上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (12): 1720-1728.doi: 10.3969/j.issn.1674-8115.2022.12.010
• 论著 · 循证医学 • 上一篇
吴媚1(
), 梁妍景1, 侯黎莉2()
收稿日期:2022-05-20
接受日期:2022-11-28
出版日期:2022-12-28
发布日期:2022-12-28
通讯作者:
侯黎莉
E-mail:583512378@qq.com;pisces_liz@163.com
作者简介:吴 媚（1994—），女，硕士生；电子信箱：583512378@qq.com。
基金资助:
WU Mei1(), LIANG Yanjing1, HOU Lili2()
Received:2022-05-20
Accepted:2022-11-28
Online:2022-12-28
Published:2022-12-28
Contact:
HOU Lili
E-mail:583512378@qq.com;pisces_liz@163.com
Supported by:摘要：
目的·对口腔癌术后言语功能的评估工具做范围审查，以获得现有研究中存在的口腔癌术后言语功能的评估工具，总结口腔癌术后言语功能评估工具的应用方法、应用场景及发展现况。方法·采用澳大利亚JBI（Joanna Briggs Institute）循证卫生保健中心范围综述的方法为方法学框架，检索库包括PubMed、Web of Science、Embase、CINAHL、CNKI、万方、维普，英文检索词为（"oral cancer" or "oral cavity cancer" or "head and neck neoplasm*"［MeSH Terms］）AND（"speech" or "language"［MeSH Terms］）AND（"assess*" or "evaluat*"［MeSH Terms］），中文检索关键词为“言语”“言语障碍”“言语功能”，检索学科限定为“口腔医学”或“护理学”。检索时限为建库至2022年7月，对纳入文献进行汇总分析。结果·从文献库中初步检索后得到4 476篇文章，剔除重复文献、与研究目的及内容无关文献、综述类文献、非中文或非英文文献等，最终纳入9篇文献，包含7篇横断面研究和2篇队列研究，纳入文献的时间范围为1990—2022年，国家来源包含美国、日本、德国、印度等，共归纳出3种评估方式，分别为量表、自动化识别技术和物联设备等其他方式，其中量表评估为目前最主流的评估方式，言语障碍指数（speech handicap index，SHI）为应用最广泛的评估量表之一，在我国已得到文化调适及汉化，但本土原创的评估工具未检索到。结论·口腔癌术后言语评估工具中，量表为应用最广泛的方式，但同时兼顾主观和客观的言语评估工具较少，目前国内相关研究处于空缺。未来可结合这两方面开展相关研究，研发适用于本土语言的口腔癌术后言语功能评估工具。
中图分类号:
吴媚, 梁妍景, 侯黎莉. 口腔癌术后言语功能的评估工具：一项范围综述[J]. 上海交通大学学报（医学版）, 2022, 42(12): 1720-1728.
WU Mei, LIANG Yanjing, HOU Lili. Evaluation tools for speech function after oral cancer surgery: a scoping review[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1720-1728.
图1 文献筛选流程图
Fig 1 Flow chart of literature selection
| Authour | Year | Nation | Subjects | Objective | Design | Sample size |
|---|---|---|---|---|---|---|
WOISARD， et al［ | 2022 | France | Patients with oropharyngeal or oral cancer who are in the "chronic" stage （i.e.， having completed treatment at least 6 months ago） and are in clinical remission， ensuring that the speech impairment is as stable as possible. The control group consisted of the patients' companion to be close to the subjects in terms of age， lifestyle， and location | Through acoustic parameters， an automatic speech severity index model suitable for clinical practice is established to help predict the degree of speech impairment | Cross-sectional studies | 87 vs 35 |
DOKHE， et al［ | 2021 | India | Patients after oral cancer surgery | It aims to develop a speech intelligibility tool that can perceive and analyze Malayalam | Cross-sectional studies | 120 |
| KEILMANN，et al［ | 2021 | Germany | Survivors of oral cancer （floor of the mouth，tongue，palatine tonsils，base of tongue， palate， jaw， oropharynx， nasopharynx or cheek） who have undergone surgery | To build a simplified assessment tool for measuring the subjective experience of dysphonia | Cross-sectional studies | 113 |
| KEILMANN，et al［ | 2016 | Germany | Patients with treated head and neck tumors.Treatment includes radiotherapy，chemotherapy， immunotherapy and surgery. Head and neck tumors include tumors of the floor of the mouth， tongue， palate， tonsils， base of tongue， maxilla， jaw， oropharynx， nasopharynx and cheeks | To develop the AHI scale and do its psychometric analysis | Cross-sectional studies | 113 |
RIEMANN， et al［ | 2015 | Germany | Patients with squamous cell carcinoma of the tongue who have undergone surgery | Through the automatic objective speech recognition system， prospective speech intelligibility evaluation was carried out for patients with postoperative oral squamous cell carcinoma | Cohort studies | 25 vs 40 |
| ELLABBAN，et al［ | 2012 | Egypt | Patients with squamous cell carcinoma of the floor of the mouth who have undergone surgery | Oral function was reported by using a FIGS scale to determine the patient's ability to speak， chew， and swallow after surgical treatment for squamous cell carcinoma of the floor of the mouth | Cohort studies | 62 |
RINKEL， et al［ | 2008 | Netherlands | Oral or pharyngeal cancer that has been treated， including chemotherapy， radiation and surgery | A SHI scale was developed for 92 patients with oral or pharyngeal cancer and 110 healthy patients | Cross-sectional studies | 92 vs 110 |
| NISHIGAWA， et al［ | 2003 | Japan | Patients with maxillary defects after oral cancer surgery | To develop a new method to use galvanic skin response as an indicator of satisfaction with pronunciation function | Cross-sectional studies | 11 |
| LIST， et al［ | 1990 | America | Patients with head and neck tumors | To develop a simple， practical assessment tool to measure function in patients with head and neck tumors in a standard and systematic way | Cross-sectional studies | 181 |
表1 纳入文献的基本特征
Tab 1 Characteristics of the included studies
| Authour | Year | Nation | Subjects | Objective | Design | Sample size |
|---|---|---|---|---|---|---|
WOISARD， et al［ | 2022 | France | Patients with oropharyngeal or oral cancer who are in the "chronic" stage （i.e.， having completed treatment at least 6 months ago） and are in clinical remission， ensuring that the speech impairment is as stable as possible. The control group consisted of the patients' companion to be close to the subjects in terms of age， lifestyle， and location | Through acoustic parameters， an automatic speech severity index model suitable for clinical practice is established to help predict the degree of speech impairment | Cross-sectional studies | 87 vs 35 |
DOKHE， et al［ | 2021 | India | Patients after oral cancer surgery | It aims to develop a speech intelligibility tool that can perceive and analyze Malayalam | Cross-sectional studies | 120 |
| KEILMANN，et al［ | 2021 | Germany | Survivors of oral cancer （floor of the mouth，tongue，palatine tonsils，base of tongue， palate， jaw， oropharynx， nasopharynx or cheek） who have undergone surgery | To build a simplified assessment tool for measuring the subjective experience of dysphonia | Cross-sectional studies | 113 |
| KEILMANN，et al［ | 2016 | Germany | Patients with treated head and neck tumors.Treatment includes radiotherapy，chemotherapy， immunotherapy and surgery. Head and neck tumors include tumors of the floor of the mouth， tongue， palate， tonsils， base of tongue， maxilla， jaw， oropharynx， nasopharynx and cheeks | To develop the AHI scale and do its psychometric analysis | Cross-sectional studies | 113 |
RIEMANN， et al［ | 2015 | Germany | Patients with squamous cell carcinoma of the tongue who have undergone surgery | Through the automatic objective speech recognition system， prospective speech intelligibility evaluation was carried out for patients with postoperative oral squamous cell carcinoma | Cohort studies | 25 vs 40 |
| ELLABBAN，et al［ | 2012 | Egypt | Patients with squamous cell carcinoma of the floor of the mouth who have undergone surgery | Oral function was reported by using a FIGS scale to determine the patient's ability to speak， chew， and swallow after surgical treatment for squamous cell carcinoma of the floor of the mouth | Cohort studies | 62 |
RINKEL， et al［ | 2008 | Netherlands | Oral or pharyngeal cancer that has been treated， including chemotherapy， radiation and surgery | A SHI scale was developed for 92 patients with oral or pharyngeal cancer and 110 healthy patients | Cross-sectional studies | 92 vs 110 |
| NISHIGAWA， et al［ | 2003 | Japan | Patients with maxillary defects after oral cancer surgery | To develop a new method to use galvanic skin response as an indicator of satisfaction with pronunciation function | Cross-sectional studies | 11 |
| LIST， et al［ | 1990 | America | Patients with head and neck tumors | To develop a simple， practical assessment tool to measure function in patients with head and neck tumors in a standard and systematic way | Cross-sectional studies | 181 |
| Author | Speech-related assessment methods | Purpose of assessment | How to measure results | Key results of the study |
|---|---|---|---|---|
| WOISARD， et al［ | ① SHI ② PHI ③ SLP ④ ASR Systems： openSMILE 3.0， PRAAT 6.1， VOCALAB 4 | ①SHI is used to assess the degree of speech impairment ②PHI is used to assess the degree of sound impairment ③SLP assesses speech comprehension ④ASR is used to measure speech intelligibility | Eighty-seven patients were treated for oral or oropharyngeal cancer and 35 controls performed different speech-producing tasks and completed questionnaires about speech-related quality of life. The recordings were then evaluated by human perception and automatic speech recognition. A score was derived from a classical Logistic regression model that can describe the severity of the patient's speech disorder | After using three software programs for acoustic treatment， 6 parameters were derived to help predict speech disorders in the future， and the assessment was automated and more reproducible than from manual evaluation |
| DOKHE， et al［ | ASIAT | ASIAT is used for perceptual analysis of speech functions to obtain speech intelligibility and comprehensibility | Internal consistency and reliability and validity tests | The scale has high internal consistency， with Cronbach's α of 0.847， a strong correlation between Malayalam and English， and a Pearson correlation coefficient of 0.646 |
| KEILMANN，et al［ | ① AHI ② Short form AHI-12 | AHI-12 is used to assess the degree of dysphonia | Reliability and validity test | The short form AHS-12 questionnaire provides almost as much information as AHI， and it takes significantly less time to complete it. Optimal with 12 entries， Cronbach's α is 0.96 |
| KEILMANN，et al［ | ①AHI ②Self-assessment | AHI is used to assess the degree of dysphonia | Cronbach's α values for the AHI scale's item total correlation， principal component analysis， and outcome component. To test its validity， the relationship between AHI and self-evaluation was applied to Kendall's tau values between AHI scores and self-assessments | AHI is one-dimensional， so only a full Cronbach's α coefficient was measured， and Cronbach's α coefficient was 0.96. The AHI score and Kendall's tau value between the self-rating and the self-rating were 0.69 （P< 0.001） |
| RIEMANN，et al［ | ASR systems PEAKS （programme for evaluation and analysis for all types speech disorders） | ASR is used to measure speech intelligibility and word recognition rate | Patients were evaluated before surgery， 14‒20 d after surgery， 3 months， 6 months and 12 months after surgery， and the cumulative speech function evaluation results of patients were obtained， and then compared between groups | At 12 months before and after surgery， patients developed significant language impairment compared with healthy controls （P≤0.002）. Speech intelligibility decreased significantly 14 to 20 d after surgery （P<0.001）， but was readjusted to preoperative levels after 12 months （P=0.159）. After 12 months， tongue retention significantly improved speech intelligibility （P=0.007） |
| ELLABBAN，et al［ | FIGS | FIGS is used to assess intraoral function and includes three dimensions： swallowing， speech， and chewing | Patient scoring data were collected preoperatively， 2， 6 and 12 months postoperatively to obtain trends in FIGS scores | The mean baseline speech score was 4.9 points， which decreased to 4.1 points two months after surgery. At 6 and 12 months after surgery， the mean speech score increased to 4.2 and 4.3 at the same time. FIGS is a simple and comprehensive way to assess functional impairment in postoperative patients |
RINKEL， et al［ | ① SHI ② EORTC QLQ-H&N35 ③The control group was asked if they had a question about speaking （answered "yes" or "no"） | ①SHI is used to assess the degree of speech impairment ②EORTC QLQ-H&N35 is used to assess quality of life in patients with head and neck tumors， including the dimension of speech function | The reliability of the SHI scale was assessed by using internal consistency （Cronbach's α） and retesting stability （Pearson's r）. | The internal consistency reliability （Cronbach's α coefficient） for the SHI total score was 0.98 in the patient group and 0.92 in the control group， and the Pearson's r coefficients for the total score and subscale were 5.85， 0.83， and 0.72， respectively. The correlation （Pearson's r coefficients） between the SHI Total Score， the SHI Verbal Function Subscale， the SHI Psychosocial Function Subscale， and the EORTC QLQ-H & N35 Speech Scale （Pearson's r coefficients） were 0.86， 0.81， and 0.84， respectively |
| NISHIGAWA，et al［ | ① Speech intelligibility test （assessed by SLP） ② VAS ③ GSR measuring instrument | ① VAS is used in patients to self-assess the degree of speech impairment ② GSR judges speech function through the results of the electric skin response | The results of galvanic skin reactions before and after the prostheses were compared | The mean rate of decline in articulation resistance in patients with prostheses was significantly smaller than the value without prostheses， and the results were statistically different （P<0.05）， suggesting that wearing prostheses helped with pronunciation |
| LIST，et al［ | PSS-HN | It is used to evaluate postoperative dietary function， speech comprehension and eating in public in patients with head and neck tumors | Reliability and validity test | The degree of agreement between rater scores was described by using κ statistics，κ = 0.88 ［standard error （SE） = 0.08］ for a normal diet； Speech comprehensibility κ = 0.64 （SE = 0.12）； Eating in public， κ = 0.78 （SE = 0.11）. Kruskal-Wallis statistics showed that the difference between groups was significant on all three subscales （P < 0.05） |
表2 口腔癌术后言语功能的评估工具
Tab 2 Evaluation tools of speech function after oral cancer surgery
| Author | Speech-related assessment methods | Purpose of assessment | How to measure results | Key results of the study |
|---|---|---|---|---|
| WOISARD， et al［ | ① SHI ② PHI ③ SLP ④ ASR Systems： openSMILE 3.0， PRAAT 6.1， VOCALAB 4 | ①SHI is used to assess the degree of speech impairment ②PHI is used to assess the degree of sound impairment ③SLP assesses speech comprehension ④ASR is used to measure speech intelligibility | Eighty-seven patients were treated for oral or oropharyngeal cancer and 35 controls performed different speech-producing tasks and completed questionnaires about speech-related quality of life. The recordings were then evaluated by human perception and automatic speech recognition. A score was derived from a classical Logistic regression model that can describe the severity of the patient's speech disorder | After using three software programs for acoustic treatment， 6 parameters were derived to help predict speech disorders in the future， and the assessment was automated and more reproducible than from manual evaluation |
| DOKHE， et al［ | ASIAT | ASIAT is used for perceptual analysis of speech functions to obtain speech intelligibility and comprehensibility | Internal consistency and reliability and validity tests | The scale has high internal consistency， with Cronbach's α of 0.847， a strong correlation between Malayalam and English， and a Pearson correlation coefficient of 0.646 |
| KEILMANN，et al［ | ① AHI ② Short form AHI-12 | AHI-12 is used to assess the degree of dysphonia | Reliability and validity test | The short form AHS-12 questionnaire provides almost as much information as AHI， and it takes significantly less time to complete it. Optimal with 12 entries， Cronbach's α is 0.96 |
| KEILMANN，et al［ | ①AHI ②Self-assessment | AHI is used to assess the degree of dysphonia | Cronbach's α values for the AHI scale's item total correlation， principal component analysis， and outcome component. To test its validity， the relationship between AHI and self-evaluation was applied to Kendall's tau values between AHI scores and self-assessments | AHI is one-dimensional， so only a full Cronbach's α coefficient was measured， and Cronbach's α coefficient was 0.96. The AHI score and Kendall's tau value between the self-rating and the self-rating were 0.69 （P< 0.001） |
| RIEMANN，et al［ | ASR systems PEAKS （programme for evaluation and analysis for all types speech disorders） | ASR is used to measure speech intelligibility and word recognition rate | Patients were evaluated before surgery， 14‒20 d after surgery， 3 months， 6 months and 12 months after surgery， and the cumulative speech function evaluation results of patients were obtained， and then compared between groups | At 12 months before and after surgery， patients developed significant language impairment compared with healthy controls （P≤0.002）. Speech intelligibility decreased significantly 14 to 20 d after surgery （P<0.001）， but was readjusted to preoperative levels after 12 months （P=0.159）. After 12 months， tongue retention significantly improved speech intelligibility （P=0.007） |
| ELLABBAN，et al［ | FIGS | FIGS is used to assess intraoral function and includes three dimensions： swallowing， speech， and chewing | Patient scoring data were collected preoperatively， 2， 6 and 12 months postoperatively to obtain trends in FIGS scores | The mean baseline speech score was 4.9 points， which decreased to 4.1 points two months after surgery. At 6 and 12 months after surgery， the mean speech score increased to 4.2 and 4.3 at the same time. FIGS is a simple and comprehensive way to assess functional impairment in postoperative patients |
RINKEL， et al［ | ① SHI ② EORTC QLQ-H&N35 ③The control group was asked if they had a question about speaking （answered "yes" or "no"） | ①SHI is used to assess the degree of speech impairment ②EORTC QLQ-H&N35 is used to assess quality of life in patients with head and neck tumors， including the dimension of speech function | The reliability of the SHI scale was assessed by using internal consistency （Cronbach's α） and retesting stability （Pearson's r）. | The internal consistency reliability （Cronbach's α coefficient） for the SHI total score was 0.98 in the patient group and 0.92 in the control group， and the Pearson's r coefficients for the total score and subscale were 5.85， 0.83， and 0.72， respectively. The correlation （Pearson's r coefficients） between the SHI Total Score， the SHI Verbal Function Subscale， the SHI Psychosocial Function Subscale， and the EORTC QLQ-H & N35 Speech Scale （Pearson's r coefficients） were 0.86， 0.81， and 0.84， respectively |
| NISHIGAWA，et al［ | ① Speech intelligibility test （assessed by SLP） ② VAS ③ GSR measuring instrument | ① VAS is used in patients to self-assess the degree of speech impairment ② GSR judges speech function through the results of the electric skin response | The results of galvanic skin reactions before and after the prostheses were compared | The mean rate of decline in articulation resistance in patients with prostheses was significantly smaller than the value without prostheses， and the results were statistically different （P<0.05）， suggesting that wearing prostheses helped with pronunciation |
| LIST，et al［ | PSS-HN | It is used to evaluate postoperative dietary function， speech comprehension and eating in public in patients with head and neck tumors | Reliability and validity test | The degree of agreement between rater scores was described by using κ statistics，κ = 0.88 ［standard error （SE） = 0.08］ for a normal diet； Speech comprehensibility κ = 0.64 （SE = 0.12）； Eating in public， κ = 0.78 （SE = 0.11）. Kruskal-Wallis statistics showed that the difference between groups was significant on all three subscales （P < 0.05） |
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