The International Dysphagia Diet Standardisation Initiative Functional Diet Scale (IDDSI-FDS)

What is it about?

For people with swallowing impairment (oropharyngeal dysphagia), the need for, and extent of dietary modification may serve as a proxy measure of dysphagia severity. To accompany the new International Dysphagia Diet Standardisation Initiative framework (www.iddsi.org), a new functional outcome scale was developed to capture degree of diet texture restriction: the IDDSI-Functional Diet Scale (IDDSI-FDS).

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Why is it important?

Previous functional scales regarding diet texture lack context frequently refer to dietary restrictions with descriptions such as “levels below a regular diet status” but lack the context of a diet framework with commonly understood levels of consistency. Recognition of the lack of a common framework for diet texture classification was the driving impetus behind development of the International Dysphagia Diet Standardisation Initiative (IDDSI) Framework (www.iddsi.org), a new scheme for describing and categorizing foods and drinks according to their texture or flow characteristics. The framework includes 8 levels, organized in two intersecting pyramids, with the outer levels (0 and 7) representing unmodified drinks and foods and intervening levels representing progressively greater degrees of texture modification. The IDDSI-FDS (IDDSI Functional Diet Scale) was developed as an accompaniment to the IDDSI Framework to capture the degree of diet texture restriction recommended for a patient based on assessment by a qualified clinician. The scale does not indicate the specific textures that are recommended, rather it classifies dysphagia severity according to the degree of diet limitation, i.e. the number of levels on the IDDSI Framework that a patient can consume. Lower numbered scores on the IDDSI-FDS reflect tighter diet texture restriction. This validation study suggests that the IDDSI-Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians to capture diet texture restriction and progression in people with dysphagia.