Heterogeneity of Outcome Measures Used in Randomized Controlled Trials for the Treatment of Oral Lichen Planus: A Methodological Study

DENTAL PATIENT-REPORTED OUTCOMES UPDATE 2023

The emergence and rapid development of disruptive innovations are quickly turning our profession into personalized dentistry, built upon evidence-based, data-oriented, and patient-centered research. In order to help improve the quality and quantity of patient-centered evidence in dentistry, further promote the wide and standard use of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs), the Journal of Evidence-Based Dental Practice has put together this special issue, the third of a series entitled Dental Patient-Reported Outcomes Update. A total of 7 solicited articles are collected in this issue. To put them into a broader perspective, this review provides a concise summary of key, selected PRO and dPRO articles published during 2023. A brief introduction to those articles included in this Special Issue follows. Four main domains are covered in this Special Issue: (1) dPROs and digital dentistry, (2) standardization of dPRO-related methodology, (3) current usage of dPROs and dPROMs in published research, and (iv) the significance and relevance of dPRO usage.

Heterogeneity of outcome measures in the clinical trials of treatment for oral submucous fibrosis-Systematic review

OBJECTIVE

This systematic review was performed to evaluate the range of outcome measures used in interventional trials for oral submucous fibrosis (OSF).

MATERIALS AND METHODS

PubMed, Scopus, and Cochrane databases were searched to identify randomized controlled trials (RCTs) published from 2004 to 2018 about OSF treatment. All the outcome measures and measurement methods mentioned in the trials were extracted and analyzed.

RESULTS

Out of 120 published papers, 12 RCTs that met the inclusion criteria were included. A total of 38 single outcome measures and 29 composite outcome measures were considered under four different outcome domains, of which clinical symptoms and clinical response were the most commonly used. The linear measurement of mouth opening (11 trials; 91.66%) and Visual Analogue Scale (10 trials, 83.33%) were the predominant measurement methods.

CONCLUSIONS

This systematic review highlights the high heterogeneity in outcome measures in therapeutic RCTs of OSF. This lack of widely agreed standard outcome measures in OSF is a great concern as it prevents the comparison of studies and meta-analyses to gather evidence. There is a dire need of establishing a core outcome set for reporting in the future clinical trials that may help facilitate treatment choice for OSF to improve life quality of patients.

Impact of Oral Lichen Planus on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis

Oral health-related quality of life (OR-QoL) measurement in patients with oral lichen planus (OLP) can provide valuable information for the optimal management of their clinical conditions. The main objective of the present study was to assess the OR-QoL of patients with OLP as measured by the short-form Oral Health Impact profile-14 (OHIP-14) questionnaire. PubMed/MEDLINE, ISI/Web of Science, clinical trial registry, Embase, Scopus, and grey literature (via Google Scholar and Scilit) were searched. Reviewers independently screened titles/abstracts, assessed full-text articles, extracted data, and appraised their quality. Random effect analysis along with subgroup analysis for age, gender, and clinical type was performed. Seventeen studies were included. Mean overall OH-QoL was 15.20, [95% CI 12.176, 18.231]; a higher OHIP-14 score was seen in OLP patients, resulting in poor OH-QoL. The impact of OLP on OH-QoL life was moderate as compared to healthy subjects. However, medical treatment of the disease improved the OH-QoL and thus reduced the impact of OLP on it. OH-QoL among patients with OLP is generally poor. Clinicians and physicians should consider the OH-QoL of these patients as part of patients’ evaluation and modulate the administered treatment based on the OH-QoL response.

Validity and responsiveness of pain rating scales in patients with chronic oral mucosal diseases

OBJECTIVES

To validate the Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) for measuring pain intensity in chronic oral mucosal diseases.

METHODS

Secondary analyses of data including the VAS, NRS, demographic, clinical and quality-of-life outcomes at baseline and 4-month follow-up were retrieved from a clinical study of chronic oral mucosal diseases. Construct and criterion validity and responsiveness of the VAS and NRS were assessed through testing hypotheses based upon strength of Spearman's correlation coefficients.

RESULTS

Data of 500 and 290 patients with chronic oral mucosal diseases were used for the assessment of validity and responsiveness, respectively. Moderate-to-high correlations between both pain scores and scores of clinical and quality-of-life outcomes were observed, supporting construct validity of the VAS and NRS. Their criterion validity was confirmed by significantly strong association between scores of both scales. Responsiveness of both scales was adequate based on moderate association between their change scores and global rating of change scale.

CONCLUSION

The present results provide evidence supporting validity and responsiveness of the VAS and NRS for pain intensity assessment in patients with chronic oral mucosal diseases. Future research examining other pain intensity domains and standardizing composite scores for pain intensity in this population is required.