The Test of Masticating and Swallowing Solids (TOMASS): Reliability and validity in patients with dysphagia

• Published in: International journal of language & communication disorders 2021-05, Vol.56 (3), p.558-566
• Main Authors: Todaro, Francesca, Pizzorni, Nicole, Scarponi, Letizia, Ronzoni, Clara, Huckabee, Maggie‐Lee, Schindler, Antonio
• Format: Article
• Language: English
• Subjects: Clinical medicine; clinical swallowing examination; deglutition; Dysphagia; Endoscopy; Interrater Reliability; Patients; Physical Disabilities; Quantitative psychology; reliability; Speech-language pathologists; Standardized Tests; Swallowing; Test Reliability; Test Validity; Test validity and reliability; Validity
• ISSN: 1368-2822; 1460-6984
• DOI: 10.1111/1460-6984.12613

Background The Test of Masticating and Swallowing Solids (TOMASS) is an international standardized swallowing assessment tool. However, its psychometric characteristics have not been analysed in patients with dysphagia. Aims To analyse TOMASS's (1) inter‐ and intra‐rater reliability in a clinical population of patients with dysphagia, (2) known‐group validity, (3) concurrent validity and (4) correlation with meal duration. Methods & Procedures Two age‐ and gender‐matched groups of 39 participants each were recruited: A group of patients with dysphagia and a control group with no history of dysphagia. The TOMASS was carried out in both populations, video‐recorded and scored offline by two speech and language therapists (SLT 1 and SLT 2) (inter‐rater reliability) and twice by the same SLT (intra‐rater reliability). In the clinical group, the TOMASS was carried out three times: (1) to verify understanding of the required tasks, (2) performed concurrently during fibreoptic endoscopic evaluation of swallowing (FEES) to assess validity and (3) during clinical assessment to assess reliability. TOMASS under endoscopic control was recorded and the number of white‐out events was counted to compare with the number of observed swallows per cracker during standard TOMASS as a measure of concurrent validity. As additional measures of TOMASS validity, oral dental status, classified as ‘functional’ or ‘partially functional’, and duration of a standard meal were assessed by an SLT (SLT 1 or SLT 2), and then correlated with TOMASS. Outcome & Results TOMASS's inter‐ and intra‐rater reliability were high (intraclass correlation coefficient (ICC) > 0.95) in both the clinical and the control groups. The number of masticatory cycles (p = 0.020), swallows (p = 0.013) and total time (p = 0.003) of TOMASS were significantly lower in the control group than in the clinical group. Patients with ‘partially functional’ oral dental status showed a significantly higher number of masticatory cycles per cracker and a longer duration of ingestion than patients with a ‘functional’ one. Concurrent validity suggested a substantial agreement between TOMASS and FEES in defining the number of swallows per cracker. The mean difference of the two measures was –0.02 (95% confidence interval (CI) = –1.7 to 1.2). Meal duration significantly correlated with the ‘number of swallows per cracker’ (r = 0.49; p = 0.002) and ‘total time’ (r = 0.41; p = 0.011). Conclusions & Implications Preliminary psychometr