A COSMIN systematic review of performance-based assessment tools for mealtime performance in Parkinson’s disease: a linking study based on the ICF framework

This study systematically reviewed performance-based outcome measurement instruments (PerFOMs) for mealtime performance in Parkinson’s disease and appraised their measurement domains and properties using the ICF framework and COSMIN methodology. PubMed, Embase, ProQuest, and CINAHL were searched for studies published between January 2006 and July 2026. Eligible studies used observer-administered PerFOMs that evaluated comprehensive ingestive skills during meals. Patient-reported outcome measures and screening tools limited to isolated swallowing tasks were excluded. Instrument items were linked to ICF components, and measurement properties were appraised using COSMIN. Two studies were included, identifying two PerFOMs: the Mealtime Assessment Scale (MAS) and the modified Older Americans Resources and Services (OARS) scale. The MAS was linked to all four ICF components, whereas the modified OARS scale was limited to utensil use. Neither instrument had undergone independent content-validity testing. The MAS showed adequate methodological quality with sufficient results for measurement error and convergent validity, whereas the modified OARS scale lacked evidence for most measurement properties. The evidence base for comprehensive mealtime assessment in PD remains limited and preliminary. Existing instruments differ in ICF coverage and lack content validation. Further research should establish psychometric evidence and address multiple dimensions of mealtime performance in PD. Mealtime difficulties in Parkinson’s disease extend beyond swallowing and involve posture, utensil handling, and cognitive-attentional demands.Patients with Parkinson’s disease may overestimate their own eating ability, so direct observation of mealtime performance should complement self-report.This review found that only two performance-based mealtime assessments exist for this population, and neither has been fully validated.Rehabilitation professionals should assess mealtime performance across ICF domains, rather than swallowing alone, to guide individualized rehabilitation in Parkinson’s disease. Mealtime difficulties in Parkinson’s disease extend beyond swallowing and involve posture, utensil handling, and cognitive-attentional demands. Patients with Parkinson’s disease may overestimate their own eating ability, so direct observation of mealtime performance should complement self-report. This review found that only two performance-based mealtime assessments exist for this population, and neither has been fully validated. Rehabilitation professionals should assess mealtime performance across ICF domains, rather than swallowing alone, to guide individualized rehabilitation in Parkinson’s disease.