Reliability and Validity of the Eating and Drinking Ability Classification System in Adults with Cerebral Palsy

The Eating and Drinking Ability Classification System (EDACS) was developed to evaluate dysphagia in children with cerebral palsy (CP). This study aimed to investigate the interrater reliability and validity of the EDACS in adults with CP. This cross-sectional study included 117 community-dwelling adults (mean age, 37.9 ± 12.5 years) with a confirmed CP diagnosis. A swallowing occupational therapist (SwOT) conducted detailed interviews with participants and/or caregivers to classify the EDACS. Another SwOT and participants/caregivers evaluated the EDACS. Correlations were evaluated between the EDACS and Functional Oral Intake Scale (FOIS), Swallowing Quality of Life (SWAL-QOL), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification System (MACS). Interrater reliabilities between SwOTs (κ = 0.866, intraclass correlation coefficient (ICC) = 0.867), and between SwOT and participant/caregiver (κ = 0.884, ICC = 0.717) were reported. The EDACS correlated with the FOIS, SWAL-QOL, and MACS, although no significant correlation was found with the GMFCS. The EDACS of spastic-type showed better correlation than that of dyskinetic-type with the FOIS, MACS, and GMFCS. There was a significant correlation between the EDACS and the GMFCS in those aged ≤ 30 years, whereas there was no correlation in those aged ≥ 30 years. The EDACS is a reliable and valid tool for classifying eating and drinking ability in adults with CP. The correlation between the EDACS with gait or hand function was more prominent in individuals with spastic CP and in younger individuals. The EDACS is a valuable adjunct to comprehensive functional classification in adults with CP.