Authors: Ingrid J Kleiss Carien H G Beurskens Peep F M Stalmeier Koen J A O Ingels Henri A M Marres
Publish Date: 2015/01/28
Volume: 272, Issue: 8, Pages: 2055-2061
Abstract
This study aimed at validating an existing healthrelated quality of life questionnaire for patients with facial palsy for implementation in the Dutch language and culture The Facial Clinimetric Evaluation Scale was translated into the Dutch language using a forward–backward translation method A pilot test with the translated questionnaire was performed in 10 patients with facial palsy and 10 normal subjects Finally crosscultural adaption was accomplished at our outpatient clinic for facial palsy Analyses for internal consistency test–retest reliability construct validity and responsiveness were performed Ninetythree patients completed the Dutch Facial Clinimetric Evaluation Scale the Dutch Facial Disability Index and the Dutch Short Form 36 Health Survey Cronbach’s α representing internal consistency was 0800 Test–retest reliability was shown by an intraclass correlation coefficient of 0737 Correlations with the House–Brackmann score Sunnybrook score Facial Disability Index physical function and social/wellbeing function were −0292 0570 0713 and 0575 respectively The SF36 domains correlate best with the FaCE social function domain with the strongest correlation between the both social function domains r = 0576 The FaCE score did statistically significantly increase in 35 patients receiving botulinum toxin type A P = 0042 Student t test The domains ‘facial comfort’ and ‘social function’ improved statistically significantly as well P = 0022 and P = 0046 respectively Student ttest The Dutch Facial Clinimetric Evaluation Scale shows good psychometric values and can be implemented in the management of Dutchspeaking patients with facial palsy in the Netherlands Translation of the instrument into other languages may lead to widespread use making evaluation and comparison possible among different providersPatients experiencing peripheral facial palsy experience both functional and psychosocial consequences The evaluation of both aspects is fundamental in the management of facial palsy Among the consequences of peripheral facial palsy are brow ptosis incomplete eye closure leading to exposure keratopathy external nasal valve collaps oral incompetence speech and articulation problems synkinesis involuntary movement during voluntary movement esthetic impairments and the inability to express emotions sometimes leading to social isolationAssessment of facial function in peripheral facial palsy comprises different perspectives evaluation by a physician using grading scales 1 2 objective sometimes automated measurement methods 3 4 5 and patient selfassessment using questionnaires In an era of rapid developments in computerized automated measurement tools the influence of the disease on the patient’s quality of life must not be overlooked and should be considered an essential feature of clinical assessment and remains important during first consultation during followup and after treatmentThe selfassessment of patients using questionnaires gives an impression of the influence of disease on quality of life For this purpose nondiseasespecific questionnaires exist 6 7 as well as diseasespecific questionnaires though very few of them are adapted in regular clinical practice Kahn et al 8 developed an instrument which covers both the functional and psychosocial aspect of facial palsy the Facial Clinimetric Evaluation Scale FaCE Scale This questionnaire consists of 15 questions with a 5point Likert scale The FaCE Scale comprises six domains facial movement facial comfort oral function eye comfort lacrimal control and social function Total and domain scores range from 0 worst to 100 bestThe FaCE Scale is a valid reliable and easily administered instrument 8 Since its original description this questionnaire has been used in several studies showing patient satisfaction following treatment 9 10 11 12 We wanted to implement this instrument in the Dutchspeaking population in the Netherlands both because we want to use an instrument that covers both functional and psychosocial domains and also so that we may compare our treatment and recovery results with international resultsIn the current literature there is no consensus on ‘gold standard’ guidelines for translating quality of life questionnaires Two methods are described the forward–backward translation 13 14 15 and the dual panel translation 16 Dual panel translation compromises the translation by a team of translators working together and assessment of the translation by a lay panel 17 The forward–backward translation seems to be the most accepted method although there is no evidence to support this view Acquadro et al 17 performed a literature review in 2008 they did not find evidence in favor of one method but strongly advised researchers to adopt a multistep approach When using a questionnaire in another country and another language translation of the items alone is not enough The items must be adapted to the new culture to maintain the content validity of the instrument crosscultural adaption is required 18 19
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