Schierz Oliver, Lee Chi Hyun, John Mike T, Rauch Angelika, Reissmann Daniel R, Kohal Ralf, Marrè Birgit, Böning Klaus, Walter Michael H, Luthardt Ralph Gunnar, Rudolph Heike, Mundt Torsten, Hannak Wolfgang, Heydecke Guido, Kern Matthias, Hartmann Sinsa, Boldt Julian, Stark Helmut, Edelhoff Daniel, Wöstmann Bernd, Wolfart Stefan, Jahn Florentine
Department of Prosthodontics and Materials Science, Medical Faculty University of Leipzig, Leipzig, Germany.
Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.
J Evid Based Dent Pract. 2023 Jan;23(1S):101794. doi: 10.1016/j.jebdp.2022.101794. Epub 2022 Oct 17.
When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets.
Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA).
This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns.
Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated.
Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.
牙科患者寻求治疗时，治疗并非总是成功的，即患者的口腔健康问题并非总能消除或大幅减轻。识别这些患者（治疗无反应者）对于临床决策至关重要。基于群体的轨迹建模（GBTM）在牙科中很少使用，但却是一种很有前景的统计技术，尤其可用于识别纵向数据集中的无反应者以及一般意义上临床特征不同的患者群体。
本研究旨在通过短牙弓（SDA）患者的实例，展示如何使用基于群体的轨迹建模来识别口腔健康相关生活质量（OHRQoL）的治疗反应模式。
本文是一项随机对照临床试验的二次数据分析。在该试验中，SDA患者接受了部分可摘义齿修复缺失牙至第一磨牙（N = 79），或者牙弓以现存的第二前磨牙或由悬臂固定义齿替代的第二前磨牙结束（N = 71）。进行了长达15年的多达十次随访检查（治疗后1 - 2、6、12、24、36、48、60、96、120和180个月）。使用49项口腔健康影响量表（OHIP）评估OHRQoL结局。进行探索性GBTM以识别治疗反应模式。
可识别出两种反应模式——“反应者”和“无反应者”。反应者的OHRQoL在15年中大幅改善并基本保持稳定。无反应者的OHRQoL随时间未显著改善或有所恶化。虽然SDA治疗与这两种反应模式无关，但尤其是更高水平的功能、疼痛相关、心理损害，以及总体上严重受损的OHRQoL预测了治疗后无反应的OHRQoL模式。此外，还评估了一种三种模式的方法。
根据治疗后的某些纵向特征对患者进行聚类通常很重要，但特别识别无反应者的治疗情况是关键。随着临床研究和常规患者护理中OHRQoL数据的可用性不断提高，GBTM已成为一种强大的工具，可用于研究哪种牙科治疗对哪些患者有效。
