Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California.
Division of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Quebec, Canada.
JAMA Facial Plast Surg. 2018 Jan 1;20(1):37-42. doi: 10.1001/jamafacial.2017.1083.
Rhinoplasty is a common operation in which shape and function are intimately related, whether the procedure is cosmetic, functional, or combined in nature. There is currently no properly developed and validated patient-reported outcome measure (PROM) to evaluate both functional and cosmetic components of rhinoplasty.
To develop, validate, and field test the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) to evaluate both functional and cosmetic outcomes of rhinoplasty.
DESIGN, SETTING, AND PARTICIPANTS: Survey development study between October 2016 and April 2017 in a tertiary referral facial plastic and reconstructive surgery clinic. Preoperative and postoperative adult patients undergoing rhinoplasty, whether cosmetic or reconstructive, were included. A fifth group of adult nonrhinoplasty patients (facial cosmetic or reconstructive) were also included for the field test.
Generated and reduced items, psychometric validation measures of the SCHNOS, and differences on scales between groups.
For survey development, a total of 18 patients and 5 experts were interviewed. Of these patients, 5 were male, and 13 were female. Their mean (SD) age was 38 (14.8) years (range, 20-64 years). Field testing included 191 patients (67% were women and the mean [SD] age was 41.5 [15.8] years). A total of 10 items were included after generation, cognitive interviews, and item reduction. The 10 items represent 2 domains: nasal obstruction (first 4 items) and nasal cosmesis (last 6 items). For both domains, Cronbach α was excellent: 0.94 (95% CI, 0.92-0.95) for obstruction and 0.94 (95% CI, 0.93-0.95) for cosmesis. Exploratory factor analysis using scree plots for each domain showed that the domains are unidimensional in nature with each domain evaluating what it is intended to assess (nasal obstruction and cosmesis). The factor loading estimates were high for all the items, varying from 0.74 to 0.92. Kruskal-Wallis testing showed a significance level of P < .001 when evaluating the difference between groups (preoperative cosmetic, postoperative cosmetic, preoperative functional, postoperative functional, and nonrhinoplasty) for all individual questions, composite scores, and Nasal Obstruction Symptom Evaluation (NOSE) score. Correlations between the obstruction composite score and the NOSE scores were r = 0.943 (P < .001), which is very strong. The obstruction and cosmesis composite scores were only weakly correlated (r = 0.388; P < .001).
We have developed and validated a new PROM to evaluate both functional and cosmetic rhinoplasty patients. The domains of obstruction and cosmesis were found to be internally consistent and unidimensional. The SCHNOS provides a short, validated questionnaire that we recommend for use in all functional or cosmetic rhinoplasty patients.
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隆鼻术是一种常见的手术，其形状和功能密切相关，无论该手术是出于美容、功能还是两者兼顾的目的。目前尚无经过适当开发和验证的患者报告结局测量（PROM）来评估隆鼻术的功能和美容成分。
开发、验证和现场测试标准化美容和健康鼻结局调查（SCHNOS），以评估隆鼻术的功能和美容结果。
设计、地点和参与者：2016 年 10 月至 2017 年 4 月在三级转诊面部整形和重建外科诊所进行的调查开发研究。纳入了接受隆鼻术的成年患者，无论其是否为美容或重建手术。还纳入了第五组非隆鼻术的成年患者（面部美容或重建）进行现场测试。
生成和减少项目、SCHNOS 的心理测量验证措施以及组间量表差异。
在调查开发过程中，共有 18 名患者和 5 名专家接受了采访。其中 5 名是男性，13 名是女性。他们的平均（SD）年龄为 38（14.8）岁（范围，20-64 岁）。现场测试包括 191 名患者（67%为女性，平均[SD]年龄为 41.5[15.8]岁）。经过生成、认知访谈和项目缩减后，共纳入 10 个项目。这 10 个项目代表了 2 个领域：鼻阻塞（前 4 个项目）和鼻美容（后 6 个项目）。对于这两个领域，Cronbach α 都非常好：阻塞为 0.94（95%CI，0.92-0.95），美容为 0.94（95%CI，0.93-0.95）。每个领域的探索性因子分析均使用散点图显示，这些领域本质上是单维的，每个领域都评估其旨在评估的内容（鼻阻塞和美容）。所有项目的因子负荷估计值都很高，范围在 0.74 到 0.92 之间。Kruskal-Wallis 检验显示，在评估所有个体问题、综合评分和鼻阻塞症状评估（NOSE）评分时，术前美容、术后美容、术前功能、术后功能和非隆鼻术组之间存在统计学意义（P<0.001）。阻塞综合评分与 NOSE 评分之间的相关性为 r=0.943（P<0.001），相关性非常强。阻塞和美容综合评分相关性较弱（r=0.388；P<0.001）。
我们已经开发并验证了一种新的 PROM，用于评估功能和美容性隆鼻术患者。阻塞和美容这两个领域被发现具有内部一致性和单维性。SCHNOS 提供了一个简短的、经过验证的问卷，我们建议在所有功能或美容性隆鼻术患者中使用。
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