cerebral palsy (CP) experience activity limitations including limitations in sitting, standing, walking, handling objects, and speaking. Impairments can also interfere with the oral functions required for eating, drinking, and swallowing, 1,2 and the ability to bring food and drink to the mouth.3 Limitations in the ability to bite, chew and swallow, and self-feed are often associated with prolonged mealtimes and loss of both food and fluid from the mouth; this can lead to insufficient food and fluid intake to ensure growth and good health, 3-7 as well as adverse respiratory consequences such as episodes of choking and aspiration. 1,[8][9][10] The prevalence of eating and drinking difficulties in individuals with CP is unclear.11 Estimates range from 27% 12 to 90%, 13 depending on the definitions and measurement tools used. It has been proposed that prevalence is related to the severity of motor impairment, 14 although eating and drinking difficulties also occur in individuals with mildly affected gross motor function. 22 The use of a consistent indicator of eating and drinking ability would enable more rigorous investigation of the prevalence of feeding disorders, and of associations between the severity of eating and drinking limitations and other health indicators such as growth, respiratory health, and gastrostomy use. 23A recent systematic review examined the psychometric performance and clinical utility of quantitative measures of oropharyngeal dysphagia in children with neurodevelopmental disabilities. 21 The aim of the current review was to examine the evidence for the validity and reliability of descriptive ordinal scales used to classify the eating and drinking ability of individuals with CP. These scales could then potentially be adopted in clinical and populationbased research. METHOD Search strategyA systematic search ...

Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy

“…Despite the indications when referring to GT surgery, another finding of the healthcare reported in the present study, was the lack of formal tools used to assess eating abilities. This corresponds to earlier stated inconsistencies in the use of clinical measures for eating, drinking, and feeding . Moreover, the children's participation in mealtimes, whether eating orally or not, was seldom a documented area of concern.…”

Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy

“…There is no agreement in the literature about the definition of the terms mild, moderate, and severe in relation to limitations to eating and drinking ability, or whether focus should be at the level of body functions and structures, activity, and/or participation. A recent systematic review identified the lack of a valid and reliable ordinal scale to classify the eating and drinking abilities of people with CP in both clinical and research contexts …”

The Eating and Drinking Ability Classification System in a population‐based sample of preschool children with cerebral palsy

“…Measurement and classification of oropharyngeal dysphagia in children with CP have been limited by lack of consensus in terms and corresponding constructs . Terms describing ‘severity’, consistent with other domains and disciplines, have been used variably, including mild, moderate, severe, and profound oropharyngeal dysphagia . A recent review identified 15 ordinal scales classifying the eating/drinking abilities of children with CP, but concluded that none had adequate psychometric properties to meet quality standards .…”