Front Neurol. 2026 Oct 7;17:1863539. doi: 10.3389/fneur.2026.1863539. eCollection 2026.
ABSTRACT
OBJECTIVE: To evaluate the reliability and validity of the 21-item ICF Core Category Scale for Dysphagia in Stroke (ICCSDS) in assessing swallowing disorders in Chinese stroke patients.
METHODS: Six experienced rehabilitation physicians evaluated the content validity of the scale. Two raters (a rehabilitation physician and a swallowing therapist) received standardized training. Rehabilitation physicians screened and enrolled 80 patients with suspected swallowing difficulties using the Toronto Bedside Swallowing Screening Test. A swallowing therapist subsequently performed the initial ICCSDS assessment using the Gugging Swallowing Screen (GUSS) as a practical reference standard. Four hours later, a rehabilitation physician conducted a second ICCSDS assessment at the same site to evaluate interrater reliability.
RESULTS: Significant differences were observed between the high-score and low-score groups for all the ICCSDS items (all p < 0.01). The Cronbach's α coefficients for assessments performed by the rehabilitation physician and swallowing therapist were 0.864 and 0.829, respectively. The S-CVI value was 0.978, and the I-CVI values ranged from 0.83 to 1.00. Exploratory factor analysis revealed that the Kaiser-Meyer-Olkin (KMO) values for assessments by the rehabilitation physician and the swallowing therapist were 0.887 and 0.848, respectively (both p < 0.01), with cumulative variance contributions of 75.69 and 73.65%, respectively. When the GUSS was used as the practical reference standard, the criterion-related validity coefficients of the ICCSDS assessed by the rehabilitation physician and the swallowing therapist were 0.790 and 0.683, respectively (both p < 0.01). Interrater reliability analysis revealed an ICC (2, 1) of 0.924 and an ICC (2, k) of 0.961. The weighted kappa coefficients exceeded 0.80 for 14 items, reached 0.799 for one item, and ranged from 0.420 to 0.547 for six items.
CONCLUSION: The 21-item ICCSDS demonstrated acceptable internal consistency, content validity, and interrater reliability in Chinese patients with poststroke dysphagia. The preliminary evidence from the criterion-related validity analysis supports its association with clinical bedside assessment tools.
PMID:42924081 | PMC:PMC13688877 | DOI:10.3389/fneur.2026.1863539