Five diagnoses’ swallow-physiology impairment profiles (Clain et al., 2024)

Purpose: The purpose of the present study was to use a large swallowing database to explore and compare the swallow-physiology impairment profiles of five dysphagia-associated diagnoses: chronic obstructive pulmonary disease (COPD), dementia, head and neck cancer (HNC), Parkinson’s disease (PD), and stroke.

Method: A total of 8,190 patients across five diagnoses were extracted from a de-identified swallowing database, that is, the Modified Barium Swallow Impairment Profile Swallowing Data Registry, for the present exploratory cross-sectional analysis. To identify the impairment profiles of the five diagnoses, we fit 18 partial proportional odds models, one for each of the 17 Modified Barium Swallow Impairment Profile components and the Penetration–Aspiration Scale, with impairment score as the dependent variable and diagnoses, age, sex, and race as the independent variables with interactions between age and diagnoses and between PD and dementia (in effect creating a PD with dementia [PDwDem] group). For components with > 5% missingness, we applied inverse probability weighting to correct for bias.

Results: PD and COPD did not significantly differ on 13 of the 18 outcome variables (all ps > .02). Dementia, stroke, and PDwDem all showed worse impairments than COPD or PD on five of six oral components (all ps < .007). HNC had worse impairment than all diagnoses except PDwDem for nine of 10 pharyngeal components (all ps < .006). Stroke and HNC had worse penetration/aspiration than all other diagnoses (all ps < .003).

Conclusions: The present results show that there are both common and differing impairment profiles among these five diagnoses. These commonalities and differences in profiles provide a basis for the generation of hypotheses about the nature and severity of dysphagia in these populations. These results are also likely highly generalizable given the size and representativeness of the data set.

Supplemental Material S1. Stroke-specific characteristics.

Supplemental Material S2. HNC-specific tumor properties and treatments.

Supplemental Material S3. Dementia subtypes. Subtypes sum to > 1,066 because there is co-occurrence of different dementia subtypes.

Supplemental Material S4. Sensitivity analysis results for collapsed versus uncollapsed component scores. In both cases, these are the impairment profiles of diagnoses at median age of the data (72) as Normalized Mean OI Scores across 17 MBSImP Components and penetration/aspiration. Error bars represent 95% confidence intervals and are only present for the main analysis because custom bootstraps were not run for the sensitivity analyses. Ph. Swall. Init. = Pharyngeal Swallow Initiation; Elev. = Elevation; Laryn. = Laryngeal; Epiglot. Move. = Epiglottis Movement; Vest. Clos. = Vestibular Closure; AP = Anterior/Posterior View; Phar. = Pharyngeal, Strip. = Stripping; Contr. = Contraction; Tong. = Tongue; Ret. = Retraction; Esoph. Clear. = Esophageal Clearance.

Supplemental Material S5. Sensitivity analysis results for the present study’s Penetration Aspiration Scale (PAS) collapsing procedure as well as uncollapsed PAS scores and the collapsing procedure suggested by Steel and Grace-Martin (2017). Error bars represent 95% confidence intervals and are only present for the main analysis because custom bootstraps were not run for the sensitivity analyses.

Supplemental Material S6. A locally weighted regression of the pairwise percent impairment differences between diagnoses versus the corresponding NMOI differences. The dashed lines at x = 0.06 and y = 0.1 show at their intersection that on average, an NMOI difference of 0.06 corresponds to a percent difference in impairment of 0.1 or 10% and is thus deemed “clinically relevant.”

Supplemental Material S7. The model-based expected proportion of scores for each impairment level at median age of the dataset (72) across the diagnoses for each MBSImP component and penetration/aspiration. Diagnoses are ordered from least to most impaired as measured by Normalized Mean OI Score. The percentage of patients with any amount of impairment is displayed above the bar plot for each diagnosis. Components for which the most severe scores were collapsed are marked with an asterisk (*). Error bars represent 95% confidence intervals. Ph. Swall. Init. = Pharyngeal Swallow Initiation; Elev. = Elevation; Laryn. = Laryngeal; Epiglot. Move. = Epiglottis Movement; Vest. Clos. = Vestibular Closure; AP = Anterior/Posterior View; Phar. = Pharyngeal, Strip. = Stripping; Contr. = Contraction; Tong. = Tongue; Ret. = Retraction; Esoph. Clear. = Esophageal Clearance.

Supplemental Material S8. NMOI differences and Confidence intervals for pairwise diagnosis comparisons; bold & underline indicates clinically relevance as NMOI diff. > 0.06. LC = Lip Closure; BH = Bolus Hold; BP/M = Bolus Preparation/Mastication; BT = Bolus Transport; OR = Oral Residue; IPS = Initiation of Pharyngeal Swallow; SPE = Soft Palate Elevation; LE = Laryngeal Elevation; AHE = Anterior Hyoid Excursion; EM = Epiglottic Movement; LVC = Laryngeal Vestibular Closure; PSW = Pharyngeal Stripping Wave; PC = Pharyngeal Contraction; PES = Pharyngeal Esophageal Segment Opening; TBR = Tongue Base Retraction; PR = Pharyngeal Residue; EC = Esophageal Clearance; Pen/Asp = Penetration/Aspiration.

Supplemental Material S9. Confidence intervals for age-associated odds ratios. LC = Lip Closure; BH = Bolus Hold; BP/M = Bolus Preparation/Mastication; BT = Bolus Transport; OR = Oral Residue; IPS = Initiation of Pharyngeal Swallow; SPE = Soft Palate Elevation; LE = Laryngeal Elevation; AHE = Anterior Hyoid Excursion; EM = Epiglottic Movement; LVC = Laryngeal Vestibular Closure; PSW = Pharyngeal Stripping Wave; PC = Pharyngeal Contraction; PES = Pharyngeal Esophageal Segment Opening; TBR = Tongue Base Retraction; PR = Pharyngeal Residue; EC = Esophageal Clearance; Pen/Asp = Penetration/Aspiration.

Supplemental Material S10. Sex- and race-associated differences in impairment profiles and effects.

Supplemental Material S11. The p values for the sex- and race-associated odds ratio of each diagnosis for each MBSImP component and penetration/aspiration. Bold/italics indicate significant effects of age at an α = 0.05 significance threshold. B/AA = Black/African American; O/NR = Other/Not Reported. LC = Lip Closure; BH = Bolus Hold; BP/M = Bolus Preparation/Mastication; BT = Bolus Transport; OR = Oral Residue; IPS = Initiation of Pharyngeal Swallow; SPE = Soft Palate Elevation; LE = Laryngeal Elevation; AHE = Anterior Hyoid Excursion; EM = Epiglottic Movement; LVC = Laryngeal Vestibular Closure; PSW = Pharyngeal Stripping Wave; PC = Pharyngeal Contraction; PES = Pharyngeal Esophageal Segment Opening; TBR = Tongue Base Retraction; PR = Pharyngeal Residue; EC = Esophageal Clearance; Pen/Asp = Penetration/Aspiration.

Supplemental Material S12. Confidence intervals for sex- and race-associated odds ratios. LC = Lip Closure; BH = Bolus Hold; BP/M = Bolus Preparation/Mastication; BT = Bolus Transport; OR = Oral Residue; IPS = Initiation of Pharyngeal Swallow; SPE = Soft Palate Elevation; LE = Laryngeal Elevation; AHE = Anterior Hyoid Excursion; EM = Epiglottic Movement; LVC = Laryngeal Vestibular Closure; PSW = Pharyngeal Stripping Wave; PC = Pharyngeal Contraction; PES = Pharyngeal Esophageal Segment Opening; TBR = Tongue Base Retraction; PR = Pharyngeal Residue; EC = Esophageal Clearance; Pen/Asp = Penetration/Aspiration.

Supplemental Material S13. Unadjusted Oral Total and Pharyngeal Total scores for patients with no missing data.

Clain, A. E., Samia, N., Davidson, K., & Martin-Harris, B. (2024). Characterizing physiologic swallowing impairment profiles: A large-scale exploratory study of head and neck cancer, stroke, chronic obstructive pulmonary disease, dementia, and Parkinson’s disease. Journal of Speech, Language, and Hearing Research, 67(12), 4689–4713. https://doi.org/10.1044/2024_JSLHR-24-00091