HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH

Journal of Evidence Based Dental Practice, vol. 23, pp. 101794

Abstract

BACKGROUND: When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets. AIM: Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA). METHODS: This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns. RESULTS: Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated. CONCLUSIONS: Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

Authors 22

1. Oliver Schierz corresponding

   Leipzig University

   Affiliation as printed

   Department of Prosthodontics and Materials Science, Medical Faculty University of Leipzig, Leipzig, Germany

2. Chi Hyun Lee

   University of Massachusetts Amherst

   Affiliation as printed

   Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA

   Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA

3. Mike Torsten John

   University of Minnesota

   Affiliation as printed

   Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN

   Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, USA

4. Angelika Rauch

   University Hospital Regensburg · University of Regensburg

   Affiliation as printed

   Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg, Germany

5. Daniel Ralph Reissmann

   University of Freiburg

   Affiliation as printed

   Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Freiburg, Germany

6. Ralf‐Joachim Kohal

   University of Freiburg

   Affiliation as printed

   Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Freiburg, Germany

7. Birgit Marré

   University Hospital Carl Gustav Carus · Technische Universität Dresden

   Affiliation as printed

   Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany

8. K. Böning

   University Hospital Carl Gustav Carus · Technische Universität Dresden

   Affiliation as printed

   Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany

9. Michael Horst Walter

   University Hospital Carl Gustav Carus · Technische Universität Dresden

   Affiliation as printed

   Department of Prosthetic Dentistry, Technische Universität Dresden, University Hospital Carl Gustav Carus Dental School, Dresden, Germany

10. Ralph Gunnar Luthardt

    Universität Ulm · University Hospital Ulm

    Affiliation as printed

    Department of Prosthetic Dentistry, Center of Dentistry, Universitätsklinikum Ulm, Ulm, Germany

11. Heike Rudolph

    Universität Ulm · University Hospital Ulm

    Affiliation as printed

    Department of Prosthetic Dentistry, Center of Dentistry, Universitätsklinikum Ulm, Ulm, Germany

12. Torsten Mündt

    Universität Greifswald

    Affiliation as printed

    Department of Prosthodontics, Gerodontology and Biomaterials, Dental School, University of Greifswald, Greifswald, Germany

13. Wolfgang B. Hannak

    Stiftung Charité · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Charité, Center for Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin, Berlin, Germany

14. Guido Heydecke

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    University Medical Center Eppendorf, Department of Prosthodontics, Hamburg, Germany

15. Matthias Kern

    Christian-Albrechts-Universität zu Kiel

    Affiliation as printed

    Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany

16. Sinsa Hartmann

    Johannes Gutenberg University Mainz

    Affiliation as printed

    Department of Prosthetic Dentistry, Johannes-Gutenberg University of Mainz, Mainz, Germany

17. Julian Boldt

    University of Würzburg

    Affiliation as printed

    Department of Prosthetic Dentistry, Julius-Maximilians University of Wuerzburg, Wuerzburg, Germany

18. Helmut Stark

    University of Bonn

    Affiliation as printed

    Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany

19. Daniel Edelhoff

    LMU Klinikum · Ludwig-Maximilians-Universität München

    Affiliation as printed

    Department of Prosthetic Dentistry, University Hospital, LMU Ludwig-Maximilians-University, Munich, Germany

20. Bernd Wöstmann

    Justus-Liebig-Universität Gießen

    Affiliation as printed

    Department of Prosthetic Dentistry, Justus-Liebig University of Giessen, Giessen, Germany

21. Stefan Wolfart Aachen Department of Prosthodontics and Biomaterials Medical Faculty

    RWTH Aachen University

    Affiliation as printed

    Department of Prosthodontics and Biomaterials, Medical Faculty, RWTH Aachen University, Aachen, Germany

22. Florentine Jahn

    Friedrich Schiller University Jena

    Affiliation as printed

    Department of Prosthetic Dentistry and Dental Material Science, Friedrich-Schiller University of Jena, Jena, Germany