Adaptation of the Italian Version of the Mealtime Assessment Scale in Pediatric Population (MAS-p)

Unlike what is observed in the adult population, in paediatric rehabilitation, no reliable and validated observational tools are available in the Italian language to evaluate subjects considered to be at risk for swallowing disorders, regardless of the pathology. The aim of this study was to adapt the Mealtime Assessment Scale (MAS) to a paediatric population. Additionally, internal consistency, intra-rater and inter-rater agreement, concurrent validity and discriminative ability were investigated to assess validity and reliability of the scale. The first part of the study consisted in an adaptation of the original version of the MAS to the paediatric population (MAS-p) by a multidisciplinary team. A pilot study, involving 40 subjects, was conducted to assess psychometric properties as validity and reliability in terms of internal consistency, intra- and inter-rater reliability, and discrimination index. Retaining MAS original structure and scoring system, items were maintained, modified, or removed through a revision by the multidisciplinary team to guarantee a correct evaluation in children. None of the patients were lost or had withdrawn. MAS-p showed good internal consistency, both in safety (Cronbach's alpha 0.857) and efficacy scale (Cronbach's alpha 0.885). No improvement was noticed removing items one at a time and an optimal item to total correlation was observed (Cronbach's alpha ≥ 0.80). No items were found to be not assessable. Intra-rater and inter-rater agreement were good for all items (ICC > 0.8 for intra-rater agreement and AD index < 0.66 for inter-rater agreement). A second revision of the scale was carried out by the multidisciplinary team after the pilot study to further modify items to fully adapt to the paediatric population. MAS-p was developed to introduce an objective dysphagia assessment in paediatric rehabilitation. It showed good validity and reliability. The validation process should be completed through further studies.