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Drooling outcome measures in paediatric disability: a systematic review
E Sforza1, R Onesimo2, C Leoni2
1Department of Pediatrics, Faculty of Medicine and Surgery, Catholic University of Rome, Rome, Italy. elisabetta.sforza@unicatt.it.
Insights
Sialorrhea (drooling) measurement tools for children with disabilities are limited. This review identified 19 measures, with the 5-min Drooling Quotient and Drooling Impact Scale showing promise for clinical use.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Clinical Measurement
Background:
- Sialorrhea (drooling) is a common challenge in children with cerebral palsy, rare diseases, and neurodevelopmental disorders.
- Physicians often lack confidence in current methods for measuring sialorrhea in pediatric populations.
- There is a need for reliable and validated outcome measures to guide clinical decision-making for sialorrhea management.
Purpose of the Study:
- To systematically review and identify validated outcome measures for assessing sialorrhea in children.
- To evaluate the measurement properties and quality of available sialorrhea assessment tools.
- To determine which measures offer the most reliable and clinically useful data for pediatric patients.
Main Methods:
- A systematic literature search was conducted across four databases following PRISMA guidelines.
- The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used for quality appraisal.
- Full-text articles were evaluated, and 19 distinct outcome measures were identified and analyzed.
Main Results:
- Nineteen different sialorrhea outcome measures were identified, including quantitative tools and parent/proxy questionnaires.
- The 5-min Drooling Quotient demonstrates objective discrimination of sialorrhea frequency in children with developmental disabilities.
- The Drooling Impact Scale and modified drooling questionnaire show potential for assessing treatment changes, severity, and social impact.
Conclusions:
- The 5-min Drooling Quotient, Drooling Impact Scale, and modified drooling questionnaire are among the few tools with adequate measurement properties for pediatric sialorrhea.
- A combination of quantitative measures and parent/proxy reports may provide a comprehensive assessment of sialorrhea.
- Further research on the reliability, validity, and responsiveness of these measures is needed to confirm their clinical utility.
Abstract:
Drooling, or sialorrhea, is a common condition in patients with cerebral palsy, rare diseases, and neurodevelopmental disorders. The goal of this review was to identify the different properties of sialorrhea outcome measures in children. Four databases were analysed in search of sialorrhea measurement tools, and the review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist was used for quality appraisal of the outcome measures. The initial search yielded 891 articles, 430 of which were duplicates. Thus, 461 full-text articles were evaluated. Among these, 21 met the inclusion criteria, reporting 19 different outcome measures that encompassed both quantitative measures and parent/proxy questionnaires. Conclusions: Among the outcome measures found through this review, the 5-min Drooling Quotient can objectively discriminate sialorrhea frequency in patients with developmental disabilities. The Drooling Impact Scale can be used to evaluate changes after treatment. The modified drooling questionnaire can measure sialorrhea severity and its social acceptability. To date, the tests proposed in this review are the only tools displaying adequate measurement properties. The acquisition of new data about reliability, validity, and responsiveness of these tests will confirm our findings. What is Known: • Although sialorrhea is a recognized problem in children with disabilities, especially those with cerebral palsy (CP), there is a lack of confidence among physicians in measuring sialorrhea. What is New: • Few sialorrhea measures are available for clinicians that may guide decision-making and at the same time have strong evidence to provide confidence in the results. • A combination of both quantitative measures and parent/proxy questionnaires might provide an adequate measurement of sialorrhea in children.
