Cardiovascular

Reliability and validity of the ICF core elements scale for swallowing function assessment in stroke patients: a single-center study from Hunan, China.

Dong Y, Tan H, et al. • Frontiers in neurology • 2026

PubMed 42924081 DOI 10.3389/fneur.2026.1863539
TL;DR

The 21-item ICF Core Category Scale for Dysphagia in Stroke (ICCSDS) demonstrated acceptable internal consistency, content validity, and interrater reliability in Chinese patients with poststroke dysphagia, with preliminary criterion-related validity evidence supporting its association with clinical bedside assessment tools.

Key Findings

Results

All 21 ICCSDS items significantly discriminated between high-score and low-score groups.

  • Significant differences were observed between the high-score and low-score groups for all ICCSDS items (all p < 0.01).
  • The study enrolled 80 patients with suspected swallowing difficulties, screened with the Toronto Bedside Swallowing Screening Test.
Results

The ICCSDS showed good internal consistency for both raters.

  • Cronbach's α was 0.864 for assessments by the rehabilitation physician.
  • Cronbach's α was 0.829 for assessments by the swallowing therapist.
Results

Content validity of the ICCSDS was high as rated by six experienced rehabilitation physicians.

  • The scale-level content validity index (S-CVI) was 0.978.
  • Item-level content validity indices (I-CVI) ranged from 0.83 to 1.00.
Results

Exploratory factor analysis supported the factorability of the data and explained a large share of variance.

  • KMO values were 0.887 (rehabilitation physician) and 0.848 (swallowing therapist), both p < 0.01.
  • Cumulative variance contributions were 75.69% and 73.65%, respectively.
Results

ICCSDS scores were correlated with the Gugging Swallowing Screen (GUSS), used as a practical reference standard.

  • Criterion-related validity coefficients were 0.790 for the rehabilitation physician and 0.683 for the swallowing therapist (both p < 0.01).
  • The GUSS was used as a practical reference standard rather than a gold standard, so the authors describe the evidence as preliminary.
Results

Overall interrater reliability between the rehabilitation physician and swallowing therapist was excellent.

  • ICC (2, 1) was 0.924 and ICC (2, k) was 0.961.
  • The second ICCSDS assessment by the rehabilitation physician took place four hours after the swallowing therapist's initial assessment, at the same site.
  • Both raters received standardized training.
Results

Item-level interrater agreement varied: most items had very good agreement but six items had only moderate agreement.

  • Weighted kappa exceeded 0.80 for 14 items.
  • Weighted kappa was 0.799 for one item.
  • Weighted kappa ranged from 0.420 to 0.547 for six items.

What This Means

This study tested a 21-item checklist, based on the World Health Organization's International Classification of Functioning (ICF), designed to assess swallowing problems after stroke. Eighty Chinese stroke patients with suspected swallowing difficulty were assessed by two trained raters, a swallowing therapist and a rehabilitation physician, working four hours apart. Six experienced physicians also judged whether the checklist items were relevant and appropriate. The checklist performed well on most measures. Its items hung together consistently, experts rated its content highly, and the two raters gave very similar overall scores. Scores also correlated with an established bedside test, the Gugging Swallowing Screen, though that test is a practical reference rather than a perfect standard. Agreement between raters on individual items was strong for most, but six items showed only moderate agreement. This research suggests the checklist could be a reliable tool for assessing swallowing problems after stroke in Chinese patients. However, the study was done at a single center with a small sample, and the criterion-validity evidence is described as preliminary. Some items may need clearer scoring guidance or further testing in larger and more varied groups of patients.

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Citation

Dong Y, Tan H, Chen J, Qin P, Yin Y, Tao X. (2026). Reliability and validity of the ICF core elements scale for swallowing function assessment in stroke patients: a single-center study from Hunan, China.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1863539