Physiologic impairment severity: LCA of MBSImP (Beall et al., 2020)
journal contributionposted on 2020-07-11, 00:09 authored by Jonathan Beall, Elizabeth G. Hill, Kent Armeson, Kendrea L. (Focht) Garand, Kate (Humphries) Davidson, Bonnie Martin-Harris
Purpose: 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.
Method: 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.
Results: 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.
Conclusions: 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.
Supplemental Material S1. Summary of the mathematical details of the latent class model and the procedures for construction of all model-derived conditional probabilities.
Beall, J., Hill, E. G., Armeson, K., (Focht) Garand, K. L., (Humphries) Davidson, K., & Martin-Harris, B. (2020). Classification of physiologic swallowing impairment severity: A latent class analysis of modified barium swallow impairment profile scores. American Journal of Speech-Language Pathology, 29(2S), 1001–1011. https://doi.org/10.1044/2020_AJSLP-19-00080
Publisher Note: This article is part of the Special Issue: Select Papers From the 2018 Charleston Swallowing Conference at Northwestern University.
This work was supported in part by National Institute on Deafness and Other Communication Disorders Awards K23DC005764 (PI: Martin-Harris) and K24DC12801 (PI: Martin- Harris) and by the Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina (P30 CA138313).
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speech-language pathologyswallowingphysiologyimpairmentdysphasiamodified barium swallow studyMBSSlatent class analysisoralpharyngealModified Barium Swallow Impairment ProfileMBSImPseveritymodelsclassgradationclinicalclinicianoropharyngealswallowbolusstructuralvideofluoroscopicimagingairwaypenetrationaspirationPhysiologySystems Physiology