The Test of Masticating and Swallowing Solids (TOMASS): reliability, validity and international normative data

Area of Science:

• Speech and Hearing Sciences
• Clinical Swallowing Assessment
• Quantitative Measurement in Deglutition

Background:

• Current clinical swallowing assessments rely heavily on qualitative observations, lacking quantitative data for comparison with healthy populations.
• This limits the objective identification and characterization of swallowing impairments, particularly in solid bolus ingestion.
• The Test of Masticating and Swallowing Solids (TOMASS) was developed to address this gap by providing a quantitative measure of solid food intake.

Purpose of the Study:

• To investigate test development indices for the TOMASS.
• To establish normative data for the TOMASS across diverse populations and food products.
• To support the clinical translation of the TOMASS for dysphagia assessment.

Main Methods:

• 228 healthy adults (20-80+ years) participated in studies assessing test-retest and interrater reliability, and validity.
• Participants ingested a standardized cracker, with measures including masticatory cycles, swallows per bite, and time per measure.
• Normative data were collected for seven different crackers, stratified by age and sex, with a minimum of 80 controls per cracker.

Main Results:

• The TOMASS demonstrated high test-retest and interrater reliability.
• Measures were sensitive to age and sex differences in swallowing performance.
• Significant differences in performance were noted between different cracker types, necessitating region-specific normative data.

Conclusions:

• The TOMASS is a valid, reliable, and broadly normed assessment tool for solid bolus ingestion.
• It can aid in the bedside identification of dysphagia.
• The TOMASS provides a sensitive, non-invasive measure of functional swallowing changes.