Revisiting the psychometric properties of a revised Danish version of the McGill ingestive skills assessment

Background: During a longstanding validation process of the Danish version of the McGill Ingestive Skills Assessment (MISA2-DK) for measuring mealtime performance in dysphagic clients, extensive revisions have been undertaken. Therefore, this study aimed to determine the psychometric properties of this revised version. Methods: In a cross-sectional study, 328 adults referred to occupational therapy for swallowing evaluation were included. MISA2-DK with 36 items distributed into four subscales (positioning for meals, self-feeding skills, liquid ingestion, and solid ingestion) was administered as observation during a meal. Statistical analysis included item analysis by the Rasch model and exploratory factor analysis (EFA). Results: The initial analysis of MISA2-DK presented misfit to the Rasch model, which was resolved by grouping items within subscales into testlets to adjust for local item dependency. However, when testing the items within each subscale, the subscale structure was not supported. The EFA and further item analysis by the Rasch model suggested a different distribution of items—namely, anticipation, bolus preparation, bolus propulsion, and airway protection. Conclusion: The total MISA2-DK score might provide a unidimensional measure of mealtime performance. However, for detailed information of qualitative aspects of dysphagic clients’ mealtime performance, the four EFA-derived subscale domains are recommended