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Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis

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Abstract

Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis.

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Acknowledgments

The authors express their gratitude to Cally Smith, Rebekah Totino, and Lauren Parsons for providing research assistant support.

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Authors and Affiliations

  1. School of Occupational Therapy and Social Work, Curtin University, Perth, WA, Australia

    R. Cordier & A. Joosten

  2. College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia

    R. Cordier & R. Speyer

  3. Unitat d’Exploracions Funcionals Digestives, Department of Surgery, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain

    P. Clavé

  4. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain

    P. Clavé

  5. Phoniatric Unit, Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, Milan, Italy

    A. Schindler

  6. Diagnostic Centre of Imaging and Functional Medicine, Malmö, Sweden

    M. Bülow

  7. Department of Clinical Sciences, Lund University, Malmö, Sweden

    M. Bülow

  8. Skane University Hospital Malmö, Malmö, Sweden

    M. Bülow

  9. Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey

    N. Demir & S. Serel Arslan

  10. Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands

    R. Speyer

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  1. R. Cordier
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  2. A. Joosten
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  3. P. Clavé
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  4. A. Schindler
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  5. M. Bülow
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  8. R. Speyer
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Correspondence to R. Cordier.

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Cordier, R., Joosten, A., Clavé, P. et al. Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis. Dysphagia 32, 250–260 (2017). https://doi.org/10.1007/s00455-016-9754-2

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  • DOI: https://doi.org/10.1007/s00455-016-9754-2

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