健康巴西成年人咀嚼和吞咽固体测试（TOMASS）的常模数据与信度

文献信息

中文摘要

引言： 咀嚼和吞咽固体测试（TOMASS）是一种标准化的临床评估工具，旨在量化固体食物摄入期间的口腔期吞咽效率。尽管TOMASS已在多个国家进行研究，但巴西人群的常模数据仍然缺乏。
目的： 建立常模数据并研究巴西葡萄牙语版TOMASS在健康成年人中的信度。
方法： 这项观察性横断面研究纳入了99名按年龄组分层的健康成年人。排除患有吞咽困难、头颈癌、神经系统疾病或胃肠道疾病的个体。参与者接受了社会人口学评估、蒙特利尔认知评估（MoCA）、口腔结构评估以及使用巴西市售的奶油饼干进行TOMASS测试。所有评估均进行视频记录以供后续分析。通过重复实施TOMASS评估重测信度，并使用视频记录分析评分者间信度。分析的变量包括咬合次数、咀嚼周期数、吞咽次数和总摄入时间。统计分析包括Student t检验、带Bonferroni事后检验的ANOVA、Wilcoxon检验和ICC系数。
结果： 样本包括99名健康成年人，分布在三个年龄组，其中54%为女性，平均年龄50.2（±16.3）岁，平均教育年限12.4（±4.1）年，月家庭收入约相当于两份最低工资（478±228美元）。年龄组间在咀嚼周期数上存在显著差异（p=0.021），具体在20-40岁和61岁以上年龄组之间（p=0.040）。在总任务时间上也观察到显著差异（p<0.001），20-40岁与61岁以上组之间（p=0.002）以及41-60岁与61岁以上组之间（p=0.013）存在对比。重测信度从中等到优秀不等，评分者间信度在TOMASS变量上表现出良好到优秀的一致性。
结论： 巴西葡萄牙语版TOMASS在评估健康巴西成年人的咀嚼和吞咽表现方面表现出令人满意的信度和适用性。本研究还提供了常模参考数据，可能支持TOMASS在巴西未来的临床和研究应用。
本文的贡献： 关于该主题已知的内容通过TOMASS方案获得的定量变量有助于临床吞咽检查（CSE）中咀嚼能力的诊断准确性，支持更精确的临床决策，特别是与先前建立的常模值相比。此外，定量数据允许监测随时间变化的生物力学变化，无论是由于衰老、神经功能成熟或自发恢复等自然过程，还是归因于特定治疗干预的效果。本文对现有知识的补充巴西人群的TOMASS常模数据可作为评估咀嚼和吞咽功能的临床指南，因为该测试成本低且实施快速，易于整合到临床评估中。这些数据在社会经济、文化和物理障碍（这是相当一部分巴西人口的现实）仍然限制医疗保健获取的背景下可能尤其相关。本研究的潜在或实际临床意义是什么？本研究的临床意义对巴西的语言治疗师和其他参与吞咽评估和康复的专业人员具有重要意义。建立巴西人群的TOMASS常模数据为识别不同年龄和性别组咀嚼表现的偏差提供了有价值的参考。此外，在资源匮乏的环境和发展中国家，像TOMASS这样简短、易于实施且成本低的方案尤其有价值，能够实现标准化评估和监测咀嚼和吞咽功能的公平获取。

英文摘要

INTRODUCTION: The Test of Masticating and Swallowing Solids (TOMASS) is a standardized clinical assessment designed to quantify oral phase swallowing efficiency during solid food intake. Although TOMASS has been investigated in several countries, normative data for the Brazilian population are still lacking.
OBJECTIVE: To establish normative data and investigate the reliability of the Brazilian Portuguese version of TOMASS in healthy adults.
METHODS: This observational cross-sectional study included 99 healthy adults stratified by age group. Individuals with dysphagia, head and neck cancer, neurological disorders, or gastrointestinal diseases were excluded. Participants underwent sociodemographic assessment, Montreal Cognitive Assessment (MoCA), oral structural evaluation, and TOMASS administration using a commercially available Cream Cracker biscuit available in Brazil. All assessments were video-recorded for subsequent analysis. Test-retest reliability was assessed through repeated administrations of TOMASS, and inter-rater reliability was analysed using video recordings. The analysed variables included the number of bites, the number of masticatory cycles, the number of swallows, and total ingestion time. Statistical analyses included Student's t-test, ANOVA with Bonferroni post hoc tests, Wilcoxon test, and ICC coefficient.
RESULTS: The sample included 99 healthy adults distributed across three age groups, with 54% women, a mean age of 50.2 (±16.3) years, mean education level of 12.4 (±4.1) years, and monthly household income equivalent to approximately two minimum wages (US$478 ± US$228). Significant differences were found between age groups in the number of masticatory cycles (p = 0.021), specifically between the 20-40 and 61+ age groups (p = 0.040). Significant differences were also observed in total task time (p < 0.001), with contrasts between the 20-40 and 61+ groups (p = 0.002), as well as between the 41-60 and 61+ groups (p = 0.013). Test-retest reliability ranged from moderate to excellent, and inter-rater reliability demonstrated good to excellent agreement across TOMASS variables.
CONCLUSION: The Brazilian Portuguese version of TOMASS demonstrated satisfactory reliability and applicability for assessing mastication and swallowing performance in healthy Brazilian adults. The present study also provides normative reference data that may support future clinical and research applications of TOMASS in Brazil.
WHAT THIS PAPER ADDS: What is already known on the subject The quantitative variables obtained through the TOMASS protocol contribute to the diagnostic accuracy of mastication abilities during a clinical swallowing examination (CSE), supporting more precise clinical decision-making, particularly when compared with previously established normative values. Moreover, the quantitative data allow for monitoring biomechanical changes over time, whether due to natural processes such as aging, neurofunctional maturation, or spontaneous recovery, or attributed to the efficacy of specific therapeutic interventions. What this paper adds to existing knowledge Normative TOMASS data for the Brazilian population may serve as clinical guidelines for assessing chewing and swallowing functions, given that the test is easily integrated into clinical evaluations due to its low cost and quick administration. These data may be especially relevant in contexts where socioeconomic, cultural, and physical barriers, a reality for a significant portion of the Brazilian population, still limit access to healthcare. What are the potential or actual clinical implications of this study? The clinical implications of this study are significant for speech-language pathologists in Brazil and other professionals involved in swallowing assessment and rehabilitation. The establishment of normative TOMASS data for the Brazilian population provides a valuable reference for identifying deviations in mastication performance across age and gender groups. Moreover, in low-resource contexts and developing countries, a brief, easy-to-administer, and low-cost protocol such as TOMASS is especially valuable, enabling equitable access to standardized assessment and monitoring of masticatory and swallowing functions.