藤島の摂食・嚥下レベルの信頼性、妥当性

藤島先生の摂食・嚥下レベルの信頼性、妥当性を検証した論文を紹介します。

Kenjiro Kunieda, Tomohisa Ohno, Ichiro Fujishima, Kyoko Hojo, Tatsuya Morita. Reliability and Validity of a Tool to Measure the Severity of Dysphagia: The Food Intake LEVEL Scale. Journal of Pain and Symptom Management, http://dx.doi.org/10.1016/j.jpainsymman.2012.07.020

藤島先生の摂食・嚥下レベル（FILS）は皆様よく御存知かと思いますが、英語では以下のようになっています。

No oral intake

Level 1: No swallowing training is performed except for oral care

Level 2: Swallowing training not using food is performed

Level 3: Swallowing training using a small quantity of food is performed

Oral intake and alternative nutrition

Level 4: Easy-to-swallow food less than the quantity of a meal (enjoyment level) is ingested orally

Level 5: Easy-to-swallow food is orally ingested in one to two meals, but alternative nutrition is also given

Level 6: The patient is supported primarily by ingestion of easy-to-swallow food in three meals, but alternative nutrition is used as a complement

Oral intake alone

Level 7: Easy-to-swallow food is orally ingested in three meals. No alternative nutrition is given.

Level 8: The patient eats three meals by excluding food that is particularly difficult to swallow

Level 9: There is no dietary restriction, and the patient ingests three meals orally, but medical considerations are given.

Level 10: There is no dietary restriction, and the patient ingests three meals orally (normal). 日本語も掲載しておきます。 【経口摂取なし】 Lv.1 ：嚥下訓練を行っていない Lv.2 ：食物を用いない嚥下訓練を行っている Lv.3 ：ごく少量の食物を用いた嚥下訓練を行っている 【経口と代替栄養】 Lv.4：１食分未満の嚥下食を経口摂取しているが代替栄養が主体 Lv.5：１-２食の嚥下食を経口摂取しているが代替栄養が主体 Lv.6：３食の嚥下食経口摂取が主体で不足分の代替栄養を行っている 【経口のみ】 Lv.7：３食の嚥下食を経口摂取している代替栄養は行っていない Lv.8：特別食べにくいものを除いて３食経口摂取している Lv.9：食物の制限はなく、３食を経口摂取している 【正常】 Lv.10：摂食・嚥下障害に関する問題なし （正常）

 

結果ですが、検者内信頼性、検者間信頼性とも高く、FOIS（Functional Oral Intake Scale、こちらは7段階）とも高い相関を認めました。これより嚥下重症度評価にFILSを使用できるという結論です。

 

もし英語で嚥下の重症度に関する論文を執筆することがあれば、FOISを使用しなければと思っていましたが、今後はこの論文を引用してFILSで評価してもよさそうですね。日本の臨床現場で最も普及している方法だと思いますし。

 

Abstract

Context

Dysphagia is one of the most prevalent and distressing symptoms among palliative care patients, and a practical assessment tool is required.

Objectives

The aim of this study was to examine the reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale (FILS), a 10-point observer-rating scale.

Methods

The inter- and intrarater reliability was evaluated by three clinicians in 30 patients using weighted kappa statistics. The convergent validity was evaluated by examining correlations of FILS with the Functional Oral Intake Scale (FOIS) and patient-reported satisfaction levels with oral intake.

Results

Weighted kappa coefficients for interrater reliability ranged from 0.70 to 0.90 and those for intrarater reliability ranged from 0.83 to 0.90. The FILS score was highly associated with FOIS (ρ = 0.96–0.99) and patient-reported satisfaction (ρ = 0.89).

Conclusion

FILS seems to have fair reliability and validity as a practical tool for assessing the severity of dysphagia. Further study on the reliability, validity, and sensitivity of FILS compared with FOIS is needed.