Mode of nutrition as a reflection of swallowing ability in acute and sub-acute stroke: Validation of a bedside tool.

BACKGROUND

The Feeding Status Scale (FSS) is a 7-point scale based on mode of nutrition in patients with swallowing impairment: normal diet, soft-diet, nasogastric-tube feeding, percutaneous endoscopic gastrostomy tube-feeding, parenteral fluids, no fluids/food and death. We assessed whether the FSS is a valid and reliable scale of feeding status.

METHODS

Validation was established through secondary analysis of individual patient data from randomised trials in hospitalised patients with stroke. Validation was assessed as concurrent and predictive validity, intra- and inter-rater reliability, content validity (using untrained assessors) and minimum clinically important difference.

RESULTS

Data were obtained from four trials with total 8435 participants, mean age 70.2 years. In stroke trial populations with or without dysphagia, FSS was associated with other stroke scales (motor impairment, dependency, mood, cognition and quality of life) at baseline (concurrent validity, e.g. motor impairment p < 0.001) and during follow-up (predictive validity, e.g. dependence, cognition, quality of life, all p < 0.001). Both intra- and inter-rater reliability showed excellent agreement (intraclass correlation coefficient ≥0.92). Item level content validity index rating indicated good-excellent (I-CVI 0.63-1.0) relevance of each point of the scale. Scale level content validity index rating was good (S-CVI-Ave 0.83). Within scale minimum clinically important difference (MCID) was found to be 1 point.

CONCLUSIONS

Mode of nutrition as assessed using the FSS is closely associated with swallow impairment and produces reliable results without specific training. FSS had good-excellent content validity, can be used with established stroke measures at different time points and is associated with swallowing impairment.