CHAPTER 58: MCGILL INGESTIVE SKILLS ASSESSMENT (MISA)

Description

The McGill Ingestive Skills Assessment (MISA) outcome measure is an occupational therapy tool designed to quantify a person’s ability to safely and independently consume a variety of food and liquid textures and was developed for use with older populations as well as those with neurologic impairment to assess their mealtime routine (Lambert, Gisel, Groher, Abrahamowicz, & Wood-Dauphinee, 2006). The MISA includes 43 items comprising 5 skill domains: (1) positioning, which has 4 items that address the ability to maintain a position that is safe for eating and drinking; (2) self-feeding skills, which has 7 items that examine self-feeding skills, behavior, and judgement; (3) liquid ingestion, which has 7 items that are considered necessary oropharyngeal skills for liquid intake; (4) solid ingestion, which has 12 items that are the oropharyngeal skills for solid intake; and (5) texture management, which has 13 items that explore the ability to manage 8 solid foods and 5 liquid textures (Lambert, Gisel, Groher, & Wood-Dauphinee, 2003). During assessment the clinician notes client abilities or impairments relative to the 5 skill domains during mealtime feeding. The MISA employs a 3-point ordinal scale and, when summed, gives a composite score as well as subscale scores, which can then be used to determine ability across the functional domains as well as areas to address for rehabilitation. The MISA can be completed in 60 minutes or less with higher scores indicative of fewer ingestive problems.

Psychometrics

Initial field testing of the MISA showed that internal consistency of all scales was α = ≥ 0.86 and inter-rater agreement was r = ≥ 0.92 (Lambert et al., 2003). A following study determined that the total item inter-rater reliability using 76 subjects with 50 raters was r = 0.85, while for the positioning subscale it was 0.68, self-feeding 0.88, liquid ingestion 0.84, solid ingestion 0.68, and texture management r = 0.74)(Lambert et al., 2006). The same study found total item intra-rater reliability to be r = 0.92, while for the positioning subscale it was 0.69, for self-feeding 0.88, liquid ingestion 0.77, solid ingestion 0.92, and texture management 0.72 (Lambert et al., 2006). Finally, that study also determined that all of the subscales of the MISA were positively correlated with the Functional Independence Measure scale with self-feeding (0.67) being stronger than the others (range; 0.22 to 0.40). An examination of 102 subjects with an average age of 77 years from acute and long-term care facilities found that an increasing total MISA score had statistically significant associations with reduced risk of death, where a 1-point increase in total MISA score was associated with a 4% decrease in the risk of death, and a 1-point increase in both the self-feeding and solid ingestion scales was associated with an approximately 11% risk reduction (Lambert, Abrahamowicz, Groher, Wood-Dauphinee, & Gisel, 2005).

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