Clinimetric Review of Patient Reported Outcome Measures (PROMs) for the Feeding Skills Domain of Pediatric Feeding Disorder (PFD)

Abstract

Introduction Children with Pediatric Feeding Disorder (PFD) present with "impaired oral intake that is not age appropriate, and is associated with medical, nutritional, feeding skill and/ or psychosocial dysfunction“ (Goday et al., 2019,p125). PFD is reported to be associated with poor short- and long-term health and nutritional outcomes (Shmaya et al., 2015; Tutor & Gosa, 2012), and can impact on parental stress and the parent-child relationship (Marshall et al., 2015). PFD is included as a stand-alone diagnostic code in the revision of the International Classification of Diseases (11th revision) (Sanstead & Pederson, 2020). In research and clinical practice, there is little clarity with regards to assessment processes to make a diagnosis for PFD. Currently, several tools exist that assess different aspects and outcomes of PFD. Therefore, this clinimetric review addresses the question: What are the clinimetric properties of Patient/Proxy Reported Outcome Measure (PROM) tools that are used to assess feeding skills in PFD in children > 6 months of age? Material and Methods Studies less than 20 years old describing published PROMs for feeding-skills based PFD in children were included in this review. This review focused on children 6 months of age and older, who would be expected to be consuming solid foods (i.e., not just a liquid diet). A comprehensive search strategy was used across 4 databases, with direction from a research librarian. Information from each PROM was extracted regarding purpose, target population and age-range, administration details, assessment properties, and how different items on each PROM mapped to the other domains of PFD. Each tool was also categorized using the International Classification of Functioning and Health (impairment, activity, and participation levels - formerly impairment, disability, and handicap levels). The different items for each PROM were also mapped to the diagnostic criteria for PFD. Clinimetric properties of each tool were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, using a revised scoring system developed by Cordier et al. (2015). Results The initial search strategy yielded 6421 papers, from which 64 duplicates were removed. Following title and Abstract screening, 492 full-text studies were assessed for eligibility. A total of 14 PROMs that met inclusion criteria were identified, with a total of 22 papers included. PROMs were predominantly used for evaluative or discriminative purposes. Although all PROMs included had aspects of feeding skills in their assessment tools, many PROMs also explored other domains of PFD. Psychometric properties for the various PROMs were variable, with more recently developed PROMs demonstrating higher scores. Discussion/Conclusion The results of this study guide clinical practice and lay the foundation for further research in PFD. A comprehensive diagnostic process will likely require use of a combination of clinical assessments and PROMs, and consideration of the functional impact of any identified impairments. Of the PROMs available, it was clear that there is no single tool available that captures all areas needed for a diagnosis of PFD, and that further work in this area is needed.