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Validity Evidence of Screening Tools for Pediatric Feeding Disorders: A Systematic Review
Haissa I Cardoso1,2, Bruna O de Vargas3, Rafaela da S Corrêa3
1Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil.
Insights
This review found a lack of reliable instruments for evaluating pediatric feeding disorders (PFDs). While some tools meet basic criteria, further research is needed to improve their validity and standardization for clinical use.
Area of Science:
- Pediatrics
- Clinical Psychology
- Speech-Language Pathology
Background:
- Pediatric feeding disorders (PFDs) significantly impact children and caregivers, necessitating early identification and evaluation.
- Existing assessment instruments for PFDs have limited evidence regarding their reliability and validity in clinical and research settings.
- A PROSPERO-registered systematic review (CRD42023411223) was conducted to address these limitations.
Purpose of the Study:
- To systematically review and assess the evidence for the validity of instruments used in the evaluation of pediatric feeding disorders (PFDs).
- To identify which PFD assessment tools possess adequate psychometric properties for reliable clinical and research application.
Main Methods:
- A comprehensive literature search was performed across multiple databases (Medline, Embase, PsycInfo, etc.) and grey literature up to August 2024.
- Two independent reviewers evaluated study eligibility, extracted data on instrument characteristics and psychometric properties, and assessed methodological quality using the COSMIN Risk of Bias checklist.
- Validity was assessed using minimum adequacy criteria and COSMIN standards; narrative synthesis described psychometric properties.
Main Results:
- Forty studies evaluated 19 different instruments for PFD assessment.
- A total of 10 instruments met the minimum adequacy criteria for validity, including 8 for general feeding problems and 2 for dysphagia.
- The majority of reviewed instruments demonstrated insufficient psychometric properties and validation robustness.
Conclusions:
- There is a significant lack of PFD assessment instruments with robust psychometric properties and adequate validation.
- While a few instruments show promise, limitations in current validation methods necessitate further research and standardization.
- Improved and standardized assessment tools are crucial for enhancing the clinical management and research of pediatric feeding disorders.
Context:
Pediatric feeding disorders (PFDs) present challenges involving food intake, feeding skills, and psychosocial or clinical dysfunctions affecting children and caregivers. Early identification and accurate evaluation are essential for improving outcomes. Despite the availability of various instruments, evidence for their reliability and validity in clinical practice and research remains limited.
Objective:
The aim for this systematic review was to assess the evidence of the validity of instruments used to evaluate PFDs.
Data Sources:
Articles were searched across Medline, Embase, APA PsycInfo, Centre for Agricultural Bioscience International, Web of Science, and Cochrane Library databases, and grey literature up to August 2024, including studies without restrictions on date or language.
Data Extraction:
Studies on PFD assessment instruments were included. Two independent reviewers assessed eligibility, extracted data (covering study and instrument characteristics, domains, psychometric properties, validation outcomes), and evaluated methodological quality.
Data Analysis:
Narrative synthesis was used to describe the psychometric properties of the instruments. The methodological quality of the included studies was evaluated using the COSMIN Risk of Bias checklist. Instrument validity was primarily assessed using minimum adequacy criteria (content, criterion, and construct validity or diagnostic performance) based on previously published cutoff points. COSMIN criteria for good measurement properties were also applied to assess the instruments. A total of 19 instruments for evaluating PFDs were reviewed across 40 studies. Among these, 10 met the minimum adequacy criteria, including 8 for feeding problems and 2 for dysphagia, regardless of their original language or cultural context.
Conclusion:
This review underscores the lack of instruments with adequate psychometric properties to evaluate PFDs. Although some instruments meet minimum adequacy criteria, limitations in validation methods and insufficient robustness highlight the need for further research and standardization to improve their use in clinical and research contexts.
Systematic Review Registration:
PROSPERO registration No. CRD42023411223.
