Classification of Physiologic Swallowing Impairment Severity: A Latent Class Analysis of Modified Barium Swallow Impairment Profile Scores

Abstract

<jats:sec> <jats:title>Purpose</jats:title> <jats:p>Our objectives were to (a) identify oral and pharyngeal physiologic swallowing impairment severity classes based on latent class analyses (LCAs) of the Modified Barium Swallow Impairment Profile (MBSImP) swallow task scores and (b) quantify the probability of severity class membership given composite MBSImP oral total (OT) and pharyngeal total (PT) scores.</jats:p> </jats:sec> <jats:sec> <jats:title>Method</jats:title> <jats:p>MBSImP scores were collected from a patient database of 319 consecutive modified barium swallow studies. Because of missing swallow task scores, LCA was performed using 25 multiply imputed data sets.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>LCA revealed a three-class structure for both oral and pharyngeal models. We identified OT and PT score intervals to assign subjects to oral and pharyngeal impairment latent severity classes, respectively, with high probability (probability of class membership ≥ 0.9 given OT or PT scores within specified ranges) and high confidence (95% credible interval [CI] widths ≤ 0.24 for all total scores within specified ranges). OT scores ranging from 0 to 10 and from 14 to 18 yielded assignments in Oral Latent Classes 1 and 2, respectively, while OT = 22 was assigned to Oral Latent Class 3. PT scores ranging from 0 to 13 and from 18 to 24 yielded assignments in Pharyngeal Latent Classes 1 and 2, respectively, while PT = 26 was assigned to Pharyngeal Latent Class 3.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>LCA of MBSImP task-level data revealed significant underlying oral and pharyngeal ordinal class structures representing increasingly severe gradations of physiologic swallow impairment. Clinically meaningful OT and PT score ranges were derived facilitating latent class assignment.</jats:p> </jats:sec> <jats:sec> <jats:title>Supplemental Material</jats:title> <jats:p> <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://doi.org/10.23641/asha.12315677">https://doi.org/10.23641/asha.12315677</jats:ext-link> </jats:p> </jats:sec>

A survey of feeding and swallowing function after free jejunal flap reconstruction in cases of head and neck cancer

“…Residues could not be assessed in laryngopharyngeal valleys and piriform sinuses following total laryngopharyngectomy, so they were substituted with pharyngeal residues, as shown in Fig. 1 (18). A uniform scoring system was applied-3 points for good function, 1 point for poor, and 2 points for the range between those two ratings.…”

Validation and Inter-rater Reliability of the Modified Videofluoroscopic Dysphagia Scale (mVDS) in Dysphagic Patients with Multiple Etiologies

“…The VFSS is the most valuable and frequently used diagnostic tool for the evaluation of dysphagia [5]. The protocol for analysis of the VFSS results has been standardized for use in many studies, such as PAS [12], the modified barium swallow impairment profile (MBSImP) [21], or the national outcomes measurements system (NOMS) [22] recommended by the American speech-language hearing association. Among these protocols, the MBSImP showed a higher inter-rater reliability after a training program, but the complexity and difficulty in learning were limitations to the use of the MBSImP in real clinical settings [21].…”

“…The protocol for analysis of the VFSS results has been standardized for use in many studies, such as PAS [12], the modified barium swallow impairment profile (MBSImP) [21], or the national outcomes measurements system (NOMS) [22] recommended by the American speech-language hearing association. Among these protocols, the MBSImP showed a higher inter-rater reliability after a training program, but the complexity and difficulty in learning were limitations to the use of the MBSImP in real clinical settings [21]. However, the mVDS is not only relatively easy to learn and simpler than the MBSImP, but it also showed a significant association with the presence of aspiration pneumonia, which could indicate a poorer prognosis.…”

Respiratory‐swallow coordination and swallowing impairment in head and neck cancer

“…The PAS scale is an 8‐point ordinal scale that rates the depth and response to food or liquid entering the larynx and trachea during a MBSS 47 . The maximum PAS score (PAS max), the highest or worse score across all swallowing tasks, was used in this analysis 51 …”

“…OT and PT scores, respectively, were calculated for each patient using the MBSImP protocol 45 . Spearman's correlation was used to test the association between percentage of optimal respiratory‐swallow phase patterns and OT, PT, and PAS max scores 51 …”