Validation Of The Chinese Version Of The FOIS Score In The Assessment Of Acute Stroke Inpatients With Dysphagia

BackgroundDysphagia is a common complication of stroke patients.if the patient is not aware of the association between dysphagia and eating,it is likely to develop pneumonia and the complication that threatens its life,such as malnutrition,dehydration,and suffocation.Therefore,the assessment of the swallowing and oral feeding function of the patient is particularly important.However,at present,Water Swallow Test is usually used to screen dysphagia in patients,there is a lack of a convenient,safe and reliable oral feeding function assessment tool.The Functional Oral Intake Scale(FOIS)for dysphagia in stroke patients was developed by the Florida Health Science Center in 2005.The scale has been well applied in Japan,Brazil and Iran.The Functional Oral Intake Scale were reported in China,but did not reported the validity and reliability of the Chinese version of the Functional Oral Intake Scale.Objective1 To translate the Functional Oral Intake Scale into Chinese version and evaluate its reliability and validity.2 To investigate the reliability and validity of the Functional Oral Intake Scale versus the water swallow test in acute stroke patients,in order to provide a more effective tool for measuring the dysphagia in these patients.MethodsThe Chinese version of the FOIS scale was obtained in accordance with the Brislin translation principle.Using accidental sampling method,a total of 304 patients with acute stroke,admitted to department of Neurology(Nanfang Hospital,Southern Medical University)from May 2017 to October,were included in this study.To verify the validity and reliability of the FOIS,the swallowing function of patients was evaluated by both FOIS and the water swallow test.ResultsRater reliability:the overall rater agreement between the first and the second evaluation was excellent with a Kappa statistic of 0.862(FOIS)and of 0.923(the water swallow test),rs=0.934 and 0.976,respectively,all P<0.001.Criterion validity:the chi square values of the first evaluation results of the FOIS and water swallow test,compared with the Modified Barthel index scores,were 118.21(rs=0.397,Cramer's V=0.624,P<0.001)and 123.93(rs=-0.574,Cramer's V=0.638,P<0.001),respectively.The chi square values of the first evaluation results of the FOIS and water swallow test were 78.50(rs=-0.461,Cramer's V=0.508,P<0.001)and 75.56(rs=0.464,Cramer's V=0.499,P<0.001)respectively,compared with the NIHSS scores.In addition,there was a significantly negative correlation between the first evaluated results of FOIS and the water swallow test(rs=-0.933,P<0.001).Content validity:It shows that has a good content validity.Discrimination validity:The evaluation results of the 3 groups were statistically significant difference(?2=272.09;P<0.001),indicating the FOIS scale can be used to determine oral feeding function of stroke patients.Cross validation:The cross-validation analysis data showed that there was a significant correlation between FOIS/WST and the occurrence of both dysphagia and aspiration verified by the V-VST assessment results.There was also a significant correlation between the severity of dysphagia and the grade of FOIS/WST assessment.Evaluation sensitivity of scale:Both the results of FOIS and water swallow test showed that the symptoms of dysphagia were significantly alleviated and the oral feeding function was improved during the hospitalization.Conclusion1.The Chinese version of the FOIS scale has a good interrater reliability and criterion validity,discrimination validity,cross-validation and evaluation sensitivity of the scale is good.2.Both FOIS and the water swallow test are reliable for evaluating the swallowing function in patients with acute stroke,with a significant correlation with each other.The Combined use of the two tests can make the swallowing function evaluation in patients with acute stroke more comprehensive and specific.3.The Chinese version of the FOIS is a reliable scale for evaluating and documenting change in the oral feeding function for inpatients with acute stroke over time,and be used to predict the swallowing function of stroke patients effectively,in addition,the rehabilitation status of stroke patients can be understood andgrasped by continuously recording the changes in oral feeding function.