Publications by authors named "Caroline M Speksnijder"

47 Publications

Nutritional interventions in patients with head and neck cancer undergoing chemoradiotherapy: Current practice at the Dutch Head and Neck Oncology centres.

Eur J Cancer Care (Engl) 2021 Oct 12:e13518. Epub 2021 Oct 12.

Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Objective: To assess variations in nutritional interventions during chemoradiotherapy (CRT) among the Dutch Head and Neck Oncology centres (HNOCs).

Methods: An online questionnaire about nutritional interventions and dietetic practices was sent to 14 oncology dietitians of the HNOCs.

Results: The response rate was 93%. The number of scheduled dietetic consultations varied from two to seven during CRT. Most centres (77%) reported using a gastrostomy for tube feeding in the majority of patients. Gastrostomies were placed prophylactically upon indication (39%) or in all patients (15%), reactive (15%), or both (31%). For calculating energy requirements, 54% of the dietitians used the Food and Agriculture Organization/World Health Organization and United Nations University (FAO/WHO/UNU) formula and 77% uses 1.2-1.5 g/kg body weight for calculating protein requirements. Almost half of the centres (46%) reported to remove the gastrostomy between 8 and 12 weeks after CR. Most centres (92%) reported to end dietary treatment within 6 months after CRT.

Conclusion: This study shows substantial variation in dietetic practice, especially in the use of a gastrostomy for tube feeding, between the HNOCs. There is a need for concise dietetic guidelines.
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http://dx.doi.org/10.1111/ecc.13518DOI Listing
October 2021

Effect of elective neck dissection versus sentinel lymph node biopsy on shoulder morbidity and health-related quality of life in patients with oral cavity cancer: A longitudinal comparative cohort study.

Oral Oncol 2021 Sep 4;122:105510. Epub 2021 Sep 4.

Radboud University Medical Center, Department of Oral and Maxillofacial Surgery, Nijmegen, the Netherlands; University Medical Center Utrecht, Department of Oral and Maxillofacial Surgery and Special Dental Care, University of Utrecht, Utrecht, the Netherlands; University Medical Center Utrecht Cancer Center, Department of Head and Neck Surgical Oncology, University of Utrecht, Utrecht, the Netherlands.

Objective: To research the difference in shoulder morbidity and health-related quality of life between patients with cTN0 oral cavity squamous cell carcinoma that undergo either elective neck dissection (END) or a sentinel lymph node biopsy (SLNB) based approach of the neck.

Materials And Methods: A longitudinal study with measurements before surgery, 6 weeks, 6 months, and 12 months after surgery. Shoulder morbidity were determined with measurements of active range of motion of the shoulder and patient-reported outcomes for shoulder morbidity (SDQ, SPADI) and health-related quality of life (HR-QoL) (EQ5D, EORTC-QLQ-HN35). Linear mixed model analyses were used to analyze differences over time between patients that had END, SLNB or SLNB followed by complementing neck dissection.

Results: We included 69 patients. Thirty-three patients were treated with END. Twenty-seven patients had SLNB without complementing neck dissection (SLNB), and nine were diagnosed lymph node positive followed by completion neck dissection (SLNB + ND). Ipsilateral shoulder abduction (P = .031) and forward flexion (P = .039) were significantly better for the SLNB group at 6 weeks post-intervention compared to the END and SLNB + ND group. No significant differences for shoulder morbidity, or health-related quality of life were found at 6 weeks, 6 months, and 12 months between the three groups.

Conclusion: With oncologic equivalence for the END and SLNB as strategies for the cN neck already demonstrated, and the SLNB being more cost-effective, our demonstrated benefit in short-term shoulder function strengthens the choice for the SLNB as a preferred treatment strategy.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105510DOI Listing
September 2021

Mandibular range of motion in children with juvenile idiopathic arthritis with and without clinically established temporomandibular joint involvement and in healthy children; a cross-sectional study.

Pediatr Rheumatol Online J 2021 Jul 3;19(1):106. Epub 2021 Jul 3.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, PO Box 85500, The Netherlands.

Background: Recognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA. The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children.

Methods: This cross-sectional study included children with JIA and healthy children of age 6-18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement.

Results: A total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children.

Conclusion: All mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.
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http://dx.doi.org/10.1186/s12969-021-00583-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254997PMC
July 2021

Mastication, swallowing, and salivary flow in patients with head and neck cancer: objective tests versus patient-reported outcomes.

Support Care Cancer 2021 Jun 25. Epub 2021 Jun 25.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85.500, 3508 GA, Utrecht, The Netherlands.

Purpose: Before and after treatment for head and neck cancer (HNC), many patients have problems with mastication, swallowing, and salivary flow. The aim of this study was to investigate the association between objective test outcomes of mastication, swallowing, and salivary flow versus patient-reported outcomes (PROs) measuring mastication-, swallowing-, and salivary flow-related quality of life.

Methods: Data of the prospective cohort "Netherlands Quality of Life and Biomedical Cohort Study" was used as collected before treatment, and 3 and 6 months after treatment. Spearman's rho was used to test the association between objective test outcomes of the mixing ability test (MAT) for masticatory performance, the water-swallowing test (WST) for swallowing performance, and the salivary flow test versus PROs (subscales of the EORTC QLQ-H&N35, Swallow Quality of Life questionnaire (SWAL-QoL-NL) and Groningen Radiation-Induced Xerostomia (GRIX)).

Results: Data of 142 patients were used, and in total, 285 measurements were performed. No significant correlations were found between the MAT or WST and subscales of the EORTC QLQ-H&N35. Significant but weak correlations were found between the MAT or WST and 4 subscales of the SWAL-QoL-NL. Weak to moderate correlations were found between the salivary flow test and GRIX at 3 and 6 months after treatment, with the highest correlation between salivary flow and xerostomia during the day (Spearman's rho =  - 0.441, p = 0.001).

Conclusion: The association between objective test outcomes and PROs is weak, indicating that these outcome measures provide different information about masticatory performance, swallowing, and salivary flow in patients with HNC.
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http://dx.doi.org/10.1007/s00520-021-06368-6DOI Listing
June 2021

Reliability of the 100 mL water swallow test in patients with head and neck cancer and healthy subjects.

Head Neck 2021 08 6;43(8):2468-2476. Epub 2021 May 6.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Background: Dysphagia may occur in up to 44% of patients with head and neck cancer (HNC) treated with radiation therapy and up to 84% of patients treated with surgery. To test the extent of dysphagia, the 100 mL water swallow test (WST) was developed. In this study, reliability of the 100 mL WST was determined in patients with HNC and healthy subjects.

Methods: Thirty-three patients and 40 healthy subjects performed the WST twice on the same day. To assess reliability, the intraclass correlation coefficient (ICC ), standard error of measurement, smallest detectable change, and limits of agreement were calculated.

Results: Good to excellent correlations were found for patients with HNC (number of swallows; ICC = 0.923, duration; ICC = 0.893), and excellent correlations for healthy subjects (number of swallows; ICC = 0.950, duration; ICC = 0.916).

Conclusion: The 100 mL WST has a good to excellent reliability in patients with HNC and healthy subjects.
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http://dx.doi.org/10.1002/hed.26723DOI Listing
August 2021

Maximum bite force in children with juvenile idiopathic arthritis with and without clinical established temporomandibular joint involvement and in healthy children: a cross-sectional study.

J Oral Rehabil 2021 Jul 4;48(7):774-784. Epub 2021 May 4.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Background: In children with juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) can be involved, resulting in dysfunction of the masticatory system. Bite force is one of the variables that reflects the function of the masticatory system. The aim of this study was to compare maximum bite force in children with JIA, with and without TMJ involvement and with healthy children.

Methods: Children with JIA and healthy children between the ages 6 and 18 were included in this cross-sectional study. The clinical examination consisted of measuring the anterior maximum voluntary bite force (AMVBF), assessment of the TMJ screening protocol items and TMJ, masseter and temporal muscle palpation pain. Unadjusted linear regression analyses were performed to evaluate the explanatory factors for AMVBF. Two adjusted models were constructed with corrections for age and gender differences: model 1 to compare children with JIA and healthy children and model 2 to compare children with JIA with and without TMJ involvement.

Results: In this cross-sectional study, 298 children with JIA and 169 healthy children participated. AMVBF was 24 Newton (N) lower in children with JIA, when compared with healthy children (95%CI: -35.5--12.4, p = .000). When children with JIA also had clinically established TMJ involvement, AMVBF was reduced 42 N (component JIA:-16.78, 95% CI -28.96--4.59, p = .007 and component TMJ involvement:-25.36, 95% CI -40.08--10.63, p = .001). Age and male gender increased AMVBF.

Conclusion: Children with JIA had a reduction in the AMVBF compared with healthy children. In children with JIA and clinically established TMJ involvement, AMVBF was more reduced.
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http://dx.doi.org/10.1111/joor.13172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251949PMC
July 2021

Identifying unmet needs and limitations in physical health in survivors of Head and Neck Cancer.

Eur J Cancer Care (Engl) 2021 Sep 11;30(5):e13434. Epub 2021 Mar 11.

Department of Oral and Maxillofacial Surgery, Radboud university medical center, Nijmegen, The Netherlands.

Objective: To gain insight into the level of unmet needs and limitations in physical health experienced by survivors of head and neck cancer, and to evaluate whether unmet needs in physical health and limitations in physical performance are associated.

Materials And Methods: In this cross-sectional study, unmet needs were measured with Supportive Care Needs Surveys (SCNS-SF34, SCNS-HNC). Limitations in physical health were measured for maximal mouth opening, neck and shoulder function, hand grip strength and lower body strength, level of mobility and walking ability.

Results: The SCNSs showed that 48% had a cancer generic unmet need and 46% had at least one HNC-specific unmet need. In total, 76% of sHNC had a cancer generic limitation in physical health and that 58% had an HNC-specific limitation in the mobility of neck and shoulders or maximum mouth opening. The domain of physical and daily living needs showed a weak association with lateral flexion of the neck to the left (R = -0.319; p = 0.024).

Conclusion: Survivors of HNC might benefit from the use of both SCNSs and physical performance measurements during usual care follow-up for early and optimal identification of unmet needs and limitations in physical health.
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http://dx.doi.org/10.1111/ecc.13434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519003PMC
September 2021

Corrigendum to "Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review" [Musculoskeletal science and practice 50 (2020) 102277].

Musculoskelet Sci Pract 2021 Jun 20;53:102344. Epub 2021 Feb 20.

University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands.

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http://dx.doi.org/10.1016/j.msksp.2021.102344DOI Listing
June 2021

Reply to 'letter to the editor concerning 'effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review' by Castien & Scholten-Peeters.

Musculoskelet Sci Pract 2021 06 10;53:102338. Epub 2021 Feb 10.

University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands.

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http://dx.doi.org/10.1016/j.msksp.2021.102338DOI Listing
June 2021

Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review.

Musculoskelet Sci Pract 2020 12 16;50:102277. Epub 2020 Oct 16.

Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.

Background: Physical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints.

Objectives: The aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD.

Data Sources: PubMed, Cochrane and PEDro were searched.

Study Eligibility Criteria: Randomized or controlled clinical trials studying physical therapy interventions were included.

Participants: Patients with TMD and headache.

Appraisal: The Cochrane risk of bias tool was used to assess risk of bias.

Synthesis Methods: Individual and pooled between-group effect sizes were calculated according to the standardized mean difference (SMD) and the quality of the evidence was rated using the GRADE approach.

Results: and manual therapy on both orofacial region and cervical spine. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision.

Limitations: The methodological quality of most included articles was poor, and the interventions included were very different.

Conclusions: Physical therapy interventions presented small effect on reducing headache pain intensity on subjects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken.
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http://dx.doi.org/10.1016/j.msksp.2020.102277DOI Listing
December 2020

Depression and related factors after oral oncological treatment: a 5-year prospective cohort study.

Support Care Cancer 2021 Jun 1;29(6):2907-2916. Epub 2020 Oct 1.

Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Purposes: Being diagnosed with oral cancer is a life-threatening life event. It often induces social, emotional and psychological consequences and may cause depressive disorders. The primary aim of this study was to identify and quantify the personal and clinical characteristics involved in depression for patients who have been treated for oral cavity malignancies, with a 5-year follow-up period after treatment. The secondary aim of this study was to identify the clinical factors that increase a patient's risk of experiencing depression 5 years after treatment.

Methods: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. A mixed-model analysis was performed, with depression measured by the Center for Epidemiologic Studies Depression Scale as outcome measure.

Results: A total of 141 patients were included in the study. Factors associated with depression were gender, tumour location and having an emotion-oriented coping style. The occurrence of depression within 5 years after treatment could be reliably predicted by a patient's gender, the location of their tumour and the extent to which they had an emotion-oriented coping style.

Conclusions: This study revealed that being female, having a maxillary tumour and having an emotion-oriented coping style are associated with higher levels of depressive symptoms in patients treated for oral cancer up to 5 years post-treatment. A substantial proportion of the patients with oral cancer experienced high levels of depression both before and after their treatment, suggesting that adequate diagnostics and care are needed to try to prevent severe depression in these patients.
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http://dx.doi.org/10.1007/s00520-020-05795-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062368PMC
June 2021

Reproducibility of measurements on physical performance in head and neck cancer survivors; measurements on maximum mouth opening, shoulder and neck function, upper and lower body strength, level of physical mobility, and walking ability.

PLoS One 2020 3;15(9):e0233271. Epub 2020 Sep 3.

Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Background: Survivors of Head and Neck Cancer experience specific problems in functional performance. The aim of this study was to obtain the test-retest reliability of measurements on Maximal Mouth Opening (MMO), shoulder and neck function, lower and upper body strength, level of mobility and walking ability.

Materials And Methods: Test-retest study design. Measurements on MMO (intra- and extra orally), Active range of motion of shoulders and neck, 30 Seconds Chair Stand Test, Grip Strength, Timed Up and Go test, and Six Minute Walk test.

Results: In total 50 participants were included. The mean age was 68.6. ± 9.9 years and median time since end of treatment was 3.0 years (Q1-Q3: 1.0-5.25 years). We found good to excellent test-retest reliability on the core set of measurements (Intraclass Correlation Coefficient (ICC) 0.77 to 0.98). Measurement of MMO with cardboard card, forward flexion shoulder and Six Minute Walk test had a relatively small measurement error (Smallest Detectable Change (SDC) % 5.4% - 15.1%). Measurement of MMO with a caliper, shoulder abduction, shoulder external rotation, later flexion and rotation of the neck, grip strength, 30 Seconds Chair Stand Test, and Timed up and Go test had a relatively large measurement error (SDC% 19.8% - 44.7%).

Conclusion: This core set of measurements on physical performance is found reliable and therefore able to differentiate in physical performance. The reported measurement errors should be taken into consideration when interpreting the results of repeated measurements.

Implications For Cancer Survivors: A core set of physical measurements can be used to measure physical performance in survivors of Head and Neck Cancer.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233271PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470389PMC
October 2020

Reliability and Agreement of 3D Anthropometric Measurements in Facial Palsy Patients Using a Low-Cost 4D Imaging System.

IEEE Trans Neural Syst Rehabil Eng 2020 08 6;28(8):1817-1824. Epub 2020 Jul 6.

The reliability (precision) and agreement (accuracy) of anthropometric measurements based on manually placed 3D landmarks using the RealSense D415 were investigated in this paper. Thirty facial palsy patients, with their face in neutral (resting) position, were recorded simultaneously with the RealSense and a professional 3dMD imaging system. First the RealSense depth accuracy was determined. Subsequently, two observers placed 14 facial landmarks on the 3dMD and RealSense image, assessing the distance between landmark placement. The respective intra- and inter-rater Euclidean distance between the landmark placements was 0.84 mm (±0.58) and 1.00 mm (±0.70) for the 3dMD landmarks and 1.32 mm (±1.27) and 1.62 mm (±1.42) for the RealSense landmarks. From these landmarks 14 anthropometric measurements were derived. The intra- and inter-rater measurements had an overall reliability of 0.95 (0.87 - 0.98) and 0.93 (0.85 - 0.97) for the 3dMD measurements, and 0.83 (0.70 - 0.91) and 0.80 (0.64 - 0.89) for the RealSense measurements, respectively, expressed as the intra-class correlation coefficient. Determined by the Bland-Altman analysis, the agreement between the RealSense measurements and 3dMD measurements was on average -0.90 mm (-4.04 - 2.24) and -0.89 mm (-4.65 - 2.86) for intra- and inter-rater agreement, respectively. Based on the reported reliability and agreement of the RealSense measurements, the RealSense D415 can be considered as a viable option to perform objective 3D anthropomorphic measurements on the face in a neutral position, where a low-cost and portable camera is required.
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http://dx.doi.org/10.1109/TNSRE.2020.3007532DOI Listing
August 2020

Mastication in maxillectomy patients: A comparison between reconstructed maxillae and implant supported obturators: A cross-sectional study.

J Oral Rehabil 2020 Sep 13;47(9):1171-1177. Epub 2020 Jul 13.

Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.

Objective: The aim of this study was to compare masticatory performance and patient reported eating ability of maxillectomy patients with implant-supported obturators and patients with surgically reconstructed maxillae.

Methods: This cross-sectional study was conducted at the University of Alberta, Edmonton, Canada and at Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Eleven surgically reconstructed maxillectomy patients have been included at University of Alberta and nine implant-supported obturator patients at MUMC+. The mixing ability test (MAT) was used to measure masticatory performance. In addition, the oral health related quality of life (OHRQoL) was measured with shortened versions of the oral health impact profile (OHIP) questionnaire. Values of the implant-supported obturator group versus the surgical reconstruction group were compared with independent t-tests in case of normal distribution, otherwise the Mann-Whitney U test was applied.

Results: Patients with reconstructed maxillae and patients with implant-supported obturator prostheses had similar mean mixing ability indices (18.20 ± 2.38 resp. 18.66 ± 1.37; P = .614). The seven OHRQoL questions also showed no differences in masticatory ability between the two groups.

Conclusion: With caution, the results of this study seem to confirm earlier results that implant-supported obturation is a good alternative to surgical reconstruction for all Class II maxillary defects. With both techniques, the masticatory performance is sufficiently restored, with careful planning being highly desirable.
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http://dx.doi.org/10.1111/joor.13043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497273PMC
September 2020

Upper body motor function and swallowing impairments and its association in survivors of head and neck cancer: A cross-sectional study.

PLoS One 2020 19;15(6):e0234467. Epub 2020 Jun 19.

Department of Physical Therapy, Instituto Biosanitario Granada (IBS Granada), University of Granada, Granada, Spain.

Background: Upper body motor function and swallowing may be affected after curative treatment for head and neck cancer. The aims of this study are to compare maximum mouth opening (MMO), temporomandibular dysfunction (TMD), cervical and shoulder active range of motion (AROM) and strength, and swallowing difficulty between survivors of head and neck cancer (sHNC) and healthy matched controls (HMC) and to examine the correlations between these outcomes in sHNC.

Methods: Thirty-two sHNC and 32 HMC participated on the study. MMO, TMD, cervical and shoulder AROM, cervical and shoulder strength, the SPADI shoulder pain and disability indices, the Eating Assessment Tool (EAT-10) score, swallowing difficulty as determined using a visual analogue scale (VAS), and the location of disturbances in swallowing, were recorded.

Results: MMO and cervical and shoulder AROM and strength were significantly lower in sHNC, whereas FAI, SPADI score, EAT-10 and VAS were higher. The MMO, TMD, cervical and shoulder AROM, and cervical shoulder strength values showed significant correlations (some direct, others inverse) with one another. Swallowing difficulty was inversely associated with the MMO, cervical AROM and shoulder strength.

Conclusion: Compared with controls, sHNC present smaller MMO, lower cervical and shoulder AROM, lower cervical and shoulder strength and higher perception of TMD, shoulder pain and disability and swallowing difficulty. sHNC suffer impaired swallowing related to lower MMO, presence of TMD, cervical AROM and shoulder strength values. Improving these variables via physiotherapy may reduce the difficulty in swallowing experienced by some sHNC.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234467PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304609PMC
August 2020

Using e-Health in the physical therapeutic care process for patients with temporomandibular disorders: a qualitative study on the perspective of physical therapists and patients.

Disabil Rehabil 2020 Jun 16:1-8. Epub 2020 Jun 16.

Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health. To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD. A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience. Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application. Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitationThe rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications.Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care.Especially during the treatment process, there is a need for clear animated videos and reminders for the patients.
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http://dx.doi.org/10.1080/09638288.2020.1775900DOI Listing
June 2020

Reliability of the mixing ability test testing masticatory performance in patients with head and neck cancer and healthy controls.

J Oral Rehabil 2020 Aug 20;47(8):961-966. Epub 2020 Jun 20.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Background: Treatment of patients with head and neck cancer can result in disrupted mastication. To measure masticatory performance in people with compromised mastication, the mixing ability test (MAT) was developed.

Objective: In this study, the reliability of the MAT was evaluated in patients with head and neck cancer and healthy controls.

Methods: Thirty-four patients with head and neck cancer and 42 healthy controls performed the MAT twice on the same day. To assess reliability, the intra-class correlation coefficient (ICC ), standard error of measurement (SEM), smallest detectable change (SDC) and limits of agreement (LoA) were calculated.

Results: A good (ICC = 0.886) and moderate correlation (ICC = 0.525) were found for patients and healthy controls, respectively. Patients had a worse mixing ability (mean = 19.12, SD = 4.56) in comparison with healthy controls (mean = 16.42, SD = 2.04). The SEM was 0.76 in patients and 1.45 in healthy controls, with a SDC of 2.12 and 4.02, respectively. The LoA was -4.46 to 4.42 in patients and -3.65 to 4.59 in healthy controls.

Conclusion: The MAT has a good reliability in patients with head and neck cancer and a moderate reliability in healthy controls.
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http://dx.doi.org/10.1111/joor.13029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497093PMC
August 2020

A pilot study of masticatory function after maxillectomy comparing rehabilitation with an obturator prosthesis and reconstruction with a digitally planned, prefabricated, free, vascularized fibula flap.

J Prosthet Dent 2020 Nov 17;124(5):616-622. Epub 2020 Jan 17.

Associate Professor, Julius Center for Health Sciences and Primary Care and Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address:

Statement Of Problem: Oral rehabilitation after maxillectomy can be performed by prosthetic obturation or with a free fibula flap. Successful prosthetic obturation of large maxillectomy defects can be difficult, and masticatory function is at risk in these patients. Surgical reconstruction might provide adequate masticatory function, but the literature is lacking evidence regarding this topic.

Purpose: The purpose of this pilot clinical study was to assess masticatory functions and health-related quality of life (HR-QoL) outcomes in patients after maxillectomy reconstructed by using the Rohner or the Alberta Reconstructive Technique and to compare outcomes with patients rehabilitated with an obturator prosthesis.

Material And Methods: Mixing ability, maximum occlusal force, maximum mouth opening, and HR-QoL were assessed. Differences between the 2 groups were analyzed by using the Kruskal-Wallis tests for continuous variables and chi-squared tests for categorical variables.

Results: The reconstructed patients (n=11) showed better mixing ability, occlusal force (nonoperated side), and overall mean HR-QoL. The nonreconstructed group (n=13) did not differ from the reconstructed groups in terms of maximum mouth opening, overall mean occlusal force, occlusal force on the operated side, and most HR-QoL questionnaire domains.

Conclusions: Maxillary reconstruction might be beneficial for masticatory performance in patients undergoing maxillectomy. A larger study is justified to support the possible benefit of the reconstruction of maxillary defects regarding mixing ability, occlusal force (nonoperated side), and HR-QoL.
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http://dx.doi.org/10.1016/j.prosdent.2019.06.005DOI Listing
November 2020

Masticatory performance and oral health-related quality of life in edentulous maxillectomy patients: A cross-sectional study to compare implant-supported obturators and conventional obturators.

Clin Oral Implants Res 2020 May 27;31(5):405-416. Epub 2020 Jan 27.

Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

Objective: The aim of this cross-sectional study was to compare the masticatory performance and oral health-related quality of life (OHRQoL) of edentulous maxillectomy patients with and without implant-supported obturator prostheses.

Material And Methods: Nineteen edentulous maxillectomy patients with completed prosthetic obturator treatment in the upper jaw participated in this study. In nine patients, the obturator prosthesis was supported by implants in the remaining bone of the midface and/or skull base to improve retention. Masticatory performance was measured objectively by the mixing ability test (MAT) and subjectively by three OHRQoL questionnaires: (a) the Oral Health Impact Profile for EDENTulous people (OHIP-EDENT), (b) the Obturator Function Scale (OFS), and (c) the Dutch Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3-NL). The independent t test and the Mann-Whitney U test were used to test for differences in outcomes of patients with and without implant-retention of their obturator prostheses.

Results: Patients with implant-supported obturator prostheses had significantly better masticatory and oral function, reported fewer chewing difficulties, and had less discomfort during food intake than did patients with a conventional obturator.

Conclusion: Supporting prosthetic obturators after maxillectomy with implants improve oral functioning, chewing, and eating comfort. This treatment modality is a viable technique to improve the functionality of prosthetic rehabilitation in patients who have undergone maxillectomy.
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http://dx.doi.org/10.1111/clr.13577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319476PMC
May 2020

Reproducibility and construct validity of the utrecht mixing ability Test to obtain masticatory performance outcome in patients with condylar mandibular fractures.

J Oral Rehabil 2020 Apr 11;47(4):460-466. Epub 2019 Dec 11.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Objective: This study assessed the test-retest reproducibility of the Utrecht mixing ability test (MAT) and the construct validity of the MAT in relation to the Mandibular Function Impairment Questionnaire (MFIQ) in patients with mandibular condylar fractures.

Material And Methods: Twenty-six patients treated for a mandibular condylar fracture participated in this clinimetric study; all patients performed the MAT twice. Simultaneously the MFIQ was conducted. Test-retest reliability and construct validity were assessed using the intra-class correlation coefficient (ICC) and Spearman correlation, respectively.

Results: The ICC of the MAT was 0.906 (95% CI: 0.801-0.957), which indicates an excellent reliability. A weak correlation of 0.386 (P = .052) between the first MAT and the overall outcome of the MFIQ was found. A significant moderate correlation of 0.401 (P = .042) was found between the retest of the MAT and the overall outcome of the MFIQ. One question on the MFIQ (about yawning) showed a moderate positive correlation of 0.569 (P = .002) and 0.416 (P = .034) for the MAT test and retest, respectively.

Conclusion: The MAT is an easy test to use in follow-up of patients. The test-retest reliability of this test is excellent in condylar trauma patients. As the validity of the MAT and the MFIQ could not be confirmed, the MFIQ may be an addition to patient's feedback about the rehabilitation process of their mandibular functioning.
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http://dx.doi.org/10.1111/joor.12917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079003PMC
April 2020

Functional Outcomes and Quality of Life After Segmental Mandibulectomy and Reconstruction with a Reconstruction Plate or Bone Graft Compared to a Digitally Planned Fibula Free Flap.

Int J Prosthodont 2019 Sep/Oct;32(5):393-401

Purpose: To compare oral function and health-related quality of life (HRQoL) in patients reconstructed with either a reconstruction plate or a free vascularized bone flap with or without 3D planning.

Materials And Methods: Patients from the Institute for Reconstructive Sciences in Medicine, University Medical Center Utrecht, and Radboud University Medical Center were included. This cross-sectional study assessed objective masticatory performance with the mixing ability test (mixing ability index [MAI]), maximum bite force, maximum mouth opening, and HRQoL. Differences between groups were analyzed using analysis of variance or Kruskal-Wallis test for continuous variables and chi-square test for categorical variables.

Results: Six patients with digitally planned resections and reconstructions were included. For comparison, five patients treated with freehand bone reconstruction and four patients treated with plate reconstruction were also included. Mixing ability was superior in 3D-planned reconstructions (MAI: 20.7 ± 6.7) compared to plate reconstructions (MAI: 30.0 ± 0.1, P = .017) and freehand reconstructions (MAI: 29.5 ± 1.1, P = .017). Maximum mouth opening, bite force, and HRQoL differences did not reach statistical significance.

Conclusion: This study indicated a possible benefit to masticatory performance of adequate surgical planning for one-phase reconstruction using 3D technology. A larger prospective study is necessary to gain more evidence regarding this finding.
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http://dx.doi.org/10.11607/ijp.6250DOI Listing
October 2019

An international perspective on integrating physiotherapists in oncology care.

J Physiother 2019 10 30;65(4):186-188. Epub 2019 Aug 30.

Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

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http://dx.doi.org/10.1016/j.jphys.2019.07.004DOI Listing
October 2019

Tongue function and its influence on masticatory performance in patients treated for oral cancer: a five-year prospective study.

Support Care Cancer 2020 Mar 4;28(3):1491-1501. Epub 2019 Jul 4.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.

Purpose: The purpose of this study was to observe the impact of oral oncological treatment, including the recovery of several tongue functions (force, mobility, and sensory functions), and to determine the influence of these functions on masticatory performance.

Materials And Methods: Masticatory performance and tongue force, mobility, and sensory functions were determined in 123 patients with oral cavity cancer. The assessments were performed 4 weeks before treatment and 4 to 6 weeks, 6 months, 1 year, and 5 years after treatment. Generalized estimation equations and mixed model analyses were performed, correcting for previously identified factors in the same population.

Results: A significant deterioration in tongue mobility and sensory function was observed in patients with mandible and tongue and/or floor-of-mouth tumors. Better tongue force and sensory function (thermal and tactile) positively influenced masticatory performance, and this effect was stronger where fewer occlusal units were present. The effect of both the tongue force and maximum bite force was weaker in dentate patients in comparison with patients with full dentures. A web-based application was developed to enable readers to explore our results and provide insight into the coherence between the found factors in the mixed model.

Conclusions: Tongue function deteriorates after oral oncological treatment, without statistically significant recovery. Adequate bite and tongue forces are especially important for patients with a poor prosthetic state. Patients with sensory tongue function deficits especially benefit from the presence of more occluding pairs.
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http://dx.doi.org/10.1007/s00520-019-04913-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989568PMC
March 2020

The diagnostic accuracy of headache measurement instruments: A systematic review and meta-analysis focusing on headaches associated with musculoskeletal symptoms.

Cephalalgia 2019 Sep 18;39(10):1313-1332. Epub 2019 Apr 18.

6 University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands.

Aim: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms.

Design: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966-2018), Cochrane (1898-2018) and Cinahl (1988-2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument.

Results: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85-0.89) and specificity of 0.75 (95% CI: 0.72-0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire - Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55-0.80) and specificity of 0.90 (95% CI 0.77-0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21-0.54) and specificity of 0.86 (95% CI 0.74-0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72-0.94) and specificity of 0.82 (95% CI 0.73-0.91).

Discussion: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches.
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http://dx.doi.org/10.1177/0333102419840777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710620PMC
September 2019

Masticatory ability improves after maxillary implant overdenture treatment: A randomized controlled trial with 1-year follow-up.

Clin Implant Dent Relat Res 2019 Apr 11;21(2):369-376. Epub 2019 Feb 11.

Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: The effect of maxillary implant overdentures on masticatory ability in edentulous patients with complaints regarding their conventional maxillary dentures is unknown.

Purpose: To assess the change in objective masticatory ability (mixing ability index, MAI), patient reported masticatory ability (questionnaire), and patient satisfaction (GSS) after maxillary implant overdenture treatment with either solitary attachments or bars.

Materials And Methods: Two groups randomly received four-implant maxillary overdentures on either solitary attachments (group I, n = 25) or bars (group II, n = 25). The MAI, questionnaire, and GSS were scored before (T0) and 12 months (T12) after treatment.

Results: After treatment, both groups had significantly better MAI outcomes, better questionnaire scores and better GSS. Post-treatment questionnaire scores and GSS were significantly better for group II. Before treatment a strong, positive correlation between the MAI and the questionnaire was found for all participants who had had full conventional dentures combined (group I, n = 17; group II, n = 3).

Conclusion: Mixing ability was the same for all the participants treated with maxillary implant overdentures on either solitary attachments or bars. Patient reported masticatory ability and satisfaction was better for participants treated with maxillary implant overdentures on bars. There was a correlation between MAI and patient reported masticatory ability in participants with full conventional dentures.
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http://dx.doi.org/10.1111/cid.12721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593446PMC
April 2019

Women in Translational Medicine: Tools to Break the Glass Ceiling.

Front Med (Lausanne) 2018 13;5:330. Epub 2018 Dec 13.

Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.

Despite the recent movements for female equality and empowerment, few women occupy top positions in scientific decision-making. The challenges women face during their career may arise from societal biases and the current scientific culture. We discuss the effect of such biases at three different levels of the career and provide suggestions to tackle them. At the societal level, gender roles can create a negative feedback loop in which women are discouraged from attaining top positions and men are discouraged from choosing a home-centred lifestyle. This loop can be broken early in life by providing children with female role models that have a work-centred life and opening up the discussion about gender roles at a young age. At the level of hiring, unconscious biases can lead to a preference for male candidates. The introduction of (unbiased) artificial intelligence algorithms and gender champions in the hiring process may restore the balance and give men and women an equal chance. At the level of coaching and evaluation, barriers that women face should be addressed on a personal level through the introduction of coaching and mentoring programmes. In addition, women may play a pivotal role in shifting the perception of scientific success away from bibliometric outcomes only towards a more diverse assessment of quality and societal relevance. Taken together, these suggestions may break the glass ceiling in the scientific world for women; create more gender diversity at the top and improve translational science in medicine.
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http://dx.doi.org/10.3389/fmed.2018.00330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315166PMC
December 2018

Masticatory function and related factors after oral oncological treatment: A 5-year prospective study.

Head Neck 2019 01 15;41(1):216-224. Epub 2018 Dec 15.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients.

Methods: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed-model analysis was performed, with masticatory performance as outcome measure.

Results: A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment.

Conclusion: Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy.
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http://dx.doi.org/10.1002/hed.25445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590803PMC
January 2019

Factors influencing neck and shoulder function after oral oncology treatment: a five-year prospective cohort study in 113 patients.

Support Care Cancer 2019 Jul 14;27(7):2553-2560. Epub 2018 Nov 14.

Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.

Background: The aim of this study was to identify factors influencing shoulder and/or neck function in patients up to five years after treatment.

Materials And Methods: Lateral flexion of the neck, ipsilateral forward flexion, and abduction of the shoulder were measured. Potential factors were entered into a linear mixed model analysis to create a multivariate model for describing the results.

Results: Predicted neck and shoulder function was negatively influenced by higher age before intervention. Contralateral flexion of the neck was lower for patients undergoing surgery and radiotherapy compared to surgery. Ipsilateral flexion of the neck is influenced by a higher age at baseline. Ipsilateral shoulder abduction is lower for female gender, bone graft/flap reconstruction, and more extensive neck dissection. Ipsilateral forward flexion of the shoulder is lower for bone graft/flap reconstruction and better for patients with a T2 tumor in comparison to T3 and T4 tumors, as predicted.

Conclusion: By our five-year follow-up outcomes of this study, neck and/or shoulder impairments can be found for high-risk patients by physiotherapists.
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http://dx.doi.org/10.1007/s00520-018-4534-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6541579PMC
July 2019

The association between a mixing ability test and patient reported chewing ability in patients treated for oral malignancies.

J Oral Rehabil 2019 Feb 1;46(2):140-150. Epub 2018 Nov 1.

Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.

Introduction: Mastication has been assessed in several ways in the past. Both patients reported and objective assessment methods have been developed. The University Medical Center (UMC) Utrecht has developed a mixing ability test (MAT) using a two-coloured wax tablet. The present study investigates the association between the mixing ability test and a chewing related questionnaire in patients treated for oral malignancies.

Patients And Methods: In a cohort study, patients treated for oral malignancies were assessed 4-6 weeks before and 4-6 weeks after treatment, as well as 6 months, 1 year and 5 years after treatment. The mixing ability test was assessed using 10 and 20 chewing strokes and was compared to seven questions about several aspects of mastication. Regression analysis was performed and density plots were drawn for statistical analysis.

Results: One hundred and twenty-three patients were included in this study. The questionnaire was less predictive for the 10-chewing stroke test and the test was less discriminatory for different food types than the 20-chewing stroke mixing ability test. Three questions about the ability to chew solid, soft and thickened liquid food types were found to be significantly predictive for the 20-chewing stroke test. Threshold values on the mixing ability index were around 20 for the ability to chew solid food types and 24 for soft food types.

Conclusion: The 10-chewing stroke mixing ability test is less suitable than 20-chewing strokes for patients with and treated for oral cancer. The 20-chewing stroke mixing ability test has a fair association with self-reported outcomes.
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http://dx.doi.org/10.1111/joor.12734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379969PMC
February 2019

Validity and reliability of the mixing ability test as masticatory performance outcome in children with spastic cerebral palsy and children with typical development: A pilot study.

J Oral Rehabil 2018 Oct 27;45(10):790-797. Epub 2018 Jul 27.

IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.

Background: The mixing ability test (MAT) as an outcome measure of masticatory performance is largely used in studies with adults, but not yet with children.

Objective: This study aimed to test the construct validity and the test-retest reliability of the MAT in children with spastic cerebral palsy (CP) and children with typical development (TD).

Method: The results of the MAT were correlated with tongue movements, mandible movements, relative muscle contraction and clinical observation measured with ultrasound, 3D kinematics, electromyography (EMG) and relevant items of the mastication observation and evaluation (MOE) instrument, respectively. Moreover, the between-groups effect was tested. Test-retest reliability was calculated with an intra-class correlation coefficient (ICC) and standard error of measurement (SEM).

Results: Twenty-one children (seven children with spastic CP and 14 children with TD) participated in this study. The MAT scores showed moderate to good correlations with some variables of the tongue movements, horizontal mandible movements and occlusion duration, relative muscle contraction of the left temporalis and all six MOE items (-0.80 < r < 0.49). The MAT scores were significantly higher for children with CP (mean 22.6; SD 2.4) compared to children with TD (mean 19.9; SD 1.9). The test-retest reliability had an ICC of 0.7 and a SEM of 1.16 (±5% of the mean score).

Conclusion: These results indicate that the MAT is suitable and complementary to ultrasound, 3D kinematics, EMG and observation to compare the masticatory performance between children with CP and children with TD, with an acceptable test-retest reliability.
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http://dx.doi.org/10.1111/joor.12690DOI Listing
October 2018
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