This study aimed to determine the validity and reliability of the Indonesian version of the Eating and Drinking Ability Classification System (EDACS) in children with cerebral palsy.
Method
The EDACS was translated and culturally adapted into Bahasa Indonesia using the FACIT (Functional Assessment of Chronic Illness Therapy) translation methodology, aligning with established international cross-cultural adaptation guidelines such as. Content validity was confirmed through expert review and cognitive debriefing interviews. Inter-rater reliability (κ) was assessed across three pairings: Speech Therapists (STs), Physical Medicine and Rehabilitation (PM&R) Residents, and cross-professionally.
Results
A total of 30 children with cerebral palsy (range 3–16 years) were classified. Inter-rater reliability showed very strong agreement among STs (κ level = 0.871; κ assistance = 1.000). Strong agreement was found among Residents (κ level = 0.703; κ assistance = 0.788), with the highest disagreement reaching 2 levels on EDACS Level I classifications. Cross-professional agreement was very strong (κ level = 0.828; κ assistance = 0.895).
Conclusion
The Indonesian EDACS is confirmed to be valid and reliable for clinical use. The demonstrated strong to very strong cross-professional reliability supports its consistent use as an effective, multidisciplinary communication tool for STs and PM&R Residents.
AdamsM. S. (2009). The management of feeding difficulties in children with cerebral palsy in Bangladesh. Doctoral dissertation, UCL (University College London).
2.
BeatonD. E.BombardierC.GuilleminF.FerrazM. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
3.
BellK. L.BenferK. A.WareR. S.PatraoT. A.GarveyJ. J.ArvedsonJ. C.BoydR. N.DaviesP. S. W.WeirK. A. (2019). Development and validation of a screening tool for feeding/swallowing difficulties and undernutrition in children with cerebral palsy. Developmental Medicine & Child Neurology, 61(10), 1175–1181. https://doi.org/10.1111/dmcn.14220
4.
BenferK. A.WeirK. A.BellK. L.WareR. S.DaviesP. S. W.BoydR. N. (2017). The Eating and Drinking Ability Classification System in a population‐based sample of preschool children with cerebral palsy. Developmental Medicine & Child Neurology, 59(6), 647–654. https://doi.org/10.1111/dmcn.13403
5.
ChiuH.-C.BuckeridgeK.LeeT. A.SellersD. (2022). Reliability and validity of the Eating and Drinking Ability Classification System (EDACS) for children with cerebral palsy in Taiwan. Disability and Rehabilitation, 44(21), 6438–6444. https://doi.org/10.1080/09638288.2021.1962989
6.
CruchinhoP.López-FrancoM. D.CapelasM. L.AlmeidaS.BennettP. M.Miranda da SilvaM.TeixeiraG.NunesE.LucasP.GasparF.Handovers4SafeCare. (2024). Translation, cross-cultural adaptation, and validation of measurement instruments: A practical guideline for novice researchers. Journal of Multidisciplinary Healthcare, 17, 2701–2728. https://doi.org/10.2147/JMDH.S419714
7.
EremencoS. L.CellaD.ArnoldB. J. (2005). A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Evaluation & the health professions, 28(2), 212–232. https://doi.org/10.1177/0163278705275342
HuangW. Y.WongS. H. (2014). Cross-cultural validation. In MichalosA. C. (Ed.), Encyclopedia of quality of life and well-being research (pp. 1369–1371). Springer Netherlands. https://doi.org/10.1007/978-94-007-0753-5_630
10.
Kerem GünelM.OzalC.SeyhanK.ArslanS. S.DemirN.KaradumanA. (2020). YEME VE İÇME BECERİLERİ SINIFLANDIRMA SİSTEMİNİN TÜRKÇE VERSİYONU: SEREBRAL PALSİLİ ÇOCUKLARDA DEĞERLENDİRİCİ-İÇİ GÜVENİRLİĞİ VE DİĞER FONKSİYONEL SINIFLANDIRMA SİSTEMLERİ İLE İLİŞKİSİ. Türk Fizyoterapi ve Rehabilitasyon Dergisi, 31(3), 218–224. https://doi.org/10.21653/tjpr.493150
11.
MouillyM.El MidaouiA.El HessniA. (2022). The effects of swallowing disorders and oral malformations on nutritional status in children with cerebral Palsy. Nutrients, 14(17), 3658. https://doi.org/10.3390/nu14173658
12.
PatelD. R.BovidK. M.RauschR.Ergun-LongmireB.GoettingM.MerrickJ. (2024). Cerebral palsy in children: A clinical practice review. Elsevier, 54(11), Article 101673. https://doi.org/10.1016/j.cppeds.2024.101673
13.
PaulsonA.Vargus-AdamsJ. (2017). Overview of four functional classification systems commonly used in cerebral Palsy. Children, 4(4), 30. https://doi.org/10.3390/children4040030
14.
SellersD.BryantE.HunterA.CampbellV.MorrisC. (2019). The Eating and Drinking Ability Classification System for cerebral palsy: A study of reliability and stability over time. Journal of Pediatric Rehabilitation Medicine, 12(2), 123–131. https://doi.org/10.3233/PRM-180581
15.
SellersD.MandyA.PenningtonL.HankinsM.MorrisC. (2014). Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy. Developmental Medicine & Child Neurology, 56(3), 245–251. https://doi.org/10.1111/dmcn.12352
16.
SellersD.PenningtonL.MandyA.MorrisC. (2014). A systematic review of ordinal scales used to classify the eating and drinking abilities of individuals with cerebral palsy. Developmental Medicine & Child Neurology, 56(4), 313–322. https://doi.org/10.1111/dmcn.12313
17.
Sellers et al. (2014). Development and reliability of a system to classif.pdf.
18.
SkalskyA. (2015). Pediatric rehabilitation. Physical Medicine and Rehabilitation Clinics of North America.
19.
TschirrenL.BauerS.HanserC.MarsicoP.SellersD.van HedelH. J. A. (2018). The Eating and Drinking Ability Classification System: Concurrent validity and reliability in children with cerebral palsy. Developmental Medicine & Child Neurology, 60(6), 611–617. https://doi.org/10.1111/dmcn.13751
20.
van HulstC. C. M. (2019). Oral motor performance in children with neurodevelopmental disabilities. Doctoral dissertation.
21.
von ElmE.AltmanD. G.EggerM.PocockS. J.GøtzscheP. C.VandenbrouckeJ. P. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ, 335(7624), 806–8.
22.
WahyuL. K. (2014). Tatalaksana Kedokteran Fisik dan Rehabilitasi: Kesulitan Makan Pada Anak (1st ed.). PB Perdosri.
23.
WahyuniL. K. (2023). Multisystem compensations and consequences in spastic quadriplegic cerebral palsy children. Frontiers in neurology, 13, 1076316. https://doi.org/10.3389/fneur.2022.1076316
24.
WildD.GroveA.MartinM.EremencoS.McElroyS.Verjee-LorenzA.EriksonP. (2005). Principles of good practice for the translation and cultural adaptation process for Patient-Reported Outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2), 94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x
25.
WilsonE. M.CenterW.HustadK. C. (2010). Early feeding abilities in children with cerebral palsy: A parental report study. Journal of medical speech-language pathology, nihpa57357.
