Defining novel pharyngeal pressure metrics to predict dysphagia treatment outcomes and clinical prognosis using high-resolution manometry

使用高分辨率测压法定义新颖的咽部压力指标来预测吞咽困难的治疗结果和临床预后

• 批准号: 10731745
• 负责人: Timothy M McCulloch
• 金额: --
• 依托单位: WM S. MIDDLETON MEMORIAL VETERANS HOSP
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10731745
• 关键词: Address; Adherence; Adult; Affect; Aftercare; Age; Algorithms; Aspiration Pneumonia; Barium swallow; Biological; Caregivers; Cessation of life; Clinical; Clinical Research; Complex; Control Groups; Data; Data Collection; Databases; Deglutition; Deglutition Disorders; Dehydration; Development; Diagnosis; Diagnostic; Diet; Documentation; Elderly; Ensure; Evaluation; Event; Exercise; Functional disorder; Goals; Health; Healthcare; Human; Impairment; Incidence; Intervention; Language; Life; Logistic Regressions; Malnutrition; Manometry; Measurement; Measures; Mediating; Modeling; Monitor; Multicenter Studies; Muscle Weakness; Oropharyngeal; Oropharyngeal Dysphagia; Outcome; Outcome Measure; Pathologist; Patient Care; Patient Outcomes Assessments; Patients; Pharyngeal structure; Physiological; Physiology; Prediction of Response to Therapy; Procedures; Prospective Studies; Quality of life; Questionnaires; Rehabilitation Outcome; Reproducibility; Research; Resolution; Resources; Speech; Standardization; Testing; Time; Treatment outcome; Uncertainty; Veterans; artificial neural network; care burden; clinical care; clinical prognosis; clinical prognostic; clinically relevant; cohort; design; diagnostic tool; dysphagia rehabilitation; empowerment; expectation; improved; innovation; mathematical model; military veteran; mortality; multimodality; novel; personalized medicine; predictive modeling; pressure; prevent; prognostic algorithm; psychosocial; standard of care; success; therapy outcome; tool; treatment effect; treatment response

Oropharyngeal dysphagia, or difficulty swallowing, is a devastating condition that affects physiological and psychosocial functioning in 1 in 25 adults. In 2016, speech-language pathologists working in the VA completed more than 102,905 evaluation and 77,786 treatment procedures for oropharyngeal dysphagia. This highlights not only the incidence of suspected dysphagia in the Veteran population but also the substantial need for dysphagia management with appropriate outcomes tracking. Many dysphagia treatments exist, but our ability to adequately measure treatment outcomes is limited. Pharyngeal high-resolution manometry (pHRM) directly measures swallowing pressures, providing an objective measurement of physiology that characterizes the basic mechanisms of swallowing. pHRM is well-poised to measure outcomes of dysphagia treatments due to its direct, objective, and reproducible measures of swallowing function. We propose that adding pHRM to standard assessments will help address three current issues: 1) lack of objective measures to accurately monitor treatment effects; 2) uncertainty of how physiological measures relate to patient-reported outcome measures; and 3) absence of prognostic algorithms that predict treatment effects. This proposed project will address our central hypotheses that objective swallowing measures (including pHRM) will reveal treatment- mediated swallowing changes, will align with outcome measures, and will be able to predict who will benefit from treatment. This multi-center prospective study will follow a cohort of Veterans with dysphagia (n=150) for 8 weeks as they undergo clinically guided oropharyngeal exercises with oropharyngeal strengthening as the primary goal. Veterans with dysphagia will be assessed at three time points: baseline, 4 weeks after treatment initiation, and 8 weeks after treatment initiation. A non-dysphagic Veteran control group (n=50) will also undergo data collection at parallel time points, without completion of a treatment paradigm. We will then compare patients to non-dysphagic controls using pHRM, videofluoroscopy, diet assessment, functional reserve tests, and patient- reported outcome measures. We aim to 1) quantify change in pHRM measures of swallowing function resulting from dysphagia treatment; 2) determine which combination of standard of care and/or pHRM-based metrics best track with outcome measures; and 3) develop multimodal prognostic algorithms that predict treatment success. This research will establish a precise outcome measurement paradigm suitable for dysphagia clinical care and research, thus improving clinical confidence and paving the way for a personalized medicine approach for dysphagia rehabilitation in Veterans.

口咽吞咽困难或吞咽困难是一种破坏性的疾病， 每25名成年人中就有1人的社会心理功能。2016年，在VA工作的语言病理学家完成了 超过102，905次评估和77，786次口咽吞咽困难治疗程序。这凸显 不仅退伍军人人群中疑似吞咽困难的发生率， 吞咽困难管理与适当的结果跟踪。有许多吞咽困难的治疗方法，但我们的能力 充分衡量治疗结果的能力有限。直接进行咽部高分辨率测压（pHRM） 测量吞咽压力，提供客观的生理测量， 吞咽的基本机制pHRM已准备好测量吞咽困难治疗的结果， 其吞咽功能的直接、客观和可重复的测量。我们建议将pHRM添加到 标准评估将有助于解决目前的三个问题：1）缺乏客观的衡量标准， 监测治疗效果; 2）生理指标与患者报告结局之间的关系不确定 措施;和3）缺乏预测治疗效果的预后算法。该项目将 解决我们的中心假设，即客观的吞咽测量（包括pHRM）将揭示治疗- 介导的吞咽变化，将与结果指标一致，并能够预测谁将受益 从治疗。 这项多中心前瞻性研究将随访一组吞咽困难的退伍军人（n=150）8周，因为他们 接受临床指导的口咽练习，以口咽强化为主要目标。 患有吞咽困难的退伍军人将在三个时间点进行评估：基线，治疗开始后4周， 治疗开始后8周。非吞咽困难的退伍军人对照组（n=50）也将接受数据 在平行时间点收集，而不完成治疗范例。然后我们将患者与 使用pHRM、视频透视、饮食评估、功能储备测试和患者- 报告的结果测量。我们的目标是：1）量化吞咽功能的pHRM指标的变化， 2）确定护理标准和/或基于pHRM的指标的哪种组合 最佳跟踪与结果的措施;和3）开发多模式预后算法，预测治疗 成功本研究将建立一个精确的结果测量范式，适用于吞咽困难的临床 护理和研究，从而提高临床信心，为个性化医疗铺平道路 退伍军人吞咽困难康复的方法。