Test of Masticating and Swallowing Solids (TOMASS): adaptação transcultural e propriedades de medida

Abstract

Objective: To cross-culturally adapt the Test of Masticating and Swallowing Solids (TOMASS) to Brazilian Portuguese and evaluate its measurement properties. Methods: Methodological study, with a qualitative and quantitative approach. A systematized process of translation and cross-cultural adaptation, content validity, synthesis of translators, evaluation by a committee of three expert judges and 12 non-expert judges with Chronic Obstructive Pulmonary Disease (COPD) was carried out, reverse translation into the original language and study carried out pilot to test its reliability and obtain validity evidence from known groups. The Portuguese version of TOMASS was applied to 32 individuals, 16 healthy and 16 with COPD recruited from a pulmonary rehabilitation outpatient clinic, matched by sex and age. For test-retest reliability, measured by the Intraclass Correlation Coefficient (ICC), and measurement of Standard Measurement Error (SEM), TOMASS was reapplied by the same evaluator after 14 days in all participants. For inter-rater reliability, measured by the ICC, the applications were recorded on video and analyzed by two more dysphagia specialists. To obtain construct validity, the measurements of the two groups for the TOMASS domains were compared. The effect size of the tests was calculated to ensure the statistical significance of the results. Results: During the cross-cultural adaptation phase, it was necessary to replace the Nabisco Saltine™ cookie suggested by the original version with a “water and salt” type cookie and adapt the command given to make it easier for patients to understand. In content validity, the Content Validity Coefficient (CVC) was greater than 0.80 for all items, indicating that the judges showed acceptable agreement. Excellent inter-rater and test-retest reliability was identified, with ICC greater than 0.95 for all test domains and with small variation in SEM. Regarding validity by known groups, the COPD group had a significantly higher number of chews, swallows and total time than the healthy group (p<0.001, 0.021 and 0.004). Number of bites had no difference between groups (p=0.121). Conclusion: The version of TOMASS translated and adapted to Brazilian Portuguese presents excellent reliability and has evidence of validity for evaluating changes in chewing and swallowing of solid consistency, especially for individuals with COPD.