McGill Ingestive Skills Assessment (MISA): Development and First Field Test of an Evaluation of Functional Ingestive Skills of Elderly Persons

Abstract

There is a lack of reliable and valid clinical assessment tools for individuals with loss of ingestive skills. The McGill Ingestive Skills Assessment (MISA) was developed to facilitate the reliable and valid bedside assessment of elderly persons with feeding difficulties. Items were generated by a literature review and selected with the collaboration of a multidisciplinary team. The first version of the MISA comprised 190 items in 7 scales, covering the domains of medical history, mealtime environment, physical characteristics of the patient, food textures consumed, solid ingestion, liquid ingestion, and behaviors related to self-feeding. The first field test for item selection included 50 individuals, aged 60 years and older, living in the community, supervised housing, and long-term care centers. After field testing, 134 items were eliminated due to poor face validity, redundancy, or poor psychometric performance. The remaining 56 items were provided with 4 response categories and were reorganized into 5 scales. The revised version was field tested to determine its preliminary psychometric properties on 33 individuals, 60 years of age and older, residing in a long-term care center. Six items were eliminated due to redundancy after the second field test. Analyses of the revised version resulted in the elimination of another 6 items that were redundant or that demonstrated poor reliability. Internal consistency of all scales is > or = 0.86 and interrater agreement is > or = 0.92. These analyses suggest that the psychometric properties of the MISA are adequate for diagnosis and treatment planning. This supports its readiness for clinical use following further reliability and validity testing with a larger sample.

Comparison of Three Types of Tongue Pressure Measurement Devices

“…Although tongue movement, strength, and coordination are normally a part of the clinical evaluation of swallowing [16,17], these evaluations are often quite subjective.…”

Decreased Tongue Pressure Reflects Symptom of Dysphagia

“…Although criteria exist for bedside evaluation of tongue movement, strength, and coordination [16,17], they are quite subjective. Objective assessments are needed for an interdisciplinary approach to assessing swallowing problems.…”

Content validation of a Danish version of “The McGill Ingestive Skills Assessment” for dysphagia management

“…The MISA seems to provide an alternative approach as it evaluates the ability of elderly patients to consume a variety of foods and liquids safely and independently during the usual mealtime routine, and guides the occupational therapist in identifying areas where skills are impaired and amenable to rehabilitation (13). The items in the MISA have been generated from an extensive literature review and focus-group methodology (17). Pilot testing and preliminary psychometric testing were carried out to enable item reduction and refinement (17).…”

“…The items in the MISA have been generated from an extensive literature review and focus-group methodology (17). Pilot testing and preliminary psychometric testing were carried out to enable item reduction and refinement (17). Finally, large-scale testing of the MISA's psychometric properties indicates adequate construct validity, known-groups validity, predictive validity, internal consistency, interrater reliability, and intrarater reliability (18,19).…”