title: Graphical modeling can be used to illustrate associations between variables describing functioning in head and neck cancer patients.
abstract: OBJECTIVE
  To examine the associations between variables of functioning measured by the International Classification of Functioning, Disability and Health (ICF) in head and neck cancer (HNC) patients by means of graphical modeling.
  
  
  METHODS
  Graphical modeling was used on a data set of a cross-sectional multicentric study of 145 patients with HNC. Functioning was qualified using the extended ICF checklist. Multiple imputation was used to handle missing data. The least absolute shrinkage and selection operator for generalized linear models was used to identify conditional associations between the ICF categories. Bootstrap aggregating was used to enhance the accuracy and validity of model selection.
  
  
  RESULTS
  The resulting graph shows largely meaningful associations between the ICF categories. One central point could be visualized consisting of a circular path of d330 Speaking, d350 Conversation, b510 Ingestion functions, s320 Structure of mouth, and b310 Voice functions. Another important structure in the graph were the bow-shaped associations beginning with d335 Producing nonverbal messages to b130 Energy and drive functions.
  
  
  CONCLUSIONS
  Graphical modeling can be used to describe associations between different areas of functioning in HNC patients. They found associations can be the basis for improved rehabilitation and gives a deeper understanding of functioning in HNC patients.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University, Marchioninistrasse 15, Munich, Germany. sven.becker@med.uni-muenchen.de
authors.forename: Sven
authors.initials: S
authors.lastname: Becker
authors.forename: Ralf
authors.initials: R
authors.lastname: Strobl
authors.forename: Alarcos
authors.initials: A
authors.lastname: Cieza
authors.forename: Eva
authors.initials: E
authors.lastname: Grill
authors.forename: Ulrich
authors.initials: U
authors.lastname: Harréus
authors.forename: Uta
authors.initials: U
authors.lastname: Tschiesner
mesh_terms: D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000145:classification* / Q000523:psychology; D005260:Female; D006258:Head and Neck Neoplasms / Q000145:classification* / Q000503:physiopathology; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology