Validity and reliability of Bahasa Malaysia Eating Assessment Tool (mEAT-10): A good screening tool for safe swallowing.

OBJECTIVE

This study aimed to investigate the validity and reliability of the Bahasa Malaysia version of the Eating Assessment Tool-10 (mEAT-10) and determine the cutoff point for abnormal swallowing.

METHODS

This prospective convenience sampling study was conducted at a tertiary center between December 2019 and May 2022. The mEAT-10 was produced following rigorous forward and backward translations. One hundred and thirty-eight participants, including 70 healthy volunteers and 68 patients with dysphagia, were recruited to complete the test-retest mEAT-10 assessment and the 3-ounce water test. The mEAT-10 was repeated within four weeks via telephone interviews or clinic visits. Patients in the dysphagia group underwent flexible endoscopic evaluation of swallowing (FEES). The FEES results were evaluated independently by four different raters to determine the reliability of the penetration-aspiration score (PAS) scoring, which categorizes them into safe and unsafe swallowing for data analysis. Internal consistency and test-retest agreement were assessed using Cronbach alpha and intraclass correlation coefficient (ICC). The mEAT-10 comparison between the normal and dysphagia groups was performed using the Mann-Whitney U test. The association between PAS and mEAT-10, gag reflex,3-ounce water test and the other risk factors were evaluated using chi-square and Fisher exact test, with univariable and multivariable logistic regression.

RESULTS

The mEAT-10 test-retest showed a Cronbach alpha of >0.90 and an ICC of >0.85. The mEAT-10 cutoff score indicating abnormal swallowing is seven, with sensitivity and specificity of 0.82 and 0.54, respectively. In univariable analysis, higher mEAT-10 scores (≥7), absence of gag reflex, and failure of the 3-ounce water test were all significantly associated with unsafe swallowing (PAS ≥3). In multivariable logistic regression, however, failure of the 3-ounce water test was the only independent predictor of unsafe swallowing (PAS ≥3; adjusted odds ratio 4.24, 95% confidence interval 1.53-11.77; p=0.006).

CONCLUSION

mEAT-10 is a reliable tool for screening and assessing patients with dysphagia. A cutoff score of 7 or more indicates abnormal swallowing and maybe associated with unsafe swallowing (PAS ≥3).