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• W4382777029 abstract "Patient-reported outcome measures (PROM) are essential for the evaluation of facial palsy. The most used PROM for facial palsy is the Facial Clinimetric Evaluation (FaCE) scale, which consists of 15 questions with a five-point Likert scale.1, 2 It consists of six subscales—facial movement, facial comfort, oral function, eye comfort, lacrimal control and social function—which sum up to a total score representing ‘overall’ facial palsy-related quality of life. The current importance of each subscale in calculating the total score is determined by the number of questions composing each subscale. It has not been analysed whether FaCE subscales' weight in the total score reflects the subscales' importance to overall facial palsy-specific quality of life. In this study, we aim to calculate the contribution of the FaCE subscales to overall quality of life. Institutional review board approval was acquired before the start of this study (METc 2019/491). Facial palsy patients older than 18 years and fluent in Dutch visiting the outpatient clinic of our tertiary plastic surgery centre were invited for participation between June and August 2020. Patients were asked to complete the validated Dutch FaCE questionnaire and, using a novel Visual Analogue Scale (VAS), to holistically score how physically and mentally burdensome their facial palsy had been in the past week. The VAS score, ranging from 0 to 100, represented overall facial palsy-related burden. The period of a week was selected for the VAS as this is also the period the FaCE scale addresses. The reliability and validity of the novel VAS were tested in a separate group of patients visiting the same outpatient clinic. This VAS validation group completed both the FaCE scale and the VAS on two occasions (T1 and T2), 1-week apart. Descriptive statistics are presented using numbers and percentages, mean and standard deviation or median and interquartile range (IQR) when appropriate. Patients with missing or incomplete responses were excluded from all analyses. The test–retest reliability of the VAS was analysed with the intraclass correlation coefficient (ICC, two-way random effects model, absolute agreement, single measures). To evaluate validity, the VAS score was correlated to the FaCE total score. Two multiple linear regression models were examined to answer our research question. First, the FaCE subscale scores were correlated with total FaCE score. The regression coefficient of each subscale represents the degree of the subscale's correlation with the total FaCE score, which should reflect the number of questions in each subscale. Second, a linear regression analysis between the FaCE subscales and a transformed VAS score was performed. The original VAS scores were subtracted from 100 so that a higher number indicated better quality of life. The coefficients of the two regression models were compared to determine if each FaCE subscale contributes equally to the total FaCE score and the transformed VAS score. The presence of multicollinearity in the second regression analysis was checked for by looking at the correlation, tolerance and variation inflation factor (VIF) between each variable. A tolerance larger than .2 and a VIF less than 10 was considered to indicate the absence of multicollinearity. All analyses were performed in the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corporation, NY). In the VAS validation group, 21 individuals responded, of whom 3 were excluded for not submitting a second VAS score. A slight majority of the 18 participants was female (n = 10 [56%]) and median (IQR) age was 71 (55–76) years. The most common aetiology of facial palsy was parotid gland tumour (n = 8 [28%]), followed by acoustic neuroma (n = 2 [11%]). Median time since diagnosis of facial palsy (IQR) was 1.8 (.8–8.7) years. A median time of 7 days elapsed between the responses. Median (IQR) VAS score was 60 (23–74) at T1 and 61 (17–73) at T2. There was a moderate, positive correlation between the VAS score and FaCE total score that was statistically significant (rs = .561, p < .001), indicating acceptable validity. Test–retest reliability was high, with an ICC of .91 (95% CI = .78–.97). A total of 80 participants were included in the linear regression analyses; of the 130 eligible patients, 14 were not interested in participating, 28 did not respond to the invitation for the following measurement and 8 respondents submitted incomplete responses. Forty-one participants were male (51%), and median (IQR) age was 63 (51–73) years (Table 1). Median (IQR) duration of facial palsy was 17.1 (9.6–33.1) years, and the most common aetiology was acoustic neuroma (n = 22 [27.5%]). Median (IQR) FaCE total and VAS scores were 51.7 (38.3–62.9) and 70 (52–93), respectively. Median (IQR) Sunnybrook composite score was 27 (18–34). Twenty-nine (36.3%) participants were treated for facial palsy in the past year, the majority of whom received Botox injections (12.5%). The multivariate linear regression analysis of the FaCE subscale scores on the FaCE total score resulted in regression coefficients that were exactly proportional to the number of questions contained in the subscales (Table 2). In the second regression analysis, social function and facial comfort contributed significantly to the VAS score (Table 3). Social function showed a higher regression coefficient than in the first regression analysis (β = .456; +.189 compared to the original coefficient), as did facial comfort (β = .334; +.134 compared to original coefficient). All other subscales were non-significant contributors to the VAS score. The explained variance in the model was 50.4% (R2 = .504). The mean (range) values for tolerance and VIF were .85 (.756–.912) and 1.18 (1.096–1.323), respectively, indicating no multicollinearity. This study aimed to determine the true contribution of FaCE subscales to overall facial palsy-specific quality of life. According to our findings, social well-being and synkinesis are the most relevant components of ‘overall’ facial palsy-related quality of life. Both constructs are currently underestimated in the calculation of the FaCE total score. Our analysis shows that the social burden patients experience is the most important component of ‘overall’ quality of life and is underestimated in the FaCE total score. Our results suggest that almost half of ‘overall’ facial palsy-related quality of life is socially related. With this, our findings more closely reflect a different PROM: the Facial Disability Index (FDI), which consists of 10 questions evenly split between the physical and social domains. Synkinesis, which is described in the facial comfort subscale, was found to be the second most important component of ‘overall’ facial palsy-related quality of life, and the only other statistically significantly contributing subscale. In a previous study, synkinesis was a significant predictor of quality of life.3 A high degree of synkinesis was also found to be associated with ‘non-effective’ self-reported emotional expression.4 Synkinesis may thus reduce quality of life by both causing physical discomfort and impairing social function, and it should form a larger component of facial palsy-specific quality of life assessment. Surprisingly, eye comfort and lacrimal control were insignificant predictors of overall quality of life. This is in line with previous research suggesting that periocular muscle function is of low importance in estimating quality of life.5 However, this is not in line with our clinical expertise or the findings of other researchers that the treatment of periocular complaints leads to a significant improvement in total FaCE score.6 A possible explanation for this discrepancy could be that most patients in our sample already received periocular treatment, and therefore no longer experience periocular problems. This is especially plausible in our sample of chronic facial palsy patients but requires further investigation. There were various limitations to the current study. First, the sample size to evaluate validity and reliability of the VAS was relatively small. Second, our sample was selected from a tertiary care setting and had a long median duration of facial palsy. The character of complaints experienced by patients has been reported to evolve over time,7 which suggests that the relative importance of each FaCE subscale in acute facial palsy may differ from our findings. The long-standing, severe nature of cases at our tertiary care centre, combined with the high treatment rate in the past year, makes it highly likely that almost all participants received facial palsy-oriented therapy. Additionally, our most common aetiology was acoustic neuroma, rather than Bell's palsy as is seen in the general facial palsy population. Such characteristics in our participants may make the interpretation of our findings challenging in acute and less severe cases of facial palsy. Our study suggests that the current weight of the FaCE subscales in calculating the FaCE total score does not actually reflect the true weight of each component in calculating ‘overall’ facial palsy-related quality of life. Our findings can be used when developing a revised version of the FaCE scale or a novel facial palsy-specific PROM. Social function is more important in estimating overall facial palsy-specific quality of life than indicated by its weight in the FaCE total score. Additionally, more questions regarding synkinesis are indicated and should be included in, perhaps, a novel questionnaire. Tessa E. Bruins and Martinus M. van Veen designed the study and acquired data. Seung-Jae Yoon analysed and interpreted data and drafted the manuscript. Seung-Jae Yoon, Tessa E. Bruins, Martinus M. van Veen and Paul M. N. Werker revised and approved the manuscript. Seung-Jae Yoon, Tessa E. Bruins, Martinus M. van Veen and Paul M. N. Werker agree to be accountable for all aspects of the work. This research has received no external funding. There are no financial conflicts of interest to disclose. The authors declare no conflicts of interest. The cross-sectional study was approved by the local ethics review board committee, Medisch Ethische Toetsingcommissie UMC Groningen, protocol number 2019/491. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/coa.14082. Data are available at request from the corresponding author." @default.
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• W4382777029 title "The <scp>Facial Clinimetric Evaluation</scp> scale underestimates social well‐being and synkinesis in overall facial palsy‐specific quality of life: A cross‐sectional study in 80 patients" @default.
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• W4382777029 doi "https://doi.org/10.1111/coa.14082" @default.
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