Bruins Tessa E, van Veen Martinus M, Mooibroek-Leeuwerke Tanja, Werker Paul M N, Broekstra Dieuwke C, Dijkstra Pieter U
Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
JAMA Otolaryngol Head Neck Surg. 2020 Apr 1;146(4):331-337. doi: 10.1001/jamaoto.2019.4559.
Knowledge of factors associated with health-related quality of life in patients with facial palsy may aid in better interpreting outcomes of research and treatment.
To identify factors associated with health-related quality of life in patients with facial palsy.
DESIGN, SETTING, AND PARTICIPANTS: The inclusion period for participants in this cross-sectional study at the University Medical Center Groningen, a tertiary referral center for facial reanimation surgery, was March 1 to June 1, 2019. Patients aged at least 18 years with facial palsy who had undergone surgery for facial palsy between January 1, 2007, and January 1, 2018, and patients visiting the outpatient clinic of the University of Groningen Department of Plastic Surgery for their facial palsy between March 1 and June 1, 2019, were also asked to participate. Of 276 patients invited, 145 gave informed consent. Twenty patients did not respond after consent, 3 patients withdrew from the study, and 1 patient was wrongly included.
Health-related quality of life was measured using the Facial Clinimetric Evaluation Scale and the Facial Disability Index (physical score and social score). Facial function was assessed with the Sunnybrook Facial Grading System. Other variables were investigated using validated questionnaires, including the Duke University Religion Index, Ten-Item Personality Inventory, and Hospital Anxiety and Depression Scale. Multivariable linear regression analyses with stepwise backward selection were performed to identify associations with health-related quality of life. Because 44 Sunnybrook composite scores were missing, a sensitivity analysis was performed that excluded the Sunnybrook composite scores from the multivariable analysis.
In total, 121 patients with facial palsy were included; their median age was 62 years (interquartile range, 48-71 years), and 63 (52%) were women. Sunnybrook composite score (β = 0.4; 95% CI, 0.2-0.5), extraversion (β = 2.6; 95% CI, 0.4-4.8), and anxiety (β = -2.4; 95% CI, -4.1 to -0.8) were associated with the Facial Clinimetric Evaluation Scale total score (R2 = 0.380; 95% CI, 0.212-0.548). The Sunnybrook composite score was associated with the Facial Disability Index physical score (β = 0.2; 95% CI, 0.0-0.4) (R2 = 0.084; 95% CI, -0.037 to 0.205). Bilateral facial palsy (β = -21.2; 95% CI, -32.3 to -10.1), extraversion (β = 2.7; 95% CI, 1.3-4.1), conscientiousness (β = 2.7; 95% CI, 0.2-5.2), emotional stability (β = 3.3; 95% CI, 1.7-4.8), and depression (β = -1.3; 95% CI, -2.5 to -0.1) were associated with the Facial Disability Index social score (R2 = 0.400; 95% CI, 0.262-0.538). In the sensitivity analysis, the Sunnybrook composite score was associated with age (Spearman ρ = -0.252).
Bilateral facial palsy, age, severity of facial palsy, mental distress, and personality traits should be taken into account in future research and treatment of patients with facial palsy.
了解与面瘫患者健康相关生活质量相关的因素，可能有助于更好地解读研究和治疗结果。
确定与面瘫患者健康相关生活质量相关的因素。
设计、地点和参与者：在格罗宁根大学医学中心（一家面部重建手术的三级转诊中心）进行的这项横断面研究中，参与者的纳入期为2019年3月1日至6月1日。年龄至少18岁、在2007年1月1日至2018年1月1日期间接受过面瘫手术的面瘫患者，以及在2019年3月1日至6月1日期间前往格罗宁根大学整形外科门诊治疗面瘫的患者也被邀请参与。在邀请的276名患者中，145名给予了知情同意。20名患者在同意后未回复，3名患者退出研究，1名患者被错误纳入。
使用面部临床测量评估量表和面部残疾指数（身体评分和社会评分）来测量健康相关生活质量。使用桑尼布鲁克面部分级系统对面部功能进行评估。使用经过验证的问卷对其他变量进行调查，包括杜克大学宗教指数、十项人格量表和医院焦虑抑郁量表。进行逐步向后选择的多变量线性回归分析，以确定与健康相关生活质量的关联。由于44个桑尼布鲁克综合评分缺失，进行了一项敏感性分析，在多变量分析中排除了桑尼布鲁克综合评分。
总共纳入了121名面瘫患者；他们的中位年龄为62岁（四分位间距，48 - 71岁），63名（52%）为女性。桑尼布鲁克综合评分（β = 0.4；95%置信区间，0.2 - 0.5）、外向性（β = 2.6；95%置信区间，0.4 - 4.8）和焦虑（β = -2.4；95%置信区间，-4.1至-0.8）与面部临床测量评估量表总分相关（R² = 0.380；95%置信区间，0.212 - 0.548）。桑尼布鲁克综合评分与面部残疾指数身体评分相关（β = 0.2；95%置信区间，0.0 - 0.4）（R² = 0.084；95%置信区间，-0.037至0.205）。双侧面瘫（β = -21.2；95%置信区间，-32.3至-10.1）、外向性（β = 2.7；95%置信区间，1.3 - 4.1）、尽责性（β = 2.7；95%置信区间，0.2 - 5.2）、情绪稳定性（β = 3.3；95%置信区间，1.7 - 4.8）和抑郁（β = -1.3；95%置信区间，-2.5至-0.1）与面部残疾指数社会评分相关（R² = 0.400；95%置信区间，0.262 - 0.538）。在敏感性分析中，桑尼布鲁克综合评分与年龄相关（斯皮尔曼ρ = -0.252）。
在未来面瘫患者的研究和治疗中，应考虑双侧面瘫、年龄、面瘫严重程度、精神困扰和人格特质。
