title: Identifying Patterns of FEES-Derived Swallowing Trajectories Using Group-Based Trajectory Model.
abstract: The present study delineates and visualizes swallowing trajectories along seven swallow trials in dysphagic patients using group-based trajectory modeling (GBTM). This model facilitates the recognition of swallowing functional categories, estimates their frequency of occurrence, and enhances the understanding of swallowing dynamics. Two hundred and five dysphagic patients underwent a standardized FEES examination protocol. Five ordinal variables were blindly assessed for each swallow by two observers independently. GBTM analysis was conducted to find and characterize trajectories of FEES responses. For most FEES outcome variables, trajectories were qualitatively distinct in degree and kind (level of impairment and how this changed over the seven swallow trials). Two FEES outcome variables-delayed initiation of the pharyngeal reflex and postswallow pyriform sinus pooling-showed the highest prevalence of severe swallowing impairment. Highly impaired categories were more stable throughout the different swallow trials. Intermediate trajectories, by contrast, were erratic, responding more sensitively to shifts in bolus consistency. GBTM can identify distinct developmental trajectories of measured FEES variables in patients with oropharyngeal dysphagia. In clinical practice, classification into distinct groups would help to identify the subgroup of dysphagic patients who may need specific medical attention.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. laura.baijens@mumc.nl.
authors.forename: Laura W J
authors.initials: LW
authors.lastname: Baijens
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Walmari
authors.initials: W
authors.lastname: Pilz
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
authors.affiliation: Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands.
authors.forename: Valeria Lima
authors.initials: VL
authors.lastname: Passos
mesh_terms: D000368:Aged; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000503:physiopathology*; D005260:Female; D005683:Gagging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological
keywords: Aspiration; Deglutition; Deglutition disorders; Dysphagia; Fiberoptic endoscopic evaluation of swallowing; Group-based trajectory modeling