Accepted Article

DR. KENJI FUEKI (Orcid ID : 0000-0002-5885-2447)

Article type : Original Article

Responsiveness of methods to evaluate chewing ability after removable partial

denture treatments

Running title: Responsiveness of chewing ability tests

Kenji Fueki, Yuka Inamochi, Eiko Yoshida-Kohno, Yoko Hayashi, Noriyuki Wakabayashi

Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental
Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, Japan,
113-8549

Corresponding author:
Kenji Fueki
Removable Partial Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo
Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, Japan.
Phone: +81-3-5803-5514 FAX: +81-3-5803-5514
Email: kunfu.rpro@tmd.ac.jp

This article has been accepted for publication and undergone full peer review but has not been
through the copyediting, typesetting, pagination and proofreading process, which may lead to
differences between this version and the Version of Record. Please cite this article as doi:
10.1111/JOOR.13128
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 Abstract
Accepted Article
Background: The ability of an instrument to detect a clinically important change in patient-
reported outcomes following prosthetic treatment is critical for its use in clinical practice and
research settings.
Objectives: This study aimed to examine the responsiveness of instruments in evaluating patient
perception of chewing ability after removable partial denture (RPD) treatment in a prospective
cohort.
Methods: A single 100-mm visual analogue scale (VAS), 20-item food intake questionnaire (FIQ),
and 6-point chewing difficulty scale (CDS) were administered to 248 partially edentulous patients
to evaluate chewing ability pre- and post-RPD treatment. We conducted a statistical comparison
between the pre- and post-treatment scores and determined the effect size (r) of RPD treatment for
the instruments.
Results: A significant improvement in chewing ability after RPD treatment was identified by VAS
and CDS (P < 0.05), but not by FIQ (P = 0.16), which identified an improvement after controlling
for sex, age, the number of missing teeth, and presence/absence of existing removable dentures.
The effect size was medium for VAS (r = 0.54), weak for CDS (r = 0.14-0.17), and absent for FIQ
(r = -0.09). The increase in r was significantly associated with impaired chewing ability before
treatment (ρ = - 0.87, P < 0.001).
Conclusions: These results suggest that the 100-mm VAS, followed by CDS, is the most
responsive instrument to detect an improvement in chewing ability after RPD treatment. Pre-
treatment impairment of chewing ability was associated with better responsiveness of the
instruments.
Keywords: mastication; removable partial denture; patient-reported outcome; chewing ability;
responsiveness; effect size

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 Introduction
Accepted Article
Recovery of impaired masticatory function due to tooth loss is one of the major objectives of
prosthetic treatment. Masticatory function is clinically evaluated objectively using a variety of
chewing test items and/or subjectively by assessing patient perception using self-administered
questionnaires.1-3 These objective/subjective evaluations are useful to interpret the effects of
prosthetic treatment on masticatory function in clinical practice and research settings. Dental
patient-reported outcome measures (PROMs) have been recently recognised to be essential for
assessing patients’ oral health status in clinical practice for evidence-based prosthetic dentistry.4
Therefore, subjective evaluation of masticatory function, referred to as “chewing ability” in this
paper, is important, because objective and subjective evaluations of masticatory function
frequently exhibited weak correlations.5-8
The validity and reliability of the methods to evaluate masticatory function have been well
established in many previous studies.1, 2 In addition to the above characteristics, the ability to
detect a transitional or clinically important change in outcome measures is critical in interpreting
the treatment effects and decision-making in clinical practice, which has been referred to as
“responsiveness” by an international expert panel (The Consensus-Based Standards for the
Selection of Health Status Measurement Instruments: COSMIN).9,10 However, the scope of
investigations in the responsiveness of methods to evaluate objective/subjective masticatory
function has been very limited.2 For example, one study used a two-coloured wax cube to show
high levels of responsiveness associated with removable partial denture (RPD) treatment,11 and a
more recent study evaluated the responsiveness of a two-coloured chewing gum method, a visual
analogue scale (VAS) with 0-10 numerical endpoints, and 3/5-point Likert scales for chewing
difficulty to assess a range of prosthetic treatments (e.g., complete dentures, RPDs, and fixed
partial dentures).12 In addition, stabilisation of RPDs using mini-implants improved food mixing
ability, as evaluated using a two-coloured chewing gum.13 The findings of these studies suggest
that the responsiveness of these evaluation methods for masticatory function are dependent on the
food types, chewing conditions, types of questionnaires used, and the types of prosthodontic
treatments. Accordingly, clinicians and researchers should consider the factors that potentially
affect the responsiveness when choosing method(s) to evaluate masticatory function.
Therefore, we evaluated the masticatory function of partially dentate patients before and three
months after RPD treatment to determine the responsiveness of a variety of objective/subjective
methods in evaluating masticatory function. In this paper, we report the responsiveness of

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 subjective assessments with a 100-mm VAS, a 20-item food intake questionnaire (FIQ), and a 6-
Accepted Article
point chewing difficulty scale (CDS).

Materials and methods

Subjects
In this study, partially dentate patients who were scheduled to receive definitive RPDs were
consecutively recruited from a prosthetic and general dentistry clinic of the dental hospital of
Tokyo Medical and Dental University (TMDU). Patients with severe pain affecting the orofacial
region were excluded. Each patient received written and oral explanations regarding the study
protocol, which was approved by the TMDU institutional review board (D2017-030). All
participants provided informed consent. Subsequently, patient characteristics such as age, sex,
number of missing teeth, type of partially edentulous arch (Kennedy and Eichnner classification),
number of occlusal units (OUs), and status of the existing removable dentures were recorded. A
sample size of 275 patients was determined to be sufficient for statistical analysis across five
subgroups categorised by pre-treatment chewing ability, according to a recommendation by
COSMIN (n = 50/group),9 while taking into account a 10% dropout rate.

Evaluation of subjective masticatory function

In this study, subjective masticatory function was evaluated using three different instruments
before and three months following RPD treatment. The 100-mm VAS has been utilised in
edentulous patients with implant overdentures or complete dentures.14, 15 The VAS contains
anchors at the ends of a 100-mm line, and the anchors are defined as “cannot chew at all” for the
left, and “can chew very well” for the right. Patients were instructed to mark a vertical line at a
point on the VAS indicating the current status of their overall chewing ability. The examiner
measured the distance (mm) from the left anchor to the point indicated by the patient, and it was
defined as the VAS score for overall chewing ability.
FIQ was originally developed for edentulous elderly patients in Japan.16 The list of food
items was slightly modified in a shorter version, and it was validated in partially dentate
individuals.17 The FIQ used in this study assessed 20 common Japanese foods associated with a
wide range of chewing difficulties (soft–hard/tough foods). The patients were asked to respond to
the items as being foods they could or could not chew. The FIQ score was calculated as the
percentage of the total items they identified as being able to chew, with a higher score indicating

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 better chewing ability (minimum: 0; maximum: 100). Additionally, food acceptability was
Accepted Article
determined during pre-treatment evaluation. The food items in the FIQ (20 items) were ranked
over five levels (F1, most difficult four foods; F5, easiest four foods) based on the rates of patients
who responded to the food items as being chewable in pre-treatment evaluation (supplementary
information).
In addition, the patients were asked to rate the difficultly in chewing vegetables and meats in
a dairy meal on a 6-point CDS (0: no difficulty, 5: most difficult) (supplementary information).
Similar scales with a variety of foods have been utilised in previous clinical studies.18-21 In this
study, no specific food items were indicated for rating chewing difficulty.

Statistical analysis
We conducted a statistical comparison of the chewing ability scores before and after RPD
treatment by using Wilcoxon’s signed-ranked test. The P-values were adjusted with Bonferroni
correction for multiple comparisons in the subgroup analysis. Further, we conducted a multivariate
analysis using a linear mixed model (LMM). In the LMM, the chewing ability score in each scale
was a dependent variable, and RPD treatment, age, sex, the number of missing teeth, and pre-RPD
status (presence/absence of existing removable denture) were included as independent variables
that were potential influencing factors. Spearman’s correlation analysis was performed to examine
the associations between pre-treatment scores and effect size. A P-value of <0.05 was considered
statistically significant. SPSS Statistics 24.0 (SPSS Japan Inc., Tokyo, Japan) was used to perform
all statistical analyses.

Evaluation of responsiveness
We conducted data analyses for the patient group as a whole. Subsequently, the patients were
divided into five subgroups based on pre-treatment chewing ability (L1: lowest; L5: highest). An
additional responsiveness analysis in FIQ was conducted on the basis of the pre-treatment chewing
ability and the food acceptability in pre-treatment evaluation. We evaluated the responsiveness
according to the method used for assessing health-related PROMs in the COSMIN checklist.10
Effect size (r), as a measure of responsiveness, was determined by dividing the Z score by n1/2.
The Z score was obtained from Wilcoxon’s signed-ranked test used for statistical analysis. We
interpreted the responsiveness as being weak (0.1 <= | r | < 0.3), moderate (0.3 <= | r | < 0.5), or
strong (| r | > = 0.5).22

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Accepted Article
Results
We recruited 295 eligible patients from November 2017 to March 2019, and 277 patients who
provided written informed consent were enrolled in the study and completed the pre-treatment
evaluation. Among the 277 participants, eight dropped out before RPD delivery and 21 dropped
out during the 3-month follow-up period. Finally, 248 (90%) completed the post-treatment
evaluation by August 2019, and they were subjected to responsiveness analysis.
The characteristics of the patients who participated in the study (n = 277) are presented in
Table 1. Among the patients who completed pre- and post-evaluations (Analysed group, n = 248),
the mean age was 71 years, the ratio of females was 63%, and the ratio of patients who were
wearing existing removable dentures was 70%. The mean number of missing teeth was 11. 4 , and
the mean number of OUs was 2.5. The characteristics of the dropouts (n = 29) were similar to
those of the Analysed group.
In the Analysed group, 324 new RPDs (157 maxillary RPDs and 167 mandibular RPDs) were
delivered to the patients, and the majority (98.5%, 319/324) were clasp-retained RPDs. The
remaining five RPDs included four thermoplastic resin-based RPDs and one double-crown
retained RPD. The distribution of RPD types was similar in both jaws.
Figure 1 presents the distribution of patients categorised by chewing ability scores in each
instrument in the pre- and post-treatment evaluations. The pre-treatment distribution of the VAS
score was slightly skewed to the left, and it shifted to the right after RPD treatment. The FIQ score
showed a left-skewed flat distribution with an almost constant (10-15) percentage of patients
across 31-70 points in the pre-treatment evaluation. The peak of the FIQ distribution slightly
shifted to the left after RPD treatment. The CDS score distribution was highly skewed to the right
in the pre-treatment evaluation, with most patients (70%-80%) exhibiting slight (1 point) or no
difficulty (0 point) in chewing vegetables and meats. However, the distribution shifted to the left
(toward improvement in chewing ability) after RPD treatment.
Tables 2 and 3 present the chewing ability scores and effect sizes for each instrument in the
pre- and post-evaluations. In the overall patient sample, the VAS score significantly increased
after RPD treatment (P < 0.05), indicating an improvement in overall chewing ability. The mean
FIQ score slightly decreased after treatment, but the difference was not statistically significant (P
> 0.05). The median pre-treatment CDS score was equivalent to the post-treatment score, but the

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 change was statistically significant (P < 0.05). The effect size was strong for VAS (r = 0.54) and
Accepted Article
weak for CDS (vegetables: r = 0.14, meat: r = 0.17), while there was no effect on FIQ (r = -0.09).
The multivariate analysis conducted in the whole group identified significant effects of RPD
treatment on VAS and CDS independent of age, sex, number of missing teeth, and pre-RPD status
(Table 4).
In the subgroup analysis, a moderate/strong positive effect (r > 0.30) on VAS and CDS was
found in subgroups with lower chewing ability (L1-L3), while an effect on FIQ was only observed
in the lowest subgroup (L1) (Tables 2 and 3). In all instruments, the subgroups with lower
chewing ability before RPD treatment exhibited a greater positive effect (Tables 2 and 3), and the
association was significant (ρ = - 0.87, P < 0.001).
The effect sizes for FIQ analysed by the pre-treatment score and food acceptability are
presented in Table 5. A moderate/strong positive effect (r > 0.30) was observed only within the
moderately acceptable food groups (F2-F4) in subgroups of patients with low chewing ability
before RPD treatment (L1 and L2), while the most of the remaining food groups with middle/high
chewing ability (L3-L5) showed a negative effect (r < -0.10).

Discussion
In this study, we evaluated the responsiveness of three different instruments in evaluating
subjective chewing ability following RPD treatment. In our analysis involving the whole patient
sample, VAS was the most responsive, followed by CDS, but FIQ was not responsive. Further, in
the subgroup analysis, VAS and CDS exhibited clinically significant effects in a broader range of
pre-treatment scores than the FIQ. Impairment of chewing ability before RPD treatment was
associated with better responsiveness.
The effect size for VAS was higher than those for CDS and FIQ, consistent with a previous
study.12 This finding indicates that VAS is the most suitable instrument to evaluate the treatment
effect of RPD on subjective chewing ability with respect to responsiveness. However, the mean
VAS score in the patients who scored more than 87 points before treatment significantly decreased
after RPD treatment. Thus, VAS showed a ceiling effect in patients with higher chewing ability
before treatment. The differences in the responsiveness of the three instruments can be attributed
to the information quantity of the scales: VAS is an analogue scale, CDS is an ordinal scale, and

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 FIQ uses binary assessments for each item. The analogue scale is the most informative, followed
Accepted Article
by the ordinal and binary scales. In addition, overall chewing ability evaluated using VAS may
include the process of swallowing food bolus. RPD treatment could improve not only the food
comminuting ability but also food bolus making and Stage 2 transport. However, FIQ and CDS
could evaluate only the ability to masticate food. Therefore, VAS seems to have the highest ability
to detect treatment effects with RPD treatment.
The FIQ employed in this study has been well validated in partially dentate individuals in a
previous study.17 The FIQ score was also shown to be significantly associated with the number of
the remaining tooth, denture-related mucosal pain, and oral-health-related quality of life in
partially dentate individuals.8, 23, 24 These findings indicate the usefulness of FIQ in evaluating
subjective chewing ability in this population. However, this study failed to identify improvement
in chewing ability with RPD treatment, consistent with the findings of previous studies.25, 26

Therefore, validity and reliability are not sufficient for an instrument to adequately detect the
treatment effect, and responsiveness is essential for this purpose.
The FIQ consists of 20 items representing different chewing difficulties.17 We analysed the
chewing difficulty of each item based on the rates of patients who responded to the items as
chewable and grouped them into five levels each containing four items. We found that the effect
size was influenced by the pre-treatment chewing ability and the chewing difficulty of test items
(ceiling and floor effects). Clinically significant responsiveness (r > 0.30) was observed in a
limited subgroup of patients with lower chewing ability before treatment (<55 points) and with
items that were moderately difficult to chew. These results suggest that FIQ is applicable in
patients with substantially impaired chewing ability.
The responsiveness for CDS was much weaker than that for VAS, but it showed statistically
significant improvement in chewing ability. In this study, the percentage of the patients who had
existing removable dentures was 70%, and they might not have remarkable difficulty to chew
vegetables and meats, which resulted in a ceiling effect on CDS. In this study, no specific foods
were indicated for patients in the CDS assessments. However, specific indications of food items
may increase responsiveness for CDS.
The increased responsiveness in this study was significantly associated with impaired pre-
treatment chewing ability. This association is commonly reported in other PRO measures, e.g.,
oral health-related quality of life 27 and shoulder pain.28 The regression to mean effect is
considered to be responsible for this relationship. The clinical significance of this association can

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 guide the selection of instruments matching the chewing ability of the target population. For
Accepted Article
example, patients with a few missing teeth retain a high level of chewing ability. Thus, VAS rather
than FIQ and CDS can be recommended in these patients. In contrast, in patients with multiple
missing teeth, chewing ability may be severely impaired before treatment. In this population, CDS
and FIQ may be applicable.
This study has some strengths as follows. Assessments of the responsiveness of subjective
chewing ability are scarce in the literature.12 Thus, the findings of this study offer valuable
evidence. Further, we investigated responsiveness with a sufficient sample size to conduct
subgroup analysis based on pre-treatment chewing ability, which facilitated selection of the
optimal instrument(s) to evaluate the subjective masticatory function and will help determination
of the sample size in future clinical studies. Furthermore, this study could help us understand why
the responsiveness for the FIQ after RPD treatment was very weak in previous studies,25, 26 and to
modify the list of food items to improve the responsiveness.
Nevertheless, this study also had several limitations. First, the responsiveness examined in
this study was for RPD treatment and may not be applicable to other prosthetic treatment
modalities such as fixed prosthodontics and complete dentures. Second, the scale type and food
items used in the instruments may influence the responsiveness. Therefore, the responsiveness of
other instruments to evaluate chewing ability may differ from those identified in this study. Third,
FIQ and CDS (meats) may not be applicable for vegetarians/ vegans. In fact, there was no
vegetarian/vegan participants in this study. However, cultural diversity in food should be
considered during evaluation of chewing ability. Forth, the degree of clinically important changes
in the instruments is unclear, but it is possible to determine this on the basis of responsiveness in a
future study. Fifth, this paper focused on the responsiveness of subjective chewing ability because
of the importance of PROMs. However, recent studies indicate an association between mastication
and health status, e.g., activity of daily living and cognitive function.29-31 Therefore, objective
masticatory function is clinically important in this point of view, and evaluation of responsiveness
for prosthetic treatments is therefore necessary.

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 Declarations of interest
Accepted Article
The authors declare that they have no known competing financial interests or personal
relationships that could have influenced the work reported in this paper.

Data availability statement

Research data are not shared.

Author contributions
K. Fueki contributed to conception, design, data analysis, and interpretation and drafted the
manuscript; Y. Inamochi contributed to interpretation and drafted the manuscript; Y. Hayashi
contributed to design, data acquisition, data analysis, and interpretation and critically revised the
manuscript; E. Kohno-Yoshida contributed to design and interpretation and critically revised the
manuscript; N. Wakabayashi contributed to interpretation and critically revised the manuscript.
All authors gave their final approval and agree to be accountable for all aspects of the work.

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 References
Accepted Article
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 Figure legend
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Fig 1. Patient distribution based on chewing ability scores in pre- and post-treatment evaluations

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 Table 1. Characteristics of the patients enrolled in the study (n = 277)
Accepted Article Analyzed group a Drop-out b

Number of patients 248 29

Age (years) # 70.8 (9.2) 72.5 (8.9)
Sex (Female) $ 156 (62.9) 22 (75.9)
Number of missing teeth # 11.4 (7.0) 10.0 (5.5)
Maxilla 6.2 (4.5) 4.9 (4.2)
Mandible 5.2 (3.5) 5.1 (3.5)
Number of occlusal units # 2.5 (3.0) 2.8 (3.1)
Eichner classification $
Group A 14 (5.6) 1 (3.4)
Group B 180 (72.6) 25 (86.2)
Group C 54 (21.8) 3 (10.3)
Maxillary dentition $
Fully dentulous 40 (16.1) 8 (27.6)
Kennedy Class I 58 (23.4) 6 (20.7)
Kennedy Class II 72 (29.0) 8 (27.6)
Kennedy Class III 39 (15.7) 6 (20.7)
Kennedy Class IV 15 (6.0) 1 (3.4)
Edentulous 24 (9.7) 0 (0)
Mandibular dentition $
Fully dentulous 43 (17.3) 3 (10.3)
Kennedy Class I 101 (40.7) 11 (37.9)
Kennedy Class II 83 (33.5) 15 (51.7)
Kennedy Class III 15 (6.0) 0 (0)
Kennedy Class IV 1 (0.4) 0 (0)
Edentulous 5 (2.0) 0 (0)
Existing removable denture
173 (69.8) 23 (79.3)
(present) $

a Patients who completed pre- and post- evaluations.

b Patients who dropped out after pre-treatment evaluation.
# Mean (SD).
$ n (%).

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 Table 2. Changes in VAS and FIQ scores after RPD treatments with reference to the pre-treatment
Accepted Article
chewing ability

Pre-Tx pre-treatment post-treatment

Score n P rb
level a mean SD mean SD
VAS
L1 <51 49 38 10 74 16 <0.001 0.86 +++
L2 51-66 51 59 6 78 15 <0.001 0.76 +++
L3 67-78 57 74 3 83 15 <0.001 0.48 ++
L4 79-86 45 82 2 84 18 0.633 0.27 +
L5 87-100 46 93 5 89 10 0.017 -0.30 --
whole 0-100 248 69 20 81 16 <0.001 0.54 +++
FIQ
L1 <51 61 38 10 47 15 <0.001 0.52 +++
L2 55-65 40 60 4 61 18 1.00 0.17 +
L3 66-80 53 74 4 71 12 0.305 -0.23 -
L4 81-94 55 88 2 79 16 <0.001 -0.56 ---
L5 95-100 39 97 2 89 12 <0.001 -0.61 ---
whole 0-100 248 70 22 68 21 0.120 -0.09

a Subgroups based on chewing ability in pre-treatment evaluation (1: lowest, 5: highest).

b +/- : positive/negative weak effect (0.1<= | r | <0.3), ++/-- positive/negative medium effect (0.3<= | r |
<0.5), +++/--- positive/negative strong effect (|r |>= 0.5).

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 Table 3. Changes in CDS scores after RPD treatments with reference to pre-treatment chewing
Accepted Article
ability

Pre-Tx pre-treatment post-treatment

Score n P rb
level a median IQR median IQR
CDS (vegetables)
L1 4,5 5 4 1 2 2 0.195 0.92 +++
L2 3 14 3 0 1.5 2 0.010 0.83 +++
L3 2 38 2 0 1 2 <0.001 0.74 +++
L4 1 55 1 0 1 1 1.00 0.16 +
L5 0 136 0 0 0 0 <0.001 -0.44 --
whole 0-5 248 0 1 0 1 0.032 0.14 +
CDS (meats)
L1 4,5 7 4 1 2 2 0.070 0.93 +++
L2 3 26 3 0 1.5 1 <0.001 0.77 +++
L3 2 41 2 0 1 2 <0.001 0.62 +++
L4 1 90 1 0 1 2 1.00 0.01
L5 0 84 0 0 0 1 <0.001 -0.51 ---
whole 0-5 248 1 2 1 2 0.009 0.17 +

a Subgroups based on chewing ability in pre-treatment evaluation (1: lowest, 5: highest).

b +/- : positive/negative weak effect (0.1<= | r | <0.3), ++/-- positive/negative medium effect (0.3<= | r |
<0.5), +++/--- positive/negative strong effect (|r |>= 0.5).

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 Table 4. Results of multivariate analysis for the effects of RPD treatment on chewing ability
Accepted Article
scores
Predictor Category Estimate se P
VAS
RPD treatment a Post-Tx 12.5 1.3 <0.001
Sex b male 2.0 1.9 0.303
Age < 65 ys (ref) - - -
65-74 ys 2.0 2.5 0.433
75 ys <= 3.0 2.6 0.250
Number of missing teeth <= 5 (ref) - - -
6-10 -3.6 2.9 0.204
11-17 -4.2 3.1 0.176
18 <= -4.7 3.2 0.146
Existing removable
present -4.9 2.5 0.055
denture c
Constant 70.9 3.1 <0.001
FIQ
RPD treatment a Post-Tx -1.6 1.0 0.120
Sex b male 10.4 2.5 <0.001
Age < 65 ys (ref) - - -
65-74 ys -1.3 3.2 0.679
75 ys <= 1.3 3.4 0.709
Number of missing teeth <= 5 (ref) - - -
6-10 -7.5 3.7 0.044
11-17 -11.1 4.1 0.007
18 <= -13.5 4.2 <0.001
Existing removable
present 0.6 3.3 0.847
denture c
Constant 73.5 4.0 <0.001
CDS (vegetables)
RPD treatment a Post-Tx -0.15 0.07 0.027
Sex b male -0.07 0.11 0.543
Age < 65 ys (ref) - - -
65-74 ys -0.20 0.14 0.148
75 ys <= -0.23 0.14 0.112

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Accepted Article Number of missing teeth <= 5 (ref) - - -
6-10 0.28 0.16 0.077
11-17 0.27 0.17 0.121
18 <= 0.48 0.20 0.009
Existing removable
present 0.09 0.14 0.522
denture c
Constant 0.70 0.17 <0.001

CDS (meats)
RPD treatment a Post-Tx -0.19 0.09 0.039
Sex b male -0.18 0.10 0.065
Age < 65 ys (ref) - - -
65-74 ys -0.13 0.13 0.294
75 ys <= -0.19 0.13 0.144
Number of missing teeth <= 5 (ref) - - -
6-10 0.23 0.14 0.110
11-17 0.24 0.16 0.125
18 <= 0.48 0.16 0.003
Existing removable
present 0.10 0.13 0.429
denture c
Constant 1.06 0.16 <0.001

a pre-treatment (reference).
b female (reference).
c absent (reference).

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 Table 5. Effect size (r) for FIQ based on pre-treatment chewing ability and food acceptability
Accepted Article Food acceptability b
Pre-Tx level a Score n
F1 F2 F3 F4 F5
L1 <55 61 0.19 0.39 0.45 0.51 0.16
L2 55-65 40 0.17 0.40 0.08 -0.33 -0.27
L3 70-80 53 -0.03 -0.19 -0.29 -0.15 -0.13
L4 85-90 55 -0.46 -0.59 -0.40 -0.24 -0.13
L5 95-100 39 -0.64 -0.49 -0.47 -0.16 -0.16
whole 0-100 248 -0.17 -0.10 -0.03 0.03 -0.03

r Interpretation

> 0.50 strong positive effect

0.30 - 0.50 medium positive effect
0.10 - 0.30 weak positive effect
0.10- -0.10 absent
-0.10 - -0.30 weak negative effect
-0.30 - -0.50 medium negative effect
< -0.50 strong negative effect

a Subgroups based on chewing ability in pre-treatment evaluation (L1: lowest, L5: highest).
b Food groups based on rank by food acceptability in pre-treatment evaluation (F1, lowest acceptability
with most difficult four foods; F5, highest acceptability with easiest four foods).

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 % %
40
Accepted Article VAS 40 FIQ
30 30

20 20

10 10

0 0
0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100

Score Score

% %
60 CDS vegetables 60 CDS meats
50 50
40 40
30 30
20 20
10 10
0 0
0 1 2 3 4 5 0 1 2 3 4 5
No difficulty Most difficult No difficulty Most difficult
Score Score

Pre-treatment Post-treatment
joor_13128_f1.eps

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