Aims: The Mealtime Assessment Scale (MAS) was developed to assess swallowing safety and efficacy during the meal. The study aims to perform a preliminary validation of MAS by investigating internal consistency, inter-rater agreement, concurrent and known-group validity, and responsiveness. Methods: MAS was tested on 100 persons without dysphagia (group 1) and 100 persons with dysphagia (group 2). Fifty subjects were simultaneously evaluated at mealtime using MAS by two independent clinicians to test inter-rater agreement. For concurrent validity, MAS was correlated with the Mann Assessment of Swallowing Ability (MASA) and American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale. MAS scores of groups 1 and 2 were compared for known-group validity. Responsiveness was tested reassessing 36 patients from group 2 after diet improvement. Results: Internal consistency and responsiveness were established for efficacy but not for safety. For inter-rater agreement, an average deviation index <0.66 was found for all items. MAS showed strong correlations with MASA and ASHA NOMS. MAS scores were significantly different between groups 1 and 2. Conclusion: Preliminary evidence of the validity and reliability of MAS was established, except for the internal consistency and the responsiveness of the safety subscale. Further studies need to complete the validation process.

1.
McHorney
CA
,
Robbins
J
,
Lomax
K
,
Rosenbek
JC
,
Chignell
K
,
Kramer
AE
, et al
The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity
.
Dysphagia
.
2002
;
17
(
2
):
97
114
.
[PubMed]
0179-051X
2.
Medin
J
,
Larson
J
,
von Arbin
M
,
Wredling
R
,
Tham
K
.
Elderly persons’ experience and management of eating situations 6 months after stroke
.
Disabil Rehabil
.
2010
;
32
(
16
):
1346
53
.
[PubMed]
0963-8288
3.
Curtis
JL
,
Langmore
SE
. Respiratory functions and complications related to deglutition. In:
Perlman
AL
,
Schulze-Delrieu
K
, editors
.
Deglutition and its disorders
.
San Diego
:
Singular Publishing
;
1997
. pp.
125
52
.
4.
Clavé
P
,
Arreola
V
,
Romea
M
,
Medina
L
,
Palomera
E
,
Serra-Prat
M
.
Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration
.
Clin Nutr
.
2008
Dec
;
27
(
6
):
806
15
.
[PubMed]
0261-5614
5.
Rofes
L
,
Arreola
V
,
Almirall
J
,
Cabré
M
,
Campins
L
,
García-Peris
P
, et al
Diagnosis and management of oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly
.
Gastroenterol Res Pract
.
2011
;
2011
:
818979
.
[PubMed]
1687-6121
6.
Hutcheson
KA
,
Barrow
MP
,
Barringer
DA
,
Knott
JK
,
Lin
HY
,
Weber
RS
, et al
Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): scale development and validation
.
Cancer
.
2017
Jan
;
123
(
1
):
62
70
.
[PubMed]
0008-543X
7.
Langmore
SE
,
Terpenning
MS
,
Schork
A
,
Chen
Y
,
Murray
JT
,
Lopatin
D
, et al
Predictors of aspiration pneumonia: how important is dysphagia?
Dysphagia
.
1998
;
13
(
2
):
69
81
.
[PubMed]
0179-051X
8.
Langmore
SE
,
Skarupski
KA
,
Park
PS
,
Fries
BE
.
Predictors of aspiration pneumonia in nursing home residents
.
Dysphagia
.
2002
;
17
(
4
):
298
307
.
[PubMed]
0179-051X
9.
Tabor
L
,
Gaziano
J
,
Watts
S
,
Robison
R
,
Plowman
EK
.
Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis
.
Dysphagia
.
2016
Jun
;
31
(
3
):
376
82
.
[PubMed]
0179-051X
10.
Pizzorni
N
,
Valentini
D
,
Gilardone
M
,
Borghi
E
,
Mozzanica
F
,
Corbo
M
,
Schindler
A
: The Mealtime Assessment Scale (MAS): I. development of a scale for meal assessment [Under review].
11.
World Health Organization
.
International Classification of Functioning, Disability and Health (ICF)
.
Geneva
:
World Health Organization
;
2001
.
12.
Hansen
T
,
Lambert
HC
,
Faber
J
.
Reliability of the Danish version of the McGill Ingestive Skills Assessment for observation-based measures during meals
.
Scand J Occup Ther
.
2012
Nov
;
19
(
6
):
488
96
.
[PubMed]
1103-8128
13.
Mann
G
:
The Mann Assessment of Swallowing Ability.
Clifton Park, Singular, Thompson, Delmar Learning,
2002
.
14.
American Speech-Language-Hearing Association
. National Outcomes Measurement System (NOMS): Adult Speech-Language Pathology User’s Guide;
2003
. Available: http://www.asha.org/noms/ [accessed 15 March 2017]
15.
Carnaby-Mann
G
,
Lenius
K
,
Crary
M
.
Update on Assessment and Management of Dysphagia Post Stroke
.
Northeast Florida Medicine
.
2007
;
58
:
31
4
.
16.
Mokkink
LB
,
Terwee
CB
,
Patrick
DL
,
Alonso
J
,
Stratford
PW
,
Knol
DL
, et al
International consensus on taxonomy, terminology, and definitions of measurement properties for health‐related patient‐reported outcomes: results of the COSMIN study
.
J Clin Epidemiol
.
2010
;
63
:
737
45
.
[PubMed]
0895-4356
17.
Lambert
HC
,
Gisel
EG
,
Wood-Dauphinee
S
.
The functional assessment of dysphagia: psychometric standards
.
Phys Occup Ther Geriatr
.
2001
;
19
:
1
14
.0270-3181
18.
Burke
MJ
,
Dunlap
WP
.
Estimating interrater agreement with the average deviation index: a user’s guide
.
Organ Res Methods
.
2002
;
5
(
2
):
159
71
. 1094-4281
19.
Irwin
DL
,
Pannbacker
M
,
Lass
NJ
.
Clinical research methods in speech-language pathology and audiology
. 2nd ed.
San Diego (CA)
:
Plural Publishing
;
2014
. p.
133
.
20.
Chen
AY
,
Frankowski
R
,
Bishop-Leone
J
,
Hebert
T
,
Leyk
S
,
Lewin
J
, et al
The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory
.
Arch Otolaryngol Head Neck Surg
.
2001
Jul
;
127
(
7
):
870
6
.
[PubMed]
0886-4470
21.
Davidson
M
. Known-groups validity. In:
Michalos
AC
, editor
.
Encyclopedia of quality of life and well-being research
.
Dordrecht
:
Springer Netherlands
;
2014
. pp.
3481
2
.
22.
Lambert
HC
,
Gisel
EG
,
Groher
ME
,
Wood-Dauphinee
S
.
McGill Ingestive Skills Assessment (MISA): development and first field test of an evaluation of functional ingestive skills of elderly persons
.
Dysphagia
.
2003
;
18
(
2
):
101
13
.
[PubMed]
0179-051X
23.
Nunnally
JC
 Jr
.
Psychometric theory
. 2nd ed.
New York
:
McGraw-Hill
;
1978
.
24.
Ponterotto
JG
,
Ruckdeschel
DE
.
An overview of coefficient alpha and a reliability matrix for estimating adequacy of internal consistency coefficients with psychological research measures
.
Percept Mot Skills
.
2007
Dec
;
105
(
3 Pt 1
):
997
1014
.
[PubMed]
0031-5125
25.
Streiner
DL
,
Norman
GR
,
Cairney
J
.
Health measurement scales: a practical guide to their development and use
. 5th ed.
Oxford
:
Oxford University Press
;
2015
.
26.
Lambert
HC
,
Gisel
EG
,
Groher
ME
,
Abrahamowicz
M
,
Wood-Dauphinee
S
.
Psychometric testing of the McGill Ingestive Skills Assessment
.
Am J Occup Ther
.
2006
Jul-Aug
;
60
(
4
):
409
19
.
[PubMed]
0272-9490
27.
Namasivayam
AM
,
Steele
CM
,
Keller
H
.
The effect of tongue strength on meal consumption in long term care
.
Clin Nutr
.
2016
Oct
;
35
(
5
):
1078
83
.
[PubMed]
0261-5614
28.
Cullins
MJ
,
Connor
NP
.
Alterations of intrinsic tongue muscle properties with aging
.
Muscle Nerve
.
2017
Dec
;
56
(
6
):
E119
25
.
[PubMed]
0148-639X
29.
Ciciliot
S
,
Rossi
AC
,
Dyar
KA
,
Blaauw
B
,
Schiaffino
S
.
Muscle type and fiber type specificity in muscle wasting
.
Int J Biochem Cell Biol
.
2013
Oct
;
45
(
10
):
2191
9
.
[PubMed]
1357-2725
30.
Kays
SA
,
Hind
JA
,
Gangnon
RE
,
Robbins
J
.
Effects of dining on tongue endurance and swallowing-related outcomes
.
J Speech Lang Hear Res
.
2010
Aug
;
53
(
4
):
898
907
.
[PubMed]
1092-4388
31.
Serra-Prat
M
,
Palomera
M
,
Gomez
C
,
Sar-Shalom
D
,
Saiz
A
,
Montoya
JG
, et al
Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study
.
Age Ageing
.
2012
May
;
41
(
3
):
376
81
.
[PubMed]
0002-0729
32.
Ortega
O
,
Parra
C
,
Zarcero
S
,
Nart
J
,
Sakwinska
O
,
Clavé
P
.
Oral health in older patients with oropharyngeal dysphagia
.
Age Ageing
.
2014
Jan
;
43
(
1
):
132
7
.
[PubMed]
0002-0729
33.
Gleeson
DC
.
Oropharyngeal swallowing and aging: a review
.
J Commun Disord
.
1999
Nov-Dec
;
32
(
6
):
373
95
.
[PubMed]
0021-9924
34.
Leslie
P
,
Drinnan
MJ
,
Ford
GA
,
Wilson
JA
.
Swallow respiratory patterns and aging: presbyphagia or dysphagia?
J Gerontol A Biol Sci Med Sci
.
2005
Mar
;
60
(
3
):
391
5
.
[PubMed]
1079-5006
35.
Nishikubo
K
,
Mise
K
,
Ameya
M
,
Hirose
K
,
Kobayashi
T
,
Hyodo
M
.
Quantitative evaluation of age-related alteration of swallowing function: videofluoroscopic and manometric studies
.
Auris Nasus Larynx
.
2015
Apr
;
42
(
2
):
134
8
.
[PubMed]
0385-8146
36.
Hiramatsu
T
,
Kataoka
H
,
Osaki
M
,
Hagino
H
.
Effect of aging on oral and swallowing function after meal consumption
.
Clin Interv Aging
.
2015
Jan
;
10
:
229
35
.
[PubMed]
1178-1998
37.
Lamy
M
,
Mojon
P
,
Kalykakis
G
,
Legrand
R
,
Butz-Jorgensen
E
.
Oral status and nutrition in the institutionalized elderly
.
J Dent
.
1999
Aug
;
27
(
6
):
443
8
.
[PubMed]
0300-5712
38.
Renvert
S
,
Persson
RE
,
Persson
GR
.
Tooth loss and periodontitis in older individuals: results from the Swedish National Study on Aging and Care
.
J Periodontol
.
2013
Aug
;
84
(
8
):
1134
44
.
[PubMed]
0022-3492
39.
Pritchard
SJ
,
Davidson
I
,
Jones
J
,
Bannerman
E
.
A randomised trial of the impact of energy density and texture of a meal on food and energy intake, satiation, satiety, appetite and palatability responses in healthy adults
.
Clin Nutr
.
2014
Oct
;
33
(
5
):
768
75
.
[PubMed]
0261-5614
40.
Ullrich
S
,
Crichton
J
.
Older people with dysphagia: transitioning to texture-modified food
.
Br J Nurs
.
2015
Jul
;
24
(
13
):
686
92
.
[PubMed]
0966-0461
41.
Lin
LC
,
Watson
R
,
Wu
SC
.
What is associated with low food intake in older people with dementia?
J Clin Nurs
.
2010
Jan
;
19
(
1-2
):
53
9
.
[PubMed]
0962-1067
42.
Yamamoto
H
,
Furuya
J
,
Tamada
Y
,
Kondo
H
.
Impacts of wearing complete dentures on bolus transport during feeding in elderly edentulous
.
J Oral Rehabil
.
2013
Dec
;
40
(
12
):
923
31
.
[PubMed]
0305-182X
43.
Brady
S
,
Donzelli
J
.
The modified barium swallow and the functional endoscopic evaluation of swallowing
.
Otolaryngol Clin North Am
.
2013
Dec
;
46
(
6
):
1009
22
.
[PubMed]
0030-6665
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.