RESUMO
BACKGROUND: Risk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia. AIM: To describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD. METHODS: Test items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions. RESULTS: The CRA and PRA differentiated the PCG (n=93) from the NCG (n=526) and the PPG (n=63) from the NPG (n=209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p=0.043), and pneumonia (p<0.001). CONCLUSIONS: The CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals.
Assuntos
Obstrução das Vias Respiratórias , Deficiências do Desenvolvimento , Deficiência Intelectual , Pneumonia , Qualidade de Vida , Medição de Risco/métodos , Adulto , Obstrução das Vias Respiratórias/complicações , Obstrução das Vias Respiratórias/diagnóstico , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Deficiências do Desenvolvimento/fisiopatologia , Deficiências do Desenvolvimento/psicologia , Feminino , Humanos , Deficiência Intelectual/fisiopatologia , Deficiência Intelectual/psicologia , Masculino , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumonia/prevenção & controle , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de RiscoRESUMO
Swallowing and feeding disorder (dysphagia) have high incidence and prevalence in children and adults with developmental disability. Standardized screening and clinical assessments are needed to identify and describe the disorder. The aim of this study was to describe the psychometric properties of the Dysphagia Disorder Survey (DDS), a screening and clinical assessment of swallowing and feeding function for eating and drinking developed specifically for this population. The statistical analysis was performed on a sample of 654 individuals (age range 8-82) with intellectual and developmental disability living in two residential settings in the United States that served somewhat different populations. The two samples had similar factor structures. Internal consistency of the DDS and subscales was confirmed using Chronbach's coefficient alpha. The DDS demonstrated convergent validity when compared to judgments of swallowing and feeding disorder severity made by clinical swallowing specialists. Discriminative validity for severity of disorder was tested by comparing the two samples. The results of the study suggest that the DDS is a reliable and valid test for identifying and describing swallowing and feeding disorder in children and adults with developmental disability.
