EAT-10による嚥下スクリーニング

EAT-10日本語版は、以下のHPからダウンロード可能です。
www.maff.go.jp/j/shokusan/seizo/kaigo/pdf/eat-10.pdf

EAT-10という嚥下スクリーニング法の信頼性、妥当性を検証した論文を紹介します。

Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ: Validity and Reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008 Dec;117(12):919-24.

EAT-10というのは、以下の10項目の質問にそれぞれ0 = No problem、4 = Severe problemとして5段階で評価する嚥下機能の自記式スクリーニングツールです。

To what extent are the following scenarios problematic for you?
1. My swallowing problem has caused me to lose weight.
2. My swallowing problem interferes with my ability to go out for meals.
3. Swallowing liquids takes extra effort.
4. Swallowing solids takes extra effort.
5. Swallowing pills takes extra effort.
6. Swallowing is painful.
7. The pleasure of eating is affected by my swallowing.
8. When I swallow food sticks in my throat.
9. I cough when I eat.
10. Swallowing is stressful.

これで40点満点となりますが、3点以上であれば嚥下障害ありと判断します。

入院で嚥下リハを行っている嚥下障害患者に行う必要はありませんが、ごく軽度から軽度の嚥下障害で外来リハも行っていないような方の嚥下障害を見つけるには、信頼性・妥当性検証済のスクリーニングですのでよいと考えます。そのような方に接する機会がある場合には、試していただければと思います。

Abstract
OBJECTIVES: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10).

METHODS: The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses.

RESULTS: A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (+/- SD) EAT-10 score of the normal cohort was 0.40 +/- 1.01. The mean EAT-10 score was 23.58 +/- 13.18 for patients with esophageal dysphagia, 23.10 +/- 12.22 for those with oropharyngeal dysphagia, 9.19 +/- 12.60 for those with voice disorders, 22.42 +/- 14.06 for those with head and neck cancer, and 11.71 +/- 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p less than 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 +/- 10.5 to 5.2 +/- 7.4 after treatment (p less than 0.001).

CONCLUSIONS: The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.