52 poorer oral conditions such as fewer teeth or occlusal units.29 However, no significant differences were found between patients with HNC and healthy controls for number of teeth or number of occlusal units, indicating that these oral conditions were similar. Strengths and limitations The Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was followed to reduce bias and ensure methodological and statistical quality.32 Reliability was tested in a large research population. Data were collected by the same authors (JAV and FMW) and the MAT score was calculated by the same observer (CMS). However, no inter-rater reliabilities were tested, because this was believed to be too time consuming for patients with HNC. In addition, significant differences were found between patients and healthy controls for age and sex, causing the groups to be noncomparable. Future research The results of the test-retest reliability can be used in future research to provide insight in differences over time and differences between different treatment modalities for patients with HNC. Because the ICC showed a good reproducibility, we expect the outcomes of the MAT to be of good reliability for future research. The SEM and SEM% values can be used as an indication for the expected random variation of a MAT score at any given time. The SDC and SDC% values can be used to describe minimal changes needed over time in order to be clinically significant. When values between different measurements are larger than the SDC, these changes are not caused by measurement uncertainty, and are actual changes over time.22 The SEM% and SDC% values generate a fair comparison between different measures, and indicate that only small changes are needed to indicate a real change in mixing ability over time for patients with HNC. In healthy controls, bigger changes are needed to determine if performance has truly changed over time. In conclusion, the MAT has a good reliability in patients with head and neck cancer and a moderate reliability in healthy controls.
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