Background
- Validity, i.e. construct validity: align with the theoretical notion of oral health; content validity: include all items considered relevant by all stakeholders; criterion validity: correlates with a reference;
- Reliability, i.e. similar results are obtained for repeated measurements;
- Responsiveness, i.e. change over time is detected.
Objective
Methodology
Study design and strategy
Selection process
General information of the included studies
Assessment of the methodological quality of the included studies per measurement property
Measurement property | Description a | Quality criteria for measurement properties b | ||
---|---|---|---|---|
Validity | Content validity | To which degree the construct assesses whether the items are relevant for the construct to be measured | +: The target population considers all items in the instrument to be relevant AND to be complete | |
?: No target population involvement | ||||
-: The target population considers the items of the instrument irrelevant OR incomplete | ||||
Construct validity | Structural validity | To which degree the scores of an instrument are an adequate reflection of the dimensionality | +: Factors should explain at least 50% of the variance | |
?: Explained variance not mentioned | ||||
-: Factors explain < 50% of the variance | ||||
Hypothesizes testing | To which extent the scores of the instrument are consistent with the theoretically derived hypotheses | +: Correlation with an instrument measuring the same construct ≥ 0.50 or at least 75% of the results are in accordance with the hypotheses AND correlation with related constructs is higher than with unrelated constructs | ||
?: Solely correlations determined with unrelated constructs | ||||
-: Correlations with an instrument measuring the same construct <0.50 OR <75% of the results are in accordance with the hypotheses OR correlation with related constructs is lower than with unrelated constructs | ||||
Cross-cultural validity | To which extend the items are an adequate reflection of the original version after translation or culturally adaptation. | +: no important DIF between language versions | ||
?: DIF not assessed | ||||
-: Important DIF found between language versions | ||||
Criterion validity | To what degree the scores of the instrument are an adequate reflection of a ‘gold standard’. The gold standard should fit the purpose of the assessed instrument. | +: Convincing arguments that gold standard is ‘’gold” AND correlations with gold standard ≥0.70 | ||
?: No convincing argument that gold standard is ‘’gold” OR doubtful design or method | ||||
-: Despite adequate design and method, correlation is < 0.70 | ||||
Reliability | Reliability | The proportion of the total variance in the measurements which is because of ‘’true” differences among patients | +: ICC/weighted kappa ≥ 0.70 OR Pearson’s r ≥ 0.80 | |
?: Neither ICC/weighted kappa, nor Pearson’s r determined | ||||
-: ICC/weighted kappa <0.70 OR Pearson’s r < 0.80 | ||||
Internal consistency | The extent to which items in a sub(scale) are inter correlated, thus measuring the same construct | +: Cronbach’s α (s) ≥ 0.70 | ||
?: Cronbach’s α not determined | ||||
-: Cronbach’s α < 0.70 | ||||
Measurement error | The systematic and random error of a patient’s score that is not attributed to true changes in the construct to be measured | +:MIC <SDC OR MIC outside the LOA OR convincing arguments that agreement is acceptable | ||
?: Doubtful design or method OR MIC not defined AND no convincing arguments that agreement is acceptable | ||||
-: MIC≥ SDC OR MIC equals or inside LOA, despite adequate design and method | ||||
Responsiveness | The ability of the instrument to detect change over time | +: Correlation with an instrument measuring the same construct ≥ 0.50 OR at least 75% of the results are in accordance with the hypotheses OR AUC ≥ 0.70 AND correlation with related constructs is higher than with unrelated constructs | ||
?: Solely correlations determined with unrelated constructs | ||||
-: Correlation with an instrument measuring the same construct <0.50 OR <75% of the results are in accordance with the hypotheses or AUC <0.70 OR correlation with related constructs is lower than with unrelated constructs. |
Quality criteria for the measurement properties on oral health assessments
Results
Search results
Included studies
Authors | Publication year | Study design | Investigated measurement property | Type of non-dental healthcare professional using assessment | Patient population | Oral health assessment | Rating scale | Duration of assessment | |
---|---|---|---|---|---|---|---|---|---|
1 | Andersson et al. [18] | 2002 | Cross-sectional observational | Inter-rater reliability | RN | older people in rehabilitation ward | ROAG | 3 point scale on 8 items | Unknown |
2 | Andersson et al. [25] | 2002 | Cross-sectional observational | Content validity | RN | Geriatric rehabilitation patients | ROAG | 3 point scale on 8 items | Unknown |
3 | Arvidson-Bufano et al. [26] | 1996 | Cross-sectional observational | Inter-rater reliability | RN and LPN | Nursing home residents | MDS-RAI (section M) and RAP summary | 2 Point scale on 7 items | 3–4 min |
4 | Blank et al. [27] | 1996 | Cross-sectional observational | Inter-rater reliability | RN and LPN | Nursing home residents | MDS-RAI (section M) and RAP summary | 2 Point scale on 7 items | Unknown |
5 | Chalmers et al. [17] | 2005 | Prognostic follow-up | Content validity Criterion validity Intra-rater reliability Inter-rater reliability Test-retest reliability | PCA, RN, Enrolled Nurses and NA | Residents from residential facilities | OHAT | 3 point scale on 8 items | Mean: 7.8 min |
6 | Cohen-Mansfield et al. [28] | 2002 | Cross-sectional observational study | Inter-rater reliability | Geriatricians | Nursing home residents with Dementia | MDS- mouth pain and inflamed gums | 8 items on 2 point scale | Unknown |
7 | Dickinson et al. [19] | 2001 | Cross-sectional study | Content validity Intra-rater reliability Inter-rater reliability | Stroke specialist nurse, staff nurses, student nurse | Older medically Ill patients | THROAT | 4 point scale on 9 items | Unknown |
8 | Fjeld et al. [29] | 2016 | Prognostic follow-up | Content validity Criterion validity Inter-rater reliability | Clinical nurse | Nursing home residents | DHR | 3 point scale on two items | Less than 1 minute |
9 | Hanne et al. [30] | 2012 | Cross-sectional | Cross-cultural validity | Nurses | Acute medical ward residents (mean age 76.5) | ROAG | 3 point scale on 8 items | Unknown |
10 | Hawes et al. [31] | 1995 | Cross-sectional | Inter-rater reliability | LN | Nursing home residents | MDS | Unclear | Unknown |
11 | Henriksen et al. [32] | 1999 | Cross-sectional | Intra-rater reliability Inter-rater reliability | Medical Nurse | older people with mental disabilities | MPS | 4 point scale on 2 items | 2–4 min |
12 | Kayser-Jones et al. [33] | 1995 | Cross-sectional | Inter-rater reliability Test-retest reliability | RN, LVN, CNA | Nursing home residents | BOHSE | 3 point scale on 10 items | Mean time RNs, LVNS, CNAs: 7.4, 7.9 and 8.7 min |
13 | Lin et al. [34] | 1999 | Cross-sectional | Criterion validity Inter-rater reliability | LN and CNA | LTC residents with Alzheimer | BOHSE | 3 point scale on 10 items | Unknown |
14 | Morris et al. [35] | 1997 | Cross-sectional | Inter-rater reliability | Nurses | Community-dwelling older people with home care | MDS-HC | Unclear | Unknown |
15 | Paulsson et al. [36] | 2008 | Prospective | Criterion validity | Nurses | Patients on medical ward (mean age 67) | ROAG | 3 point scale on 8 items | Unknown |
16 | Riberio et al. [37] | 2014 | Cross-sectional | Cross-cultural validity Criterion validity Intra-rater reliability | CHW | Community-dwelling older people | ROAG | 3 point scale on 8 items | 11 min |
17 | Simpelaere et al. [38] | 2016 | Cross-sectional with two- week follow-up for test-retest | Intra-rater reliability Inter-rater reliability Test-retest reliability | Speech Pathologists | Acute geriatric department/hospitalized, residential care settings (assisted living and nursing homes) | OHAT | 3 point scale on 8 items | Mean time: 2.45 min |
18 | Yanagisawa et al. [39] | 2017 | Cross-sectional | Internal consistency Inter-rater reliability | Caregivers | Institutionalized older people | OAS | 3 point scale on 9 items | Unknown |
The methodological quality of the included studies per measurement property
Study | Assessment | Measurement property | Reason for poor methodological quality |
---|---|---|---|
Andersson et al. (2002b) [25] | ROAG | Content validity | - Target population not involved - Not assessed if all items together comprehensively reflect the construct to be measured |
Arvidson-Bufano et al. (1996) [26] | MDS-RAI | Inter-rater reliability | - Small sample size - Only percent agreement calculated |
Blank et al. (1996) [27] | MDS-RAI | Inter-rater reliability | - Unclear how many patients the dentist assessed - Only percent agreement is calculated - Other important methodological flaws in design or execution of study |
Chalmers et al. (2005) [10] | OHAT | Content validity Criterion Validity Test-retest | - Target population not involved - Not assessed if all items together comprehensively reflect the construct to be measured - Small sample size - No ICC or correlation calculated |
Cohen-Mansfield et al. (2002) [28] | MDS | Inter-rater reliability | - Small sample size - No ICC or correlations calculated - Other important methodological flaws in design or execution of study |
Dickinson et al. (2001) [19] | THROAT | Content validity | - Target population not involved |
Fjeld et al. (2017) [29] | DHR | Content validity | - Target population not involved |
Hanne et al. (2012) [30] | ROAG | Cross-cultural validity | - Only forward translation |
Hawes et al. (1995) [31] | MDS | Inter-rater reliability | - Only percent agreement is calculated |
Henriksen et al. (1999) [32] | MPS | Intra-rater reliability Inter-rater reliability | - Small sample size |
Kayser-Jones et al. (1995) [33] | BOHSE | Content validity | - Target population not involved |
Paulsson et al. (2008) [36] | ROAG | Criterion validity | - Other important methodological flaws in design or execution of study - Correlations or AUC not calculated - Sensitivity and specificity not calculated |
Simpelaere et al. (2016) [38] | OHAT | Intra-rater reliability | - Small sample size - Only percent agreement is calculated |
Yanagisawa et al. (2017) [39] | OAS | Criterion-validity | - No factor analysis performed and no reference to another study |
The methodological quality of the measurement property validity
Assessment | Study | Validity | |||||
---|---|---|---|---|---|---|---|
Content validity | Cross-cultural validity | Criterion Validity | |||||
M | Q | M | Q | M | Q | ||
ROAG | Andersson et al. (2002b) [25] | Poor | N.A. | ||||
Hanne et al. (2012) [30] | Poor | N.A. | |||||
Paulsson et al. (2008) [36] | Poor | N.A. | |||||
Ribeiro et al. (2014) [37] | Fair | ? | Gooda | ? (Sens: 0.17-0.80) (Spec: 0.69-0.98) | |||
OHAT | Chalmers et al. (2005) [17] | Poor | N.A. | Poor | N.A. | ||
THROAT | Dickinson et al. (2001) [19] | Poor | N.A. | ||||
DHR | Fjeld et al. (2017) [29] | Poor | N.A. | Fair | + (r(s) = 0.78) | ||
BOHSE | Kayser-Jones et al. (1995) [33] | Poor | N.A. | ||||
Lin et al. (1999) [34] | Gooda | - (r: 0.351-0.578) |
The methodological quality of the measurement property reliability
Intra-rater reliability
Assessment | Study | Reliability | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Internal-consistency | Intra-rater reliability | Inter-rater reliability | Test-retest reliability | Raters | ||||||
M | Q | M | Q | M | Q | M | Q | |||
ROAG | Andersson et al. (2002a) [18] | Gooda | ?/− (κ/κw: 0.45-0.84)b | Nurse/Dental hygienist | ||||||
Ribeiro et al. (2014) [37] | Good | +/− (κw: 0.38-0.88) | Community health workers | |||||||
MDS | Arvidson-Bufano et al. (1996) [28] | Poora | N.A. | Nurse/Dentist | ||||||
Blank et al. (1996) [27] | Poora | N.A. | Nurse/Dentist | |||||||
Cohen-Mansfield (2002) [28] | Poora | N.A. | Geriatricians/Dentist | |||||||
Hawes et al. (1995) [31] | Poor | N.A. | Nurses | |||||||
MDS-HC | Morris et al. (1997) [35] | Good | +/− (κw: 0.57-0.7) | Nurses | ||||||
OHAT | Chalmers et al. (2005) [17] | Fair | + (ICC = 0.78) ? (κ: 0.51-0.80)b | Fair | + (ICC = 0.74) ? (κ: 0.48-0.80)b | Poor | N.A. | Nurses | ||
Simpelaere et al. (2016) [38] | Poor | N.A. | Fair | + (ICC = 0.96) ? (κ: 0.83-1.00) | Fair | + (ICC = 0.81 & 0.78) ? (κ: 0.14-0.91) | Speech pathologists | |||
THROAT | Dickinson et al.(2001) [19] | Good | +/− (κw: 0-0.96) | Gooda | +/− (κw: 0.46-0.97) | Dental hygienist,/ stroke specialist nurse and staff Nurse | ||||
DHR | Fjeld et al. (2017) [29] | Fair | + (κ: 0.7-0.8) | Faira | ? (κ: 0.4-0.8) | Dental hygienist and Nurse | ||||
MPS | Henriksen et al. (1999) [32] | Poor | N.A. | Poora | N.A. | Dentist, 2 Dental Hygienist, and Nurse | ||||
BOHSE | Kayser-Jones et al. (1995) [33] | Faira | -(r: 0.4-0.68) ? (κ: -0.02-0.82)b | Fair | +/− (r: 0.79-0.88) | Dentist and Nurses | ||||
Lin et al. (1999) [34] | Faira | ? (κ: -0.018-0.519)b | Dentist and Nurses | |||||||
OAS | Yanagisawa et al. (2017) [39] | Poor | N.A | Fair | ? (κ: 0.25-0.90) +/- (ICC: 0.54-0.98) | Dental professionals and care workers |
Inter-rater reliability
Test-retest reliability
Characteristics of individual oral health assessments and the quality assessment of their measurement properties
ROAGa | MDSb | OHATb/c | THROATa | DHR | MPS | BOHSEd | OAS | |
---|---|---|---|---|---|---|---|---|
1. Mucosa membrane | X | X | X | X | X | X | X | |
Color/Rash | X | X | X | X | X | X | ||
Moistness | X | X | X | X | ||||
Swelling/glazing/granulations/Hyperplasia | X | X | X | X | X | |||
Bleeding | X | X | X | X | X | |||
Ulcers / Spots (under dentures) | X | X | X | X | X | X | X | |
2. Gums | X | X | X | X | X | |||
Color | X | X | X | X | ||||
Moistness | X | X | ||||||
Swelling/glazing | X | X | X | X | ||||
Bleeding | X | X | X | X | ||||
Firmness | X | X | ||||||
Inflammation | X | X | ||||||
Ulceration/spots | X | X | X | |||||
Loose teeth | X | |||||||
3. Teeth | X | X | X | X | ||||
Decay/Cariës/Broken teeth | X | X | X | X | ||||
Number of teeth | X | X | ||||||
Tooth erosion/wear | X | |||||||
4. Dentures | X | X | X | X | X | |||
Broken parts | X | X | X | |||||
Does the individual wear the dentures | X | X | X | |||||
Fit of dentures/need for adhesive | X | X | ||||||
Label on dentures | X | |||||||
Functionality | X | |||||||
5. Lips | X | X | X | X | ||||
Color | X | X | X | X | ||||
Surface structure/Candida infection | X | X | X | X | ||||
Moistness | X | X | X | X | ||||
Ulceration | X | X | X | X | ||||
Bleeding | X | X | X | X | ||||
Swelling | X | |||||||
6. Tongue | X | X | X | X | X | |||
Color | X | X | X | X | ||||
Surface structure | X | X | X | X | ||||
Moistness | X | X | X | X | ||||
Ulceration/coating | X | X | X | X | X | |||
Swelling | X | X | ||||||
Bleeding | X | |||||||
7. Saliva | X | X | X | X | X | |||
Measured as friction/adherence of mouth mirror at buccal mucosa | X | |||||||
Amount/structure of saliva | X | X | X | X | ||||
Involvement of tissues | X | X | X | |||||
Experience of individual | X | |||||||
8. Palate | X | X | ||||||
Color | X | X | ||||||
Surface structure | X | X | ||||||
Moistness | X | X | ||||||
Ulceration | X | X | ||||||
Swelling | X | |||||||
Inflammation/bleeding | X | X | ||||||
9. Floor of mouth | X | X | ||||||
Color | X | X | ||||||
Surface structure | X | X | ||||||
Moistness | X | X | ||||||
Ulceration/coating | X | X | ||||||
Swelling | X | |||||||
Inflammation/bleeding | X | X | ||||||
10. Oral hygine (debris and plaque) | X | X | X | X | X | X | X | |
11. Referral to a dental professional | X | X | ||||||
12. Smell | X | X | X | |||||
13. Pairs in chewing position (amount) | X | X | ||||||
14. Pain (physical signs and verbal signs) | X | |||||||
15. Voice (deep, rasping or painful) | X | |||||||
16. Ability to swallow (pain/inability to swallow) | X | |||||||
17. Functionality (mouth opening, tong thrusting) | X | |||||||
18. Lymph nodes (enlargement and tenderness) | X |