Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Dysphagia. 2022 Aug;37(4):1014-1021. doi: 10.1007/s00455-021-10364-7. Epub 2021 Oct 8.
The pervasive nature of dysphagia in the head/neck cancer (HNC) population necessitates a comprehensive evaluation approach, including both objective assessment of dysphagia, and subjective patient-reported functional measures. However, the congruence between clinician-rated and patient-perceived function is still not well understood. The current study investigated the association between objective clinician-rated swallow physiology (using the MBSImP) and patient-reported measures of swallowing-related quality of life (using the MDADI) in a secondary analysis of patients with oropharyngeal HNC treated with (chemo)radiotherapy. Seventy-nine patients with oropharyngeal HNC receiving (chemo)radiotherapy completed a standardised videofluoroscopic swallow study (VFSS) rated using the MBSImP, and the MDADI, at pre-treatment (baseline), 6 weeks and 3 months post-treatment as per a previous prospective RCT. Data on n = 67 participants were analysed as part of the secondary analysis. Association between MBSImP oral and pharyngeal composite scores versus MDADI Global and subscale scores was examined using ordinary least squares regression and mixed-effects general linear modelling (GLM). Univariable analyses demonstrated significant associations between MBSImP oral composite scores and each of the MDADI subscales, as well as the MBSImP pharyngeal composite scores and all MDADI subscales. GLM analysis revealed significant associations were maintained between MBSImP pharyngeal scores and the MDADI global and emotional subscale scores at the multivariable level, with the physical subscale trending towards significance. No significant association was observed between the MBSImP oral composite scores and any of the MDADI subscales at the multivariable level. This study found significant associations between objective measures of pharyngeal swallow physiology and patient-perceived swallowing-related quality of life. These findings suggest a higher degree of concordance between clinician-rated and patient-reported measures up to 3 months post-(C)RT than previously reported.
在头颈部癌症（HNC）人群中，吞咽困难普遍存在，因此需要采用全面的评估方法，包括对吞咽困难的客观评估和患者主观报告的功能测量。然而，临床医生评估的功能和患者感知的功能之间的一致性仍未得到很好的理解。本研究在一项头颈部 HNC 患者接受（放）化疗的二次分析中，调查了客观的临床医生评估的吞咽生理（使用 MBSImP）与患者报告的吞咽相关生活质量（使用 MDADI）之间的关联。79 例接受（放）化疗的口咽 HNC 患者在治疗前（基线）、治疗后 6 周和 3 个月完成了一项标准的视频透视吞咽研究（VFSS），使用 MBSImP 进行评分，并使用 MDADI 进行评分，这是之前前瞻性 RCT 的一部分。对 n=67 名参与者的数据进行了二次分析。使用普通最小二乘回归和混合效应一般线性模型（GLM）分析 MBSImP 口腔和咽部综合评分与 MDADI 全球和亚量表评分之间的关系。单变量分析显示，MBSImP 口腔综合评分与 MDADI 各亚量表以及 MBSImP 咽部综合评分与 MDADI 所有亚量表之间均存在显著相关性。GLM 分析显示，在多变量水平上，MBSImP 咽部评分与 MDADI 全球和情绪亚量表评分之间仍存在显著相关性，而身体亚量表则存在显著相关性。在多变量水平上，MBSImP 口腔综合评分与 MDADI 任何亚量表之间均无显著相关性。本研究发现，咽部吞咽生理的客观测量与患者报告的吞咽相关生活质量之间存在显著相关性。这些发现表明，在（C）RT 后 3 个月内，临床医生评估的功能和患者报告的功能之间的一致性比以前报告的更高。
