Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis

Abstract

Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis.

An Introduction to Item Response Theory and Rasch Analysis: Application Using the Eating Assessment Tool (EAT-10)

“…There were several key findings from the Cordier et al’s (2017) report. First, they found evidence that a subset of items had questionable fit with the model using standardized but not mean-square fit statistics and evidence that the measure was reasonably, if not strictly, unidimensional.…”

“…Subsequently, Rasch-model IRT analysis of the EAT-10 was performed by Cordier et al in a population of persons with oropharyngeal dysphagia receiving evaluations at outpatient dysphagia or otorhinolaryngology clinics in Italy, Spain, Sweden, and Turkey (Cordier et al, 2017). They reported on rating scale validity, operationalized as monotonically increasing scores, on the fit of persons and items to the model, on the dimensionality of the measure, on differential item functioning, and on floor and ceiling effects of the measure.…”

“…Additionally, they noted monotonically increasing average measure scores, consistent with the assumption of IRT models, but large steps (relative to the centre of the rating scale) and disorder between the average item thresholds where adjacent categories are equally probable (i.e., Rasch–Andrich thresholds: the sum of (person measures−item measures)/count of observations in a category). Based on this disordering, Cordier and colleagues (2017) suggested that thought should be given to collapsing rating scale categories.…”

Development of a simplified dysphagia assessment by dentists in older persons

“…It showed several methodological weaknesses and problems with intercultural validation. The authors suggest that all versions be redesigned and investigated from the Rasch analysis . This study suggests that the Brazilian version of EAT‐10 also presents some methodological weaknesses and problems related to intercultural validation.…”

Prediction of aspiration in dysphagia using logistic regression: oral intake and self-evaluation

“…The EAT-10 [24] is a short 10-item self-administered questionnaire [7]. Although predominantly regarding FHS, it also includes some HR-QoL items [25]. Each one is rated on a five-point scale (0-4); the summed score ranges from 0 to 40 (higher scores are more abnormal).…”