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

口咽吞咽困难，或吞咽困难，是一种毁灭性的疾病，影响生理和 每25个成年人中就有1人有心理社会功能。2016年，在退伍军人管理局工作的言语病理学家完成了 对口咽吞咽困难进行了102,905次评估和77,786次治疗。这突出了 不仅在退伍军人人群中疑似吞咽困难的发生率，而且还需要大量的 通过适当的结果跟踪进行吞咽困难的治疗。吞咽困难的治疗方法有很多，但我们的能力 要充分衡量治疗结果是有限的。直接咽高分辨率测压(PHRM) 测量吞咽压力，提供了一种客观的生理测量，其特征是 吞咽的基本机制。PHRM可以很好地衡量吞咽困难治疗的结果，因为 其吞咽功能的直接、客观和可重复性的测量。我们建议将PHRM添加到 标准评估将有助于解决当前的三个问题：1)缺乏客观措施来准确 监测治疗效果；2)生理措施如何与患者报告的结果相关的不确定性 措施；以及3)缺乏预测治疗效果的预后算法。这项拟议的项目将 解决我们的核心假设，即客观的吞咽措施(包括PHRM)将揭示治疗- 协调吞下变化，将与结果衡量标准保持一致，并将能够预测谁将受益 从治疗中。 这项多中心前瞻性研究将跟踪观察一组患有吞咽困难的退伍军人(n=150)，为期8周，因为他们 接受临床指导的口咽练习，以加强口咽为首要目标。 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周和 治疗开始后8周。非吞咽困难退伍军人对照组(n=50)也将接受数据 在平行的时间点收集，而没有完成治疗范例。然后我们会将患者与 使用PHRM、视频透视、饮食评估、功能储备试验和患者- 报告的结果衡量标准。我们的目标是1)量化吞咽功能的PHRM测量结果的变化 来自吞咽困难治疗；2)确定护理标准和/或基于PHRM的指标的哪种组合 最佳结果跟踪；以及3)开发预测治疗的多模式预测算法 成功。这项研究将建立一种适用于吞咽困难临床的精确结局测量范式 护理和研究，从而提高临床信心，为个性化医疗铺平道路 退伍军人吞咽困难的康复途径。

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.