Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
Int J Surg. 2018 Jul;55:92-97. doi: 10.1016/j.ijsu.2018.04.061. Epub 2018 May 19.
Facial palsy leads to functional and aesthetic deficits, which impair the quality of life of affected patients. General health-related and disease-specific questionnaires are available for quality of life assessment. In this study, observer-based analysis of facial function (Sunnybrook Facial Grading Scale) was compared patient-based to facial palsy-specific gradings (Facial Clinimetric Evaluation Scale and Facial Disability Index), and general health-related quality of life questionnaires (SF-36). We hypothesized that only facial palsy-specific instruments capture functional and social impairments of affected patients.
Thirty facial palsy patients treated at a tertiary referral centre were included in this study. Inclusion criteria were unilateral facial palsy with stable facial function, age over 18 years and fluency in German. Facial function was assessed with general and disease-specific patient-reported outcome measures and subsequently evaluated by the treating facial plastic surgeon. Statistical analysis included descriptive statistics for all assessed measurements. Correlations were calculated to compare general and facial palsy-specific instruments, as well as observer-based grading.
Observer-based evaluation of facial function correlated well to the patients-based assessment of physical function, however social subscores did not correlate demonstrating the limited correlation of patient distress and facial nerve impairment. Physical function scores of disease-specific instruments did not correlate with general health assessment scores, while social function scores showed moderate to good correlations.
Validated disease-specific instruments are essential for the assessment of facial palsy patients. Patient-reported outcome measures like the FaCE Scale and the Facial Disability Index should be applied in addition to standardized observer-based ratings to capture the patients' perspective on functional and social impairments associated with facial palsy to fully assess the burden of disease.
面瘫导致功能和美容缺陷，影响患者的生活质量。目前已有用于生活质量评估的一般健康相关和疾病特异性问卷。在这项研究中，我们比较了观察者评估的面部功能（桑尼布鲁克面部分级量表）与基于患者的面瘫特异性分级（面部临床计量评估量表和面部残疾指数）以及一般健康相关生活质量问卷（SF-36）。我们假设只有面瘫特异性仪器才能捕捉到受影响患者的功能和社交障碍。
本研究纳入了在一家三级转诊中心接受治疗的 30 例面瘫患者。纳入标准为单侧面瘫，面部功能稳定，年龄大于 18 岁，且能流利使用德语。面部功能采用一般和疾病特异性患者报告结局测量进行评估，随后由治疗面部整形外科医生进行评估。统计分析包括对所有评估测量的描述性统计。计算相关性以比较一般和面瘫特异性仪器，以及观察者评估。
观察者评估的面部功能与患者基于自身的身体功能评估相关性良好，但社会子评分无相关性，表明患者痛苦和面神经损伤的相关性有限。疾病特异性仪器的身体功能评分与一般健康评估评分无相关性，而社会功能评分显示出中度至高度相关性。
验证后的疾病特异性仪器对面瘫患者的评估至关重要。应在应用标准化观察者评估的基础上，应用基于患者的面部残疾量表和面部残疾指数等患者报告结局测量，以捕捉患者对面瘫相关功能和社交障碍的看法，从而全面评估疾病负担。
