Reliability and Validity of the Korean Version of the Eating and Drinking Ability Classification System in Children with Cerebral Palsy

Research Objectives: The objective of this study is to assess the reliability and validity of the Korean version of Eating and Drinking Ability Classification System (EDACS) for pediatric patients with cerebral palsy (CP).

Design: This study is a prospective cross-sectional study and psychometric study.

Setting: The subjects were patients who are aged 3 to under 18 and visited the rehabilitation medicine outpatient clinic from October 2022 to August 2023.

Participants: Children who had surgery within the past 3 months were excluded. Out of a total of 42 children, 2 withdrew their consent, leaving 40 children for analysis.

Interventions: The physician evaluated Gross Motor Function Classification System (GMFCS) and Manual Activity Classification System (MACS), through direct face-to-face assessment, while the speech therapist assessed Communication Functional Classification System (CFCS) through a interview. Evaluation using EDACS was conducted through recorded videos. Two video recordings were made by the caregiver with a one-week interval. At the time of video recording, caregivers were instructed to conduct the EDACS evaluation independently, without supervision from the physician or speech therapist. The submitted videos were evaluated separately by the physician and speech therapist, with the physician additionally assessing Functional Oral Intake System (FOIS).

Main Outcome Measures: The Korean version of EDACS was utilized as the official translated version, prepared by Kim et al. and three other individuals, and downloaded from www.edacs.org. The reliability was examined using weighted kappa (κW) and the validity was assessed by Kendall’s tau-b (Kτ) through SPSS 27.0.

Results: In the evaluation of each stage and independence in EDACS, there was almost perfect agreement between physicians and speech therapists (κW = 0.940, 0.919). Substantial agreement was observed between physicians and caregivers (κW = 0.618, 0.592), and a moderate agreement between speech therapists and caregivers (κW = 0.557, 0.556). Intra-rater reliability was consistently at an almost perfect level across all comparisons. Additionally, moderate or higher validity was found in FOIS (Kτ = -0.863), GMFCS (Kτ = 0.656), MACS (Kτ = 0.720), and CFCS (Kτ = 0.616).

Conclusions: In the context of pediatric patients with CP, the Korean version of EDACS shows significant consistency among professionals, including a physician and a speech therapist, as well as their caregivers who contributed to the evaluation. This indicates a strong agreement in evaluating EDACS, especially in terms of communicating the dietary levels in children with CP, thus augmenting its clinical utility. Furthermore, it demonstrates notable validity when compared to other functional classification systems for CP.

Author(s) Disclosures: The authors declare no competing interests.