Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale

Abstract

Context: Dysphagia is one of the most prevalent and distressing symptoms among palliative care patients, and a practical assessment tool is required.

Objectives: The aim of this study was to examine the reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale (FILS), a 10-point observer-rating scale.

Methods: The inter- and intrarater reliability was evaluated by three clinicians in 30 patients using weighted kappa statistics. The convergent validity was evaluated by examining correlations of FILS with the Functional Oral Intake Scale (FOIS) and patient-reported satisfaction levels with oral intake.

Results: Weighted kappa coefficients for interrater reliability ranged from 0.70 to 0.90 and those for intrarater reliability ranged from 0.83 to 0.90. The FILS score was highly associated with the FOIS (ρ = 0.96-0.99) and patient-reported satisfaction (ρ = 0.89).

Conclusion: The FILS seems to have fair reliability and validity as a practical tool for assessing the severity of dysphagia. Further study on the reliability, validity, and sensitivity of the FILS compared with the FOIS is needed.

Keywords: Dysphagia; food intake; measurement tool; validation.