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Larson JH, Ho KC, Lai H, Shaholli V, Smetona J, Vicari F, Naran S. Individuals with Cleft Lip and/or Palate Demonstrated Improved Self-Reported Psychosocial Functioning Following the Onset of the COVID-19 Pandemic. JPRAS Open 2024; 41:138-147. [PMID: 39027011 PMCID: PMC11255094 DOI: 10.1016/j.jpra.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 07/20/2024] Open
Abstract
Objective To evaluate the impact of the COVID-19 pandemic on the psychosocial functioning of individuals with cleft lip and/or palate (CL/P). Methods Patients with CL/P ≥ 6 years old were prospectively recruited from the Cleft and Craniofacial Clinic of a tertiary children's hospital. From July-October 2021, eligible patients (or their parent/guardian) were sent a survey regarding their psychosocial functioning before and after the start of the pandemic. Main Outcome Measure The difference between prepandemic and intrapandemic patient-reported outcome scores. Results Thirty-six patients (20 female, age: 15.9 ± 9.8 years) responded. Most had cleft lip and palate (77.8%), responded online (69.4%), interacted remotely via both voice- and video-conferencing (62.9%), and wore masks routinely (77.1%). Similar numbers of patients responded independently (27.8%), responded with the help of a parent/guardian (36.1%), or had a parent/guardian respond on their behalf (36.1%). General social-emotional well-being (p = 0.004, r rb = 0.659) and satisfaction with facial appearance (p = 0.044, r rb = 0.610) significantly improved after the start of the pandemic. Compared to their general intrapandemic social-emotional well-being scores, patients reported higher scores while wearing a mask (r rb = 0.827) and lower scores while interacting remotely (r rb = 0.605), although all were still significantly improved compared to their prepandemic scores (p ≤ 0.010). Patients also reported significant improvement in social functioning while wearing a mask (p = 0.036, r rb = 0.519), whereas they did not when considering their general intrapandemic feelings/experiences (p = 0.269, r rb = 0.211). Conclusion Patients with CL/P demonstrated significant improvement in overall social-emotional well-being, satisfaction with facial appearance, and social functioning after the start of the COVID-19 pandemic, particularly when wearing a mask.
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Affiliation(s)
- Jordan H. Larson
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Kelly C. Ho
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Hillary Lai
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Vick Shaholli
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - John Smetona
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Frank Vicari
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Sanjay Naran
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
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Stock NM, Crerand CE, Johns AL, McKinney CM, Koudstaal MJ, Drake AF, Heike CL. Establishing an International Interdisciplinary Research Network in Craniofacial Microsomia: The CARE Program. Cleft Palate Craniofac J 2024; 61:1470-1479. [PMID: 37248561 PMCID: PMC10984877 DOI: 10.1177/10556656231176904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Craniofacial microsomia (CFM) is a broad clinical term used to describe a congenital condition most commonly involving the underdevelopment of the external ear, mandible, soft tissues, and facial nerve. Despite medical advances, understanding of the psychological health and healthcare experiences of individuals with CFM and their caregivers remains limited. This article describes a research program designed to address these knowledge gaps, and identify opportunities for psychosocial intervention and improved healthcare provision. DESIGN The Craniofacial microsomia: Accelerating Research and Education (CARE) research program aims to: 1) Conduct up to 160 narrative interviews with individuals and caregivers to validate a conceptual framework; 2) Administer an online international survey of up to 800 individuals with CFM and caregivers to identify predictors of psychological distress; 3) Perform up to 60 semi-structured interviews with healthcare providers and advocacy leaders to examine the extent to which current healthcare provisions address identified patient needs; and 4) Establish a participant registry to build a longitudinal database and develop an international community. RESULTS Teams in the USA and UK have been established, alongside an international, interdisciplinary Advisory Committee. Data analysis for Aim 1 is ongoing and informing the delivery of Aims 2-3. Aim 4 is also in development. A dedicated website serves as a recruitment tool, educational resource, and mechanism for engaging with the CFM community. CONCLUSIONS The CARE program provides a comprehensive approach to understanding the experiences of individuals with CFM and their caregivers. Challenges encountered and lessons learned are shared for the benefit of the community.
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Affiliation(s)
- Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Canice E. Crerand
- Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, USA 43205
| | - Alexis L. Johns
- Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, USA 90027
| | - Christy M. McKinney
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
| | - Maarten J. Koudstaal
- Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Amelia F. Drake
- University of North Carolina at Chapel School of Medicine, 170 Manning Drive, CB 7070, Chapel Hill, NC, USA 27599
| | - Carrie L. Heike
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
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Salinero LK, Villavisanis DF, Cheung L, Ferro DF, Folsom N, Cho DY, Low DW, Jackson O, Bartlett SP, Swanson JW. Integration of the CLEFT-Q Patient-Reported Outcome Tool into a Multidisciplinary Cleft and Craniofacial Clinic: A Proof of Concept. Plast Reconstr Surg 2024; 154:351e-355e. [PMID: 37337325 DOI: 10.1097/prs.0000000000010859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
SUMMARY Implementation of patient-reported outcome (PRO) tools has increased internationally in a variety of clinical settings, with emerging evidence suggesting benefits for patient satisfaction, improved patient-provider communication, and management of chronic conditions. However, integrating PROs into clinical workflow remains a barrier to implementation, with common challenges including patient completion, provider review of results, and future accessibility of data. Cleft lip and/or palate presents with a variety of aesthetic, functional, and psychosocial sequelae optimally managed by a multidisciplinary team, and the CLEFT-Q is a validated 12-module PRO that captures patient perception in these domains. Given the emerging proven benefits of using PROs in a clinical setting, the authors integrated the CLEFT-Q PRO at a multidisciplinary cleft and craniofacial clinic at a large, urban, tertiary care center. The authors collaborated with their institution's electronic health record clinical informatics team to automatically identify eligible cleft lip and/or palate patients and generate the CLEFT-Q PRO before weekly multidisciplinary cleft and craniofacial clinic days. Patient results were automatically scored, compared with age-based normative data, and populated into the electronic health record patient note. CLEFT-Q results were viewed by clinicians during patient visits to initiate module-specific discussion in relation to patient age-based normative results. Patient-specific CLEFT-Q data were also discussed during multidisciplinary cleft and craniofacial team discussions to aid in clinical decision-making. This experience may have applicability to other PRO tools in plastic surgery and other medical specialties where integrating PROs may yield superior patient experience and outcomes.
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Affiliation(s)
| | | | - Liana Cheung
- From the Division of Plastic and Reconstructive Surgery
| | - Daria F Ferro
- Division of General Pediatrics and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Nancy Folsom
- From the Division of Plastic and Reconstructive Surgery
| | - Daniel Y Cho
- From the Division of Plastic and Reconstructive Surgery
| | - David W Low
- From the Division of Plastic and Reconstructive Surgery
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Hollier LH. Discussion: Integration of the CLEFT-Q Patient-Reported Outcome Tool into a Multidisciplinary Cleft and Craniofacial Clinic: A Proof of Concept. Plast Reconstr Surg 2024; 154:356e-357e. [PMID: 39046843 DOI: 10.1097/prs.0000000000010860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Larry H Hollier
- From the Department of Surgery, Texas Children's Hospital; and Division of Plastic Surgery, Baylor College of Medicine
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Kreshanti P, Djarot KR, Kaligis F, Friska D, Swanson JW, Blum J, Martin VJ, Bangun K. Translation, Validation, and Cultural Adaptation of CLEFT-Q © for use in Indonesia. Cleft Palate Craniofac J 2024; 61:1202-1212. [PMID: 36949554 DOI: 10.1177/10556656231160392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE To translate and validate CLEFT-Q©, patient-reported outcome measure for patients with cleft lip and/or palate (CL and/or P), into Indonesian. CLEFT-Q© covers the domains of appearance, facial function, health-related quality of life and consists of scales describing outcomes after cleft surgery. DESIGN The CLEFT-Q© instrument was translated according to the International Society of Pharmacoeconomics and Outcomes Research guidelines, including translation, cognitive debriefing, and field-testing. SETTING Dr. Cipto Mangunkusumo Hospital, Indonesia; independent CL and/or P support groups. PATIENTS Patients ages 8-29 with a history of repaired CL and/or P were grouped based on age. Those unable to complete the questionnaire independently were excluded. INTERVENTIONS The primary objective was reliable translation of the CLEFT-Q® instrument. Each scale was assessed for its internal consistency (Cronbach's alpha) and validity (inter-item correlation), and sub-group analyses were performed based on age group. RESULTS Forward and back translation revealed 25(13.3%) and 12(6.3%) of items were difficult to translate. Cognitive debriefing revealed 10(5.3%) items were difficult to understand, with the lowest reliability on the facial appearance scale (α=0.27). Other scales demonstrated acceptable to excellent reliability (α=0.53-0.68). Field testing revealed acceptable reliability and validity of the translation (α = 0.74-0.92; 69% ideal range of inter-item correlation). Sub-group analyses revealed patients in the <11y.o. and >18y.o. groups had the lowest scores on the "cleft lip scar" scale while those 11-18y.o. had the lowest scores on the "nostrils" scale. CONCLUSION Iterative translation and cultural adaptation of CLEFT-Q© into Indonesian demonstrated reliability and validity of the tool, supported by acceptable to excellent internal consistency and ideal inter-item correlation.
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Affiliation(s)
- Prasetyanugraheni Kreshanti
- Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kasih Rahardjo Djarot
- Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fransiska Kaligis
- Department of Psychiatry, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dewi Friska
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica Blum
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Valencia Jane Martin
- Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kristaninta Bangun
- Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Westerlund M, Heliövaara A, Leikola J, Homsy P. Finnish Translation and Linguistic Validation of the CLEFT-Q Questionnaire. Cleft Palate Craniofac J 2024; 61:1081-1086. [PMID: 36883010 PMCID: PMC11155202 DOI: 10.1177/10556656231162454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Cleft lip and/or palate (CL/P) can have long-lasting effects on the appearance, function, and psychosocial wellbeing of patients. The CLEFT-Q questionnaire is a patient-reported outcomes instrument specifically designed to assess the health-related quality of life of patients with CL/P. The aim of this study was to produce and linguistically validate a Finnish version of the CLEFT-Q questionnaire. DESIGN The CLEFT-Q questionnaire was translated into Finnish following guidelines of the International Society for Pharmacoeconomics and Outcomes Research. Pilot testing with cognitive debriefing interviews was conducted on patients of the target age range of the questionnaire, 8-29, and with various cleft types. RESULTS The CLEFT-Q questionnaire translated readily into Finnish. A review of the backward translation led to two words being changed. Thirteen patients - ten females and three males - with a median age of 14 years, participated in the cognitive debriefing interviews. The interviews led to further nine word changes. The pilot study data suggested that the performance of the Finnish version of the instrument is in line with the original CLEFT-Q questionnaire. CONCLUSIONS The Finnish version of CLEFT-Q produced here is linguistically valid and ready for use in the evaluation of the health-related quality of life of patients with CL/P. However, future work is needed to further assess the validity and the reliability of the CLEFT-Q in the Finnish patient population.
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Affiliation(s)
- Mikael Westerlund
- Department of Plastic Surgery, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Arja Heliövaara
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Junnu Leikola
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Pauliina Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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van der Knaap-Kind LS, Schipper LA, Bonifacio CC, Wolvius EB, Kragt L. Self-perceived oral health and orofacial aesthetics of cleft patients. Eur Arch Paediatr Dent 2024; 25:359-366. [PMID: 38575757 PMCID: PMC11233304 DOI: 10.1007/s40368-024-00891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To evaluate the self-perceived oral health and aesthetics of the dentition and jaw in patients with different types of oral cleft, measured by patient-reported outcome measures (PROMs). Additionally, to compare the results of the PROMs between cleft lip and or/palate (CL/P) patients and non-affected controls. METHODS 420 CL/P patients treated at the cleft team of the Erasmus Medical Center, Rotterdam, The Netherlands, were included, and 138 non-cleft patients were recruited as control-group. Patient's perceptions were retrospectively evaluated using the CLEFT-Q Teeth for dental aesthetics at ages 8, 12 and 22, CLEFT-Q Jaw for jaw aesthetics at ages 12 and 22, and the Child Oral Health Impact Profile-Oral Symptoms Subscale (COHIP-OSS) for oral health at ages 8 and 12. One-way ANOVA was used to compare differences in oral health and aesthetic perceptions among age-groups, cleft types, as well as between cases and controls. RESULTS CL/P patients were significantly less satisfied than controls with their dental aesthetics (p = 0.001). CL/P patients reported significantly lower satisfaction on CLEFT-Q Teeth scores at ages 8 and 12, than at 22 years (p < 0.001). Patients with the most extensive cleft phenotype, Cleft Lip and Palate (CLAP), reported lowest satisfaction on the CLEFT-Q Teeth. No differences in perceptions of oral health nor in aesthetics of the jaw were found in the different cleft types, ages, nor in study versus control group. CONCLUSION This study found differences in self-perceived dental aesthetics: CL/P patients are less satisfied than non-affected controls. CLAP patients are least satisfied, but satisfaction increases with age.
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Affiliation(s)
- L S van der Knaap-Kind
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - L A Schipper
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Paediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - C C Bonifacio
- Department of Paediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - L Kragt
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Salinero LK, Romeo DJ, Pontell ME, Friedman L, Ahluwalia VS, Wagner CS, Barrero CE, Napoli J, Jackson OA, Low DW, Bartlett SP, Swanson J, Magee L, Taylor JA. Psychosocial Status and Self-Perception in Patients with Cleft Lip and/or Palate. Cleft Palate Craniofac J 2024:10556656241236369. [PMID: 38436069 DOI: 10.1177/10556656241236369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE To describe how the psychosocial status of patients with cleft lip and/or palate (CL/P) relates to patient-reported outcomes (PROs). DESIGN Cross-sectional retrospective chart review. SETTING Tertiary care pediatric hospital. PATIENTS/PARTICIPANTS Patients aged 8 to 29 years attending cleft team evaluations during a 1-year period. MAIN OUTCOME MEASURES CLEFT-Q. RESULTS Patients (N = 158) with isolated or syndromic CL/P and mean age 13.4 ± 3.0 years were included. Fifteen (9%) patients had siblings who also had CL/P. Of 104 patients who met with the team psychologist, psychosocial concerns were identified in 49 (47%) patients, including 25 (24%) with Attention-Deficit/Hyperactivity Disorder or behavior concerns, 28 (27%) with anxiety, and 14 (13%) with depression or mood concerns. Younger age and having siblings with cleft were associated with better PROs, while psychosocial concerns were associated with worse PROs on Speech, Psychosocial, and Face Appearance scales. CONCLUSIONS Patient perception of cleft outcomes is linked to psychosocial factors.
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Affiliation(s)
- Lauren K Salinero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dominic J Romeo
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew E Pontell
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leigh Friedman
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vinayak S Ahluwalia
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph Napoli
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Oksana A Jackson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David W Low
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leanne Magee
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Chaisrisawadisuk S, Jaruniphakul K, Tongchenchitt S, Prathyajuta J, Liadprathom K. Thai CLEFT-Q: Phase 1-A Pilot Study of Translation and Cultural Adaptation in Thailand. Cleft Palate Craniofac J 2024; 61:357-364. [PMID: 36259289 DOI: 10.1177/10556656221132031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To translate and culturally adapt the original English version of the CLEFT-Q into Thai (Thai CLEFT-Q). A pilot study. A single tertiary referral hospital in Thailand. Patients with cleft lip or palate (CL/P) aged between 8 and 29 years. The CLEFT-Q was translated and culturally adapted from English into Thai using the good practice guidelines developed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Two forward translations and reconciliation, 1 back translation, and 2 sets of cognitive debriefing interviews with patients were performed to develop the Thai CLEFT-Q. The English version of the CLEFT-Q consists of 13 scales (119 items) assessing appearance, health-related quality of life (HRQOL), and facial function. The forward translations revealed 33.6% inconsistencies. They were related to narrow meaning (2.5%) and improper (16.8%) or incorrect (14.3%) wording or phrasing of the items. After reconciliation, the back translation showed 5 inconsistencies (4.2%) with the original version. However, no changes were needed because the reconciliation version was consistent with the source version. Sixteen participants underwent cognitive debriefing interviews, which revealed a comprehensive interpretation of the Thai CLEFT-Q. Interim reports revealed fair facial appearance scores, albeit with HRQOL and facial function outcomes. Translation and cultural adaptation of the Thai CLEFT-Q provided evidence of its transferability and equivalence with the original English version. Feasible comprehension of the Thai version was also achieved.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kollawat Jaruniphakul
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sigunya Tongchenchitt
- Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirapat Prathyajuta
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokwan Liadprathom
- Division of Speech-Language Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Liao D, Pereira N, Obayemi A, Sclafani AP. Secondary Cleft Rhinoplasty. Facial Plast Surg Clin North Am 2024; 32:43-54. [PMID: 37981415 DOI: 10.1016/j.fsc.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Secondary cleft rhinoplasty remains a challenging operation that requires an understanding of the aberrant anatomy in cleft lip nasal deformity as well as the ability to adapt various techniques suited to the needs of each patient. In this article, we review some of the classically described approaches in cleft rhinoplasty and different strategies to address the nasal subunits. Presurgical adjuncts, surgical interventions before facial skeletal maturity, and patient reported outcome measures are also discussed.
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Affiliation(s)
- David Liao
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Nicola Pereira
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA
| | - Adetokunbo Obayemi
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Anthony P Sclafani
- Department of Otolaryngology, Weill Cornell Medicine, 1305 York Avenue, 5th Floor, New York, NY 10021, USA.
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Ombashi S, Kurniawan MSIC, Koudstaal MJ, Allori AC, Jansson K, Rogers-Vizena CR, Mathijssen IMJ, Klassen AF, Versnel SL. Most Efficient and Meaningful Patient-Reported Appearance Assessment in Different Cleft Types and Age Groups with CLEFT-Q. Plast Reconstr Surg 2024; 153:120e-129e. [PMID: 37054385 DOI: 10.1097/prs.0000000000010523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND The CLEFT-Q, a questionnaire developed and validated specifically for cleft patients, contains seven appearance scales. The International Consortium of Health Outcomes Measurement (ICHOM) has incorporated only some CLEFT-Q appearance scales in the Standard Set to minimize burden. This study evaluates which appearance scales provide the most meaningful information in the different cleft types at specific ages, for the most efficient cleft appearance outcome assessment. METHODS Within this international multicenter study, outcomes of the seven appearance scales were collected, either as part of the ICHOM Standard Set, or as part of the field test study performed to validate the CLEFT-Q. Analyses were performed in separate age groups and cleft types, and involved univariate regression analyses, trend analyses, t tests, correlations, and floor and ceiling effects. RESULTS A total of 3116 patients were included. Scores for most appearance scales showed a downward trend by age group, with the exception of the Teeth and Jaw scales. In all cleft types, several scales correlated strongly with each other. No floor effects were observed, but ceiling effects were found in several scales in different age groups, most often in the CLEFT-Q Jaw scale. CONCLUSIONS A proposition for the most meaningful and efficient appearance outcome assessment in cleft patients is made. It was composed so that recommendations are of value for different cleft protocols and initiatives. Suggestions for the use of scales in the ICHOM Standard Set at different ages are given, and also from a clinical perspective. Use of the CLEFT-Q Scar, Lips, and Nose scales will provide additional relevant information.
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Affiliation(s)
- Saranda Ombashi
- From the Department of Plastic and Reconstructive Surgery
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
| | | | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, Special Dental Care and Orthodontics
- Dutch Craniofacial Center, Erasmus University Medical Center Rotterdam
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
| | - Alexander C Allori
- Department of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital & Children's Health Center
| | - Kristina Jansson
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
- Department of Reconstructive Plastic Surgery, Stockholm Craniofacial Team, Karolinska University Hospital
| | | | - Irene M J Mathijssen
- From the Department of Plastic and Reconstructive Surgery
- Dutch Craniofacial Center, Erasmus University Medical Center Rotterdam
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
| | | | - Sarah L Versnel
- From the Department of Plastic and Reconstructive Surgery
- Dutch Craniofacial Center, Erasmus University Medical Center Rotterdam
- European Reference Network for Rare and/or Complex Craniofacial Anomalies and Ear, Nose, and Throat Disorders
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Ombashi S, Kurniawan MS, Allori A, Sharif-Askary B, Rogers-Vizena C, Koudstaal M, Franken MC, Mink van der Molen AB, Mathijssen I, Klassen A, Versnel SL. What is the optimal assessment of speech? A multicentre, international evaluation of speech assessment in 2500 patients with a cleft. BMJ Open 2023; 13:e071571. [PMID: 38154881 PMCID: PMC10759067 DOI: 10.1136/bmjopen-2023-071571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/23/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES Speech problems in patients with a cleft palate are often complex and multifactorial. Finding the optimal way of monitoring these problems is challenging. The International Consortium of Health Outcomes Measurement (ICHOM) has developed a set of standardised outcome measures at specific ages for patients with a cleft lip and/or palate, including measures of speech assessment. This study evaluates the type and timing of speech outcome measures currently included in this ICHOM Standard Set. Additionally, speech assessments in other cleft protocols and initiatives are discussed. DESIGN, SETTING AND PARTICIPANTS An international, multicentre study was set up including centres from the USA and the Netherlands. Outcomes of clinical measures and Patient Reported Outcome Measures (PROMs) were collected retrospectively according to the ICHOM set. PROM data from a field test of the CLEFT-Q, a questionnaire developed and validated for patients with a cleft, were collected, including participants from countries with all sorts of income statuses, to examine the value of additional moments of measurement that are used in other cleft initiatives.Data from 2500 patients were included. Measured outcomes contained univariate regression analyses, trend analyses, t-tests, correlations and floor and ceiling effects. RESULTS PROMs correlated low to moderate with clinical outcome measures. Clinical outcome measures correlated low to moderate with each other too. In contrast, two CLEFT-Q Scales correlated strongly with each other. All PROMs and the Percent Consonants Correct (PCC) showed an effect of age. In patients with an isolated cleft palate, a ceiling effect was found in the Intelligibility in Context Scale. CONCLUSION Recommendations for an optimal speech outcome assessment in cleft patients are made. Measurement moments of different cleft protocols and initiatives are considered in this proposition. Concerning the type of measures, adjustment of the current PCC score outcome seems appropriate. For centres with adequate resources and specific interest in research, translation and validation of an upcoming tool, the Cleft Audit Protocol for Speech Augmented, is recommended.
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Affiliation(s)
- Saranda Ombashi
- Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Alexander Allori
- Plastic, Maxillofacial and Oral Surgery, Duke University Hospital and Children's Health Center, Durham, North Carolina, USA
| | - Banafsheh Sharif-Askary
- Plastic, Maxillofacial and Oral Surgery, Duke University Hospital and Children's Health Center, Durham, North Carolina, USA
| | | | - Maarten Koudstaal
- Department of Oral and Maxillofacial Surgery, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | | | | | - Irene Mathijssen
- Department of Plastic and Reconstructive Surgery, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
| | - Anne Klassen
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Lisa Versnel
- Plastic and Reconstructive Surgery, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands
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13
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Van der Straeten C, Verbeke J, Alighieri C, Bettens K, Van Beveren E, Bruneel L, Van Lierde K. Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2654-2675. [PMID: 37844623 DOI: 10.1044/2023_ajslp-23-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments. METHOD Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20-33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20-32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available. RESULTS Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L. CONCLUSIONS The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24243901.
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Affiliation(s)
- Charis Van der Straeten
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Jolien Verbeke
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Ellen Van Beveren
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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14
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Dunworth K, Sharif-Askary B, Grames L, Jones C, Kern J, Nyswonger-Sugg J, Suárez A, Thompson K, Ching J, Golden B, Merrill C, Nguyen P, Patel K, Rogers-Vizena CR, Rottgers SA, Skolnick GB, Allori AC. Using "Real-World Data" to Study Cleft Lip/Palate Care: An Exploration of Speech Outcomes from a Multi-Center US Learning Health Network. Cleft Palate Craniofac J 2023:10556656231207469. [PMID: 37844605 DOI: 10.1177/10556656231207469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE To assess the ability of a cleft-specific multi-site learning health network registry to describe variations in cleft outcomes by cleft phenotypes, ages, and treatment centers. Observed variations were assessed for coherence with prior study findings. DESIGN Cross-sectional analysis of prospectively collected data from 2019-2022. SETTING Six cleft treatment centers collected data systematically during routine clinic appointments according to a standardized protocol. PARTICIPANTS 714 English-speaking children and adolescents with non-syndromic cleft lip/palate. INTERVENTION Routine multidisciplinary care and systematic outcomes measurement by cleft teams. OUTCOME MEASURES Speech outcomes included articulatory accuracy measured by Percent Consonants Correct (PCC), velopharyngeal function measured by Velopharyngeal Competence (VPC) Rating Scale (VPC-R), intelligibility measured by caregiver-reported Intelligibility in Context Scale (ICS), and two CLEFT-Q™ surveys, in which patients rate their own speech function and level of speech distress. RESULTS 12year-olds exhibited high median PCC scores (91-100%), high frequency of velopharyngeal competency (62.50-100%), and high median Speech Function (80-91) relative to younger peers parsed by phenotype. Patients with bilateral cleft lip, alveolus, and palate reported low PCC scores (51-91%) relative to peers at some ages and low frequency of velopharyngeal competency (26.67%) at 5 years. ICS scores ranged from 3.93-5.0 for all ages and phenotypes. Speech Function and Speech Distress were similar across phenotypes. CONCLUSIONS This exploration of speech outcomes demonstrates the current ability of the cleft-specific registry to support cleft research efforts as a source of "real-world" data. Further work is focused on developing robust methodology for hypothesis-driven research and causal inference.
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Affiliation(s)
- Kristina Dunworth
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Banafsheh Sharif-Askary
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Lynn Grames
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
| | - Carlee Jones
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
| | - Jennifer Kern
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Jillian Nyswonger-Sugg
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Arthur Suárez
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University Hospital, Durham, NC, USA
| | - Karen Thompson
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Ching
- University of Florida Craniofacial Center, University of Florida, Gainesville, FL, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Brent Golden
- Pediatric Cleft Lip and Palate Surgery Program, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Phuong Nguyen
- Division of Plastic Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kamlesh Patel
- Cleft Palate and Craniofacial Institute, St. Louis Children's Hospital, St. Louis, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Carolyn R Rogers-Vizena
- Cleft Lip and Palate Program/Craniofacial Program, Boston Children's Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - S Alex Rottgers
- Cleft and Craniofacial Center, Johns Hopkins Children's Center, Baltimore, MD, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Alexander C Allori
- Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Cleft & Craniofacial Center, Duke Children's Hospital, Durham, NC, USA
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC, USA
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15
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Phippen G. Articulating the issues: speech assessment and intervention in cleft lip and palate. Br Dent J 2023; 234:912-917. [PMID: 37349440 DOI: 10.1038/s41415-023-5954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
This paper describes the impact of cleft lip and palate on speech. It provides an overview for the dental clinician of the key issues affecting speech development and clarity. The paper summarises the complex speech mechanism and cleft-related factors that affect speech, including palatal, dental and occlusal anomalies. It outlines the framework for speech assessment throughout the cleft pathway and provides a description of cleft speech disorder, as well as describing treatment approaches for cleft speech and velopharyngeal dysfunction.This is followed by a spotlight on speech prosthetics for treating nasal speech, with an emphasis on joint management by the Speech and Language Therapist and Consultant in Restorative Dentistry. This includes the core multidisciplinary approach, clinician and patient-reported outcome measures, and brief discussion of national developments in this area.The importance of multidisciplinary cleft care is highlighted and, within this, the essential interaction between speech and dental clinicians in providing routine care, as well as in delivering a highly specialist speech prosthetics service.
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Affiliation(s)
- Ginette Phippen
- Lead Speech & Language Therapist, The Spires Cleft Centre, Salisbury NHS Foundation Trust/Oxford University Hospitals NHS Foundation Trust, United Kingdom.
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16
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HOW PRO'S CAN CONTRIBUTE TO WHAT MATTERS MOST TO PATIENTS WITH OROFACIAL CLEFTS. J Evid Based Dent Pract 2023; 23:101792. [PMID: 36707166 DOI: 10.1016/j.jebdp.2022.101792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
An orofacial cleft (OC) is a congenital cleft that may affect the lip, alveolus, hard and soft palate. An OC impacts the individuals' appearance, psychosocial well-being and causes functional problems including feeding, dentition, growth of jaws, hearing and speech. The treatment of an orofacial cleft usually reaches from birth until 22 years of age or later. To understand and listen in an objective manner, OC specific Patient reported Outcome (PRO) and experience (PRE) measures are imperative. In patients with OCs many shared decision making moments exist from birth until adulthood. The aim is to understand what knowledge exists on PROs and PREs in patients with OCs, to formulate challenges to improve care to OC patients and how research on OCs needs to adapt. PROs and PREs need to be tailored to the individual with an OC. A framework with specific OC key domains including appearance, facial function and Health related Quality of Life exists. The current framework does not include the social network around the OC patients yet. However attention should be put on including family and community support into the framework. Also at an individual level more attention should be paid to enhancing experiences compared to impeding experiences. To create a better understanding traditional indicators and outcomes are combined with PROMs in a structured way. Challenges were identified that seek to improve our complete set of (PRO and PRE) instruments to provide better care to the individual with an OC and provide a voice so that good shared decision making is enabled. Thereby the individual with an OC is further empowered.
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17
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Meazzini MC, Tortora C, Cohen N, Mazzoleni F, Balbo N, Donati V, Autelitano L. Comparison of the psychosocial impact on patients affected by cranio facial anomalies between traditional orthodontic brackets and aligners. Int J Adolesc Med Health 2022; 34:357-365. [PMID: 32866118 DOI: 10.1515/ijamh-2020-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Malocclusion affects the psychological wellness and social interaction, impacting negatively on adolescents' quality of life and self-esteem. Facial attractiveness is mostly based on the esthetics of the smile and patients seek orthodontic treatment mainly to improve aesthetics. The aim of this prospective clinical study is to compare the psychosocial impact of aligners (AL) and fixed appliances (FA) as orthodontic treatments in patients affected by craniofacial anomalies (CFA). METHODS 100 syndromic Caucasian patients with CFA followed in two different hospitals were divided in two groups: 50 patients treated with AL and 50 patients treated with FA. The two groups were matched for gender, age and CFA and filled out a modified psychosocial impact of dental aesthetics questionnaire (mPIDAQ). RESULTS Patients affected by CFA treated with AL reported a better psychosocial impact than patients treated with FA, showing higher esthetic self-perception and self-esteem, lower social interaction impairments, and lower physical/practical disturbances. CONCLUSIONS The results of this study suggest that AL could be a valid alternative, especially in complex patients with CFA. Since AL application requires more cooperative patients the orthodontist should dedicate more time to motivate the patient to adhere to the treatment schedule.
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Affiliation(s)
| | - Chiara Tortora
- Smile-House, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy
| | - Noah Cohen
- Smile-House, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy
| | | | - Nicoletta Balbo
- Department of Social and Political Sciences, Dondena Centre for Research on Social Dynamics and Public Policies, Bocconi University, Milan, Italy
| | - Vera Donati
- Smile-House, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy
| | - Luca Autelitano
- Smile-House, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy
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18
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Chhina H, Klassen A, Bade D, Kopec J, Cooper A. Establishing content validity of LIMB-Q Kids: a new patient-reported outcome measure for lower limb deformities. Qual Life Res 2022; 31:2805-2818. [DOI: 10.1007/s11136-022-03140-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/27/2023]
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19
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Tsuchiya S, Tsuchiya M, Momma H, Aida J, Nagatomi R, Yaegashi N, Arima T, Igarashi K. Neurodevelopmental trajectories in children with cleft lip and palate: A longitudinal study based on the Japan Environment and Children's Study. Eur J Oral Sci 2022; 130:e12857. [PMID: 35166390 DOI: 10.1111/eos.12857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/17/2022] [Indexed: 01/31/2023]
Abstract
Cleft lip and/or palate (CL/P), the most prevalent congenital anomaly, is understood to negatively affect a wide range of child development. Since the concept remains controversial, because most published work is from cross-sectional studies, we examined the neurodevelopmental trajectories in participants with CL/P through a longitudinal comparison with the general population during early childhood using data from a nationwide birth cohort study in Japan. The linear mixed models for each domain of the Ages and Stages Questionnaire, third edition (ASQ-3), were used to detect differences in standardised mean scores between groups. The ASQ-3 is a general neurodevelopmental screening tool comprising communication, gross motor, fine motor, problem-solving, and personal-social domains. Participants' neurodevelopment was determined semi-annually from 6 to 36 months of age. The trajectories of standardised mean scores in each domain showed several significant differences between the control and CL/P groups, with the maximum difference at 24 months of age in the communication domain. Indeed, CL/P was associated with significantly lower scores in the communication (coefficient: -3.31, 95% CI: -5.09 to -1.14), problem-solving (coefficient: -3.13, 95% CI: -5.07 to -1.18), and personal-social domains (coefficient: -1.99, 95% CI: -3.87 to -0.11). Trajectories of ASQ-3 scores suggest neurodevelopmental delays in children with CL/P.
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Affiliation(s)
- Shinobu Tsuchiya
- Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Japan
| | | | - Haruki Momma
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoichi Nagatomi
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan.,Division of Biomedical Engineering for Health & Welfare, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynaecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahiro Arima
- Department of Informative Genetics, Environment and Genome Research Centre, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Igarashi
- Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Japan.,Division of Craniofacial Anomalies, Tohoku University Graduate School of Dentistry, Sendai, Japan
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20
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Jensen ED, Poirier BF, Oliver KJ, Roberts R, Anderson PJ, Jamieson LM. Childhood Experiences and Perspectives of Individuals With Orofacial Clefts: A Qualitative Systematic Review. Cleft Palate Craniofac J 2022:10556656221084542. [PMID: 35254151 DOI: 10.1177/10556656221084542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Children and adolescents with orofacial clefts may experience ongoing psychosocial impacts due to the continuous nature of cleft treatments, facial and dental differences, and speech and hearing difficulties. The aim of this qualitative systematic review was to better understand the experiences of children and adolescents with orofacial clefts. DESIGN A systematic search strategy using PubMed, Embase, Emcare, Scopus, and Web of Science databases was performed to identify relevant qualitative studies evaluating the lived experience of children and adolescents with orofacial clefts from inception through to June 2021. Eligible studies were critically appraised using the Joanna Briggs methodology and a meta-aggregative approach. RESULTS The search identified 2466 studies, with 13 found to meet the inclusion criteria. Extraction of 155 findings resulted in 27 categories, which were meta-aggregated into 7 overarching synthesized findings. These 7 core findings included aspects of child experience and findings that enhanced or impeded child experience at the individual, family, and community levels. CONCLUSIONS Factors that impeded child experience at the individual, family, and community levels were more pronounced than factors that enhanced their experience among children and adolescents with orofacial clefts. Further initiatives are needed to provide support to individuals, families, and school communities to enhance children's experience of orofacial cleft during the formative childhood and adolescent years.
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Affiliation(s)
- Emilija D Jensen
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia.,Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, Australia
| | - Brianna F Poirier
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Kelly J Oliver
- Department of Paediatric Dentistry, Women's and Children's Hospital, North Adelaide, Australia
| | - Rachel Roberts
- School of Psychology, The University of Adelaide, Adelaide, Australia
| | - Peter J Anderson
- Cleft and Craniofacial South Australia, Women's and Children's Hospital, North Adelaide, Australia.,Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Lisa M Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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21
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Bertucci V, Stevens K, Sidhu N, Suri S, Bressmann T. The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2022:10556656221084541. [PMID: 35249395 DOI: 10.1177/10556656221084541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment. Prospective longitudinal. Tertiary university-affiliated hospital. Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents. Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6). Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance. Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4. RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.
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Affiliation(s)
- Virginia Bertucci
- Department of Orthodontics, 70374Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Stevens
- Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole Sidhu
- Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunjay Suri
- Department of Orthodontics, 70374Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.,Division of Orthodontics, Department of Dentistry, 7979The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim Bressmann
- Department of Speech-Language Pathology, 12366Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Alighieri C, Bettens K, Verhaeghe S, Van Lierde K. Speech diagnosis and intervention in children with a repaired cleft palate: A qualitative study of Flemish private community speech-language pathologists' practices. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:53-66. [PMID: 34229538 DOI: 10.1080/17549507.2021.1946153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This study investigated the practice patterns of private community speech-language pathologists (SLPs) when treating children with a repaired cleft of the palate with or without a cleft of the lip (CP ± L). Practices were explored in terms of diagnostics and treatment focus, treatment dosage and experienced difficulties when treating children with a CP ± L.Method: Eleven female private community SLPs, who lived in Flanders (i.e. the northern part of Belgium) and were aged between 23 and 62 years participated in this study. Data were collected from semi-structured face-to-face interviews. The qualitative software program NVivo 12 was used for data analysis. The interviews were analysed using an inductive thematic approach.Result: SLPs reported a lack of available information on speech-related cleft care. SLPs expressed the need to receive a referral letter from the hospital in order to make an adequate speech diagnosis. Most therapists reported that they performed an articulatory assessment combined with a language assessment. Most SLPs used a hybrid treatment model including a variety of intervention techniques. These techniques were not always in line with available scientific evidence. SLPs reported the desire to receive practical step-by-step guidelines on how to provide speech intervention to children with a CP ± L. In contrast, there was a strong consensus among the therapists that an individualised treatment plan is necessary.Conclusion: The results of this study have revealed gaps in the dissemination and implementation of scientific evidence relevant to speech services for children with a CP ± L (i.e. a research-practice gap) in Flanders. Research evidence needs to be adequately translated into clinical practice by providing concrete and practical guidelines.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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23
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Ajami S, Torabi S, Dehghanpour S, Ajami M. Farsi version of the CLEFT-Q: translation, cultural adaptation process and reliability. BMC Oral Health 2021; 21:593. [PMID: 34798845 PMCID: PMC8603523 DOI: 10.1186/s12903-021-01957-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was the translation and cultural adaptation of the CLEFT-Q to Farsi and evaluating the reliability of it. Methods The English version of the CLEFT-Q was translated to Farsi following the guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). To calculate the reliability, 50 participants filled out the Farsi version of the questionnaire twice at 2-week intervals. Results The difficulties during the translation and cultural adaptation process were as follows: 7.56% of items from the independent forward translations, 62.18% of items from the comparison between two forward translations, and 21% of items from the comparison between post-back translation and the original version. The internal consistency and stability of the Farsi version of the CLEFT-Q were 0.979 and 0.997, which both were categorized as excellent. Conclusion The Farsi version of the CLEFT-Q is a valid and reliable tool currently available for Farsi-speaking families around the world. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01957-7.
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Affiliation(s)
- Shabnam Ajami
- Orthodontics Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Torabi
- Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Dehghanpour
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Valuing Patient-Reported Outcome Measures as an Intrinsically Important Aspect of Quality Improvement Agenda in Surgical Cleft-Craniofacial Care. J Craniofac Surg 2021; 32:2568-2569. [PMID: 34705365 DOI: 10.1097/scs.0000000000007923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Klassen AF, Rae C, Bulstrode NW, Berenguer B, Cui C, Fisher DM, Kasrai L, Li Y, Lloyd M, Panchapakesan V, Pusic A, Reinsch J, Stewart K, Todd A, Frank R, Tsangaris E, Wang Y, Wong Riff KW, Zhang R, Cano S. An international study to develop the EAR-Q patient-reported outcome measure for children and young adults with ear conditions. J Plast Reconstr Aesthet Surg 2021; 74:2341-2348. [PMID: 33637465 DOI: 10.1016/j.bjps.2021.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is currently a lack of patient-reported outcome measures for ear reconstruction. We developed the EAR-Q to measure ear appearance and post-operative adverse effects from the patient perspective. METHODS Field-test data were collected from children and young adults in eight countries between 13 May 2016 and 12 December 2019. Rasch measurement theory (RMT) analysis was used to refine the scales and to examine their psychometric properties. RESULTS Participants had microtia (n = 607), prominent ears (n = 145) or another ear condition (n = 111), and provided 960 assessments for the Appearance scale (e.g., size, shape, photos), and 137 assessments for the Adverse Effects scale (e.g., itchy, painful, numb). RMT analysis led to the reduction of each scale to 10-items. Data fit the Rasch model for the Appearance (X2(80) = 90.9, p = 0.19) and Adverse Effects (X2(20) = 24.5, p = 0.22) scales. All items in each scale had ordered thresholds and good item fit. There was no evidence of differential item function for the Appearance scale by age, gender, language, or type of ear condition. Reliability was high for the Appearance scale, with person separation index (PSI) and Cronbach alpha values with and without extremes ≥0.92. Reliability for the Adverse Effects scale was adequate (i.e., PSI and Cronbach alpha values ≥0.71). Higher scores (liked appearance more) correlated with higher scores (better) on Psychological, Social and School scales. INTERPRETATION The EAR-Q can be used in those 8-29 years of age to understand the patient perspective in clinical practice and research, and in addition, can be used to benchmark outcomes for ear reconstruction internationally.
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Affiliation(s)
- Anne F Klassen
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Charlene Rae
- Dept of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Neil W Bulstrode
- Dept of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
| | - Beatriz Berenguer
- Division of Pediatric Plastic Surgery, Hospital General Universitario Gregorio Maranon, Calle de O´Donnell 48, 28009, Madrid, Spain
| | - Chunxiao Cui
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - David M Fisher
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Leila Kasrai
- Department of Surgery, St Joseph's Health Centre, University of Toronto, 30 The Queensway, Toronto, ON M6R 1B5, Canada.
| | - Yiyuan Li
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China
| | - Mark Lloyd
- Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Ln, Birmingham B4 6NH, UK.
| | - Vivek Panchapakesan
- Dept of Surgery, William Osler Health System, 101 Humber College Blvd, Etobicoke, ON M9V 1R8, Canada
| | - Andrea Pusic
- Dept of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
| | - John Reinsch
- Dept of Pediatric Plastic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ken Stewart
- Dept of Plastic Surgery, Royal Hospital for Sick Children 9 Sciennes Rd, Edinburgh EH9 1LF, UK.
| | - Anna Todd
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada
| | - Ryan Frank
- Section of Plastic Surgery, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB T3B 6A8, Canada.
| | - Elena Tsangaris
- Dept of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON L8N 3Z5, Canada.
| | - Yi Wang
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
| | - Karen Wy Wong Riff
- Dept of Surgery, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON M5G 1 × 8, Canada.
| | - Ruhong Zhang
- Dept of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639, Zhi Zao Ju Rd., Shanghai 200011, China.
| | - Stefan Cano
- Modus Outcomes, Suite 210b, Spirella Building, Letchworth Garden City SG6 4ET, UK.
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Discussion: Considerations for Payment Bundling in Cleft Care. Plast Reconstr Surg 2021; 147:933-934. [PMID: 33776037 DOI: 10.1097/prs.0000000000007791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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de Blacam C, Baylis AL, Kirschner RE, Smith S, Sell D, Sie KCY, Harris HE, Orr DJA. Core Outcome Set for Reporting Outcomes of Interventions for Velopharyngeal Dysfunction: Final Results of the COS-VPD Initiative. Cleft Palate Craniofac J 2021; 59:S84-S96. [PMID: 34398725 DOI: 10.1177/10556656211035026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To date, the recording of outcomes of interventions for velopharyngeal dysfunction (VPD) has not been standardized. This makes a comparison of results between studies challenging. The aim of this study was to develop a core outcome set (COS) for reporting outcomes in studies examining the management of VPD. DESIGN A two-round Delphi consensus process was used to develop the COS. PATIENTS, PARTICIPANTS The expert Delphi panel comprised patients and caregivers of patients with VPD, surgeons and speech and language therapists specializing in cleft palate, and researchers with expertise in VPD. INTERVENTIONS A long list of outcomes was derived from the published literature. In each round of a Delphi survey, participants were asked to score outcomes using the Grading of Recommendations, Assessment, Development, and Evaluations scale of 1 to 9, with 1 to 3 labeled "not important," 4 to 6 labeled "important but not critical," and 7 to 9 labeled "critical." MAIN OUTCOME MEASURE Consensus criteria were specified a priori. Outcomes with a rating of 75% or more of the panel rating 7 to 9 and 25% or fewer rating 1 to 3 were included in the COS. RESULTS A total of 31 core outcomes were identified from the Delphi process. This list was condensed to combine topic areas to produce a final COS of 10 outcomes, including both processes of care and patient-reported outcomes that should be considered for reporting in future studies of VPD. CONCLUSIONS Implementation of the COS-VPD will facilitate consistency of outcomes data collection and comparison of results across studies.
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Affiliation(s)
- Catherine de Blacam
- 575349Department of Plastic Surgery, 11595Children's Health Ireland at Crumlin, Dublin, Ireland.,8863Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adriane L Baylis
- Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Richard E Kirschner
- Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,12305The Ohio State University College of Medicine, Columbus, OH, USA
| | - Susan Smith
- 162839Department of General Practice, 8863Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Debbie Sell
- Speech and Language Therapy, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kathleen C Y Sie
- Pediatric Otolaryngology, 7274Seattle Children's Hospital, Seattle, Washington, USA
| | | | - David J A Orr
- 575349Department of Plastic Surgery, 11595Children's Health Ireland at Crumlin, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
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Klassen AF, Rae C, Wong Riff KW, Bulstrode N, Denadai R, Goldstein J, Hol ML, Murray DJ, Bracken S, Courtemanche DJ, O'Hara J, Butler D, Tassi A, Malic CC, Ganske IM, Phua YS, Marucci DD, Johnson D, Swan MC, Breuning EE, Goodacre TE, Pusic AL, Cano S. FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions. J Plast Reconstr Aesthet Surg 2021; 74:2319-2329. [PMID: 34274246 DOI: 10.1016/j.bjps.2021.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/09/2021] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The CLEFT-Q includes 12 independently functioning scales that measure appearance (face, nose, nostrils, teeth, lips, jaws), health-related quality of life (psychological, social, school, speech distress), and speech function, and an eating/drinking checklist. Previous qualitative research revealed that the CLEFT-Q has content validity in noncleft craniofacial conditions. This study aimed to examine the psychometric performance of the CLEFT-Q in an international sample of patients with a broad range of facial conditions. METHODS Data were collected between October 2016 and December 2019 from 2132 patients aged 8 to 29 years with noncleft facial conditions. Rasch measurement theory (RMT) analysis was used to examine Differential Item Function (DIF) by comparing the original CLEFT-Q sample and the new FACE-Q craniofacial sample. Reliability and validity of the scales in a combined cleft and craniofacial sample (n=4743) were examined. RESULTS DIF was found for 23 CLEFT-Q items when the datasets for the two samples were compared. When items with DIF were split by sample, correlations between the original and split person locations showed that DIF had negligible impact on scale scoring (correlations ≥0.995). In the combined sample, RMT analysis led to the retention of original content for ten CLEFT-Q scales, modification of the Teeth scale, and the addition of an Eating/Drinking scale. Data obtained fit with the Rasch model for 11 scales (exception School, p=0.04). Person Separation Index and Cronbach alpha values met the criteria. CONCLUSION The scales described in this study can be used to measure outcomes in children and young adults with cleft and noncleft craniofacial conditions.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Karen Wy Wong Riff
- Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Neil Bulstrode
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo , Brazil.
| | - Jesse Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Marinka Lf Hol
- Department of Otolaryngocoloy and Head and Neck Surgery, University Medical Center Utrecht, Prinses Maxima Center for Childhood oncology, Utrecht, The Netherlands.
| | - Dylan J Murray
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Shirley Bracken
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | | | - Justine O'Hara
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Daniel Butler
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Ali Tassi
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Claudia C Malic
- Department of Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Yun S Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, Brisbane, Australia.
| | - Damian D Marucci
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia.
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Marc C Swan
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Eleonore E Breuning
- Department of Plastic Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom.
| | - Tim Ee Goodacre
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Stefan Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom.
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Stiernman M, Klintö K, Persson M, Becker M. Comparison of Corresponding Scores From the Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q in Swedish Patients With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 58:736-745. [PMID: 33047614 PMCID: PMC8165751 DOI: 10.1177/1055665620964124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to compare corresponding scores between 2 existing cleft-specific patient-reported outcome measures (PROMs)-Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q. The second aim of the study was to investigate patient opinion on the 2 PROMs. DESIGN Cross-sectional questionnaire study. SETTING Participants were recruited from a University Hospital. They answered CHASQ and CLEFT-Q either in the hospital or at home. PARTICIPANTS Thirty-three participants with cleft lip and/or palate, aged 10 to 19 years. MAIN OUTCOME MEASURE CHASQ and CLEFT-Q. RESULTS The CHASQ scores and the corresponding CLEFT-Q scores on appearance correlated significantly. Corresponding scores regarding speech did not correlate significantly. A majority, 15 (58%) participants, answered that they liked CLEFT-Q more than CHASQ, 18 participants (69%) thought CHASQ was easier to complete, and 19 (76%) thought CLEFT-Q would better inform health care professionals. CONCLUSION Both instruments showed strengths and limitations. Clinicians will have to consider each instrument's respective qualities when choosing to implement either PROM.
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Affiliation(s)
- Mia Stiernman
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Kristina Klintö
- Department of Clinical Sciences in Malmö, Lund University, Sweden
- Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
| | - Martin Persson
- Department of Health and Society, Kristianstad University, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
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Willis J, Zeratkaar D, Ten Hove J, Rosenbaum P, Ronen GM. Engaging the Voices of Children: A Scoping Review of How Children and Adolescents Are Involved in the Development of Quality-of-Life-Related Measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:556-567. [PMID: 33840434 DOI: 10.1016/j.jval.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Patient-reported outcomes are increasingly recommended to guide patient care, develop and evaluate interventions, and modify health systems. However, not enough is known about whether and how children and adolescents, as "experts" in their own health and quality of life (QoL), are being engaged in the development of instruments. Our goals in this review were (1) to identify all QoL-related instruments that have included children and/or adolescents in the development of questionnaire content, including identification of themes and items; and (2) to report how this was done; and (3) to highlight those that used qualitative methods. METHODS MEDLINE and Embase were searched for child- or adolescent-completed QoL-related instruments, supplemented by hand-searching of relevant reviews until 2020. Original development papers were identified and retrieved when possible, from which instrument characteristics and details of qualitative development methods were extracted. RESULTS We identified 445 instruments, of which 88 used qualitative methods for content development. Interviews and focus groups were the most common methods. A variety of play techniques were used to engage the child and adolescent participants. The specific criteria for the inclusion of children and adolescents (age, developmental stage, duration, and nonclinical location) varied considerably. CONCLUSIONS Researchers frequently involve children and adolescents in qualitative methods when developing QoL-related measures; however, there is little information about the methods used. Better reporting of methodology, improved dissemination of methods guidelines, and research into optimal ways of including children and adolescents in the process of instrument development would be useful.
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Affiliation(s)
- Jessica Willis
- Department of Pediatrics, Western University, London, Ontario, Canada.
| | - Dena Zeratkaar
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Julia Ten Hove
- University of Waterloo, Department of Kinesiology, Warerloo, Ontario, Canada.
| | - Peter Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Klassen AF, Rae C, Riff W, Denadai R, Murray DJ, Bracken S, Courtemanche DJ, Bulstrode N, O'Hara J, Butler D, Goldstein J, Tassi A, Hol ML, Johnson D, Ganske IM, Kölby L, Benitez S, Breuning EE, Malic CC, Allen GC, Pusic AL, Cano S. FACE-Q craniofacial module: Part 2 Psychometric properties of newly developed scales for children and young adults with facial conditions. J Plast Reconstr Aesthet Surg 2021; 74:2330-2340. [PMID: 34172403 DOI: 10.1016/j.bjps.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/09/2021] [Accepted: 03/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The FACE-Q Craniofacial Module is a patient-reported outcome measure designed for patients aged 8 to 29 years with conditions associated with a facial difference. In part 1, we describe the psychometric findings for the original CLEFT-Q scales tested in patients with cleft and noncleft facial conditions. The aim of this study was to examine psychometric performance of new FACE-Q Craniofacial Module scales. METHODS Data were collected between December 2016 and December 2019 from patients aged 8 to 29 years with conditions associated with a visible or functional facial difference. Rasch measurement theory (RMT) analysis was used to examine psychometric properties of each scale. Scores were transformed from 0 (worst) to 100 (best) for tests of construct validity. RESULTS 1495 participants were recruited with a broad range of conditions (e.g., birthmarks, facial paralysis, craniosynostosis, craniofacial microsomia, etc.) RMT analysis resulted in the refinement of 7 appearance scales (Birthmark, Cheeks, Chin, Eyes, Forehead, Head Shape, Smile), two function scales (Breathing, Facial), and an Appearance Distress scale. Person separation index and Cronbach alpha values met criteria. Three checklists were also formed (Eye Function, and Eye and Face Adverse Effects). Significantly lower scores on eight of nine scales were reported by participants whose appearance or functional difference was rated as a major rather than minor or no difference. Higher appearance distress correlated with lower appearance scale scores. CONCLUSION The FACE-Q Craniofacial Module scales can be used to collect and compare patient reported outcomes data in children and young adults with a facial condition.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Wong Riff
- Department of Surgery, Hospital for Sick Children, ON Canada.
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Dylan J Murray
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Shirley Bracken
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | | | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Justine O'Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Daniel Butler
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Jesse Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA United States.
| | - Ali Tassi
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University, London ON, Canada.
| | - Marinka Lf Hol
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands AND Princess Maxima Center for Childhood oncology, Utrecht, Netherlands.
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA United States.
| | - Lars Kölby
- University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Department of Plastic Surgery, Sahlgrenska, University Hospital, Gothenburg, Sweden.
| | - Susana Benitez
- Department of Plastic Surgery, Clinica Las Condes, Santiago, Chile
| | - Eleonore E Breuning
- Department of Plastic Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom.
| | - Claudia C Malic
- University of Ottawa, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Gregory C Allen
- Department of Otolaryngology - Head & Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, United States.
| | - Stefan Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom.
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Tassi A, Tan J, Piplani B, Longmire N, Wong Riff KWY, Klassen AF. Establishing content validity of an orthodontic subset of the FACE-Q Craniofacial Module in children and young adults with malocclusion. Orthod Craniofac Res 2021; 24:553-560. [PMID: 33539636 DOI: 10.1111/ocr.12474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The FACE-Q Craniofacial Module for children and young adults is a patient-reported outcome measure (PROM) designed to measure outcomes for patients aged 8 to 29 years with facial conditions. The aim of this study was to establish content validity of a relevant subset of the module for its use in orthodontic patients with malocclusion. SETTING AND SAMPLE POPULATION Experts in orthodontics were emailed and invited to provide feedback through a Research Electronic Data Capture survey. Patient feedback was obtained through cognitive interviews with patients aged 8 to 29 years recruited from a university-based orthodontic clinic in Canada. MATERIALS AND METHODS Expert opinion and patient interviews were used to obtain feedback on the content of 4 appearance (face, smile, teeth and jaws) and 1 function (eating and drinking) scales hypothesized to be relevant to orthodontic malocclusions, and to elicit new concepts. Interviews were audio-recorded, transcribed, and coded using a line-by-line approach. RESULTS Twenty-one experts and 15 patients participated. Expert feedback led us to drop 9, retain 40, revise 4 and add 16 new items. At the conclusion of cognitive interviews no items were dropped, 55 were retained, 5 were revised and 8 new items were added. The final set of 68 items demonstrated content validity for orthodontic patients. CONCLUSION Expert feedback and cognitive interviews enabled us to revise and refine 5 scales as part of the FACE-Q Craniofacial Module for use in orthodontic patients. These scales were included in the internationalfield-test of the FACE-Q Craniofacial Module.
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Affiliation(s)
- Ali Tassi
- Division of Graduate Orthodontics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Jessica Tan
- Bachelor of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Bhoomika Piplani
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Natasha Longmire
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Karen W Y Wong Riff
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Tan RA, Mulder FJ, Schwirtz RMF, Mosmuller DGM, De Vet HCW, Griot JPWD. Atypical Outcomes of Nasal and Lip Appearance After Unilateral Cleft Lip Repair: Judgment by Professionals, Patients, and Laypeople. Cleft Palate Craniofac J 2021; 58:1226-1235. [PMID: 33461321 PMCID: PMC8494007 DOI: 10.1177/1055665620982801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To gain more insight into the assessment of “atypical” nasal and lip appearance outcomes compared to “typical” appearance outcomes after unilateral cleft lip and palate (UCLP) repair, when judged by professionals, patients with repaired UCLP, and laypeople. Design: An online survey containing 3 series of photographs with various degrees of “typical” and “atypical” nasal and lip appearance outcomes after UCLP repair was sent to 30 professionals, 30 patients with repaired UCLP, and 50 laypeople in 2 countries. Participants were instructed to rank the photographs from excellent to poor based on overall appearance. Mean rank positions of photographs were analyzed and differences in mean rank score between “typical” and “atypical” results were assessed using a T-test. Agreement of ranking between the 3 groups was assessed with an analysis of variance analysis. Setting: Amsterdam UMC, location VUmc, Netherlands and Boston Children’s Hospital, Boston, USA. Patients: Photographs of 6- to 18-year-old patients with repaired UCLP. Results: “Atypical” appearance outcomes were ranked significantly less favorably (small nostril: P = 0.00; low vermillion border: P = 0.02; whistling deformity: P = 0.00) compared to “typical” outcomes. Difference between professionals, patients and laypeople in rank positioning the photographs was not statistically significant (P = 0.89). Conclusions: Noses with a smaller nostril and lips containing a whistling deformity were perceived as poorer outcome compared to the “typical” results. Professionals, patients, and laypeople are in agreement when assessing these outcomes.
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Affiliation(s)
- Robin A Tan
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Frans J Mulder
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Roderic M F Schwirtz
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - David G M Mosmuller
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Henrica C W De Vet
- Department of Epidemiology and Data Science and the Amsterdam Public Health, Research Institute, 1209Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - J Peter W Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
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Sakran KA, Song S, Li H, Pan P, Chen N, Zeng N, Chi T, Shi B, Huang H, Wang Y, Gong C. Self-Consciousness of Appearance in Chinese Patients With Cleft Lip: Validation of the Chinese Derriford Appearance Scale 59 (DAS 59) Instrument. Front Pediatr 2021; 9:825997. [PMID: 35223716 PMCID: PMC8863654 DOI: 10.3389/fped.2021.825997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To develop a reliable and valid Chinese version of the Derriford Appearance Scale 59 (DAS 59) instrument for assessing the self-consciousness of appearance in Chinese patients with cleft lip. METHODS The original DAS 59 instrument was translated into Mandarin, back-translated, and culturally adapted among the Chinese population, following the protocol of the original DAS 59. The validation of the Chinese DAS 59 instrument was estimated on 443 adult participants including 213 subjects with a history of cleft lip with/without palate (CL/P, study group) and 230 normal subjects without facial appearance concern (control group). The reliability was estimated by Cronbach's α coefficient and Guttman's split-half coefficient. Content validity was tested using the Spearman correlation coefficient, while discriminant validity was tested by the Mann-Whitney U test. RESULTS The overall internal consistency of Chinese DAS 59 was excellent; Cronbach's α was 0.951 (α = 0.965 and 0.959 in the study and control groups, respectively). Further, Guttman's split-half coefficient was excellent in the study group (0.935) and control group (0.901). The validity of content was good with an acceptable correlation between all the items and domains. The construct validity through the discrimination was good with a statistically significant difference in most domains between the two groups. Patients with CL/P had more concern about the general self-consciousness and social self-consciousness of appearance. They also showed a good self-concept score. CONCLUSION The Chinese version of DAS 59 demonstrated acceptable reliability and good construct and discriminant validity. It can be used for the research and assessment of the psychological state and quality of life for Chinese patients with cleft lip as well as other appearance problems and concerns.
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Affiliation(s)
- Karim A Sakran
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sixing Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Huo Li
- Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Peiyue Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ting Chi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Caixia Gong
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Alighieri C, Bettens K, Bruneel L, D'haeseleer E, Van Gaever E, Van Lierde K. Effectiveness of Speech Intervention in Patients With a Cleft Palate: Comparison of Motor-Phonetic Versus Linguistic-Phonological Speech Approaches. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:3909-3933. [PMID: 33253622 DOI: 10.1044/2020_jslhr-20-00129] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study was to compare the effect of two different speech therapy approaches, a traditional motor-phonetic approach and a linguistic-phonological approach, on the speech and health-related quality of life in Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) between 4 and 12 years old. Method A block-randomized, sham-controlled design was used. Fourteen children with a CP ± L (M age = 7.71 years) were divided into two groups using block randomization stratified by age and gender: one receiving motor-phonetic intervention (n = 7) and one receiving linguistic-phonological intervention (n = 7). Each group received 10 hr of speech therapy divided over 2 weeks. Perceptual speech assessments were performed on several baseline and posttreatment data points. The psychosocial effects of the intervention were assessed using the patient-reported Velopharyngeal Insufficiency Effects on Life Outcomes questionnaire. Both groups were compared over time using (generalized) linear mixed models. Within-group effects of time were determined using pairwise comparisons with post hoc Bonferroni correction. Results Significant Time × Group interactions with large effect sizes were revealed in terms of consonant proficiency, indicating significant differences in evolution over time among the two groups. Only in the group receiving linguistic-phonological intervention, percentage of correctly produced consonants and places significantly improved after the treatment. Total Velopharyngeal Insufficiency Effects on Life Outcomes scores of the parents significantly improved in both groups after the intervention. Conclusions Both motor-phonetic and linguistic-phonological speech interventions can have a positive impact on the occurrence of cleft speech characteristics and consonant proficiency in children with a CP ± L. A linguistic-phonological approach, however, was observed to be more effective in terms of improving these speech outcomes compared with a motor-phonetic approach. Speech intervention, irrespective of the used approach, significantly improved the participant's health-related quality of life.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Ghent University, Belgium
| | | | - Ellen Van Gaever
- Department of Rehabilitation Sciences, Ghent University, Belgium
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Kamran R, Longmire NM, Rae C, Riff KWYW, Forrest CR, O’Hara J, Bulstrode N, Klassen AF. Concepts Important to Patients With Facial Differences: A Qualitative Study Informing a New Module of the FACE-Q for Children and Young Adults. Cleft Palate Craniofac J 2020; 58:1020-1031. [DOI: 10.1177/1055665620969589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient’s perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Justine O’Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Public Perception of a Normal Head Shape in Children With Sagittal Craniosynostosis. J Craniofac Surg 2020; 31:940-944. [PMID: 32149974 DOI: 10.1097/scs.0000000000006260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
: A question that remains unanswered is at what level of surgical correction does the public perceive a head shape to be "normal" or "acceptable?" For most cases of non-syndromic asymptomatic craniosynostosis, the parents desire for surgical correction is to improve the cosmetic appearance of head shape. At the time of this writing, the intraoperative surgeons' perspective of what constitutes an acceptable head shape is the target for surgical correction. In introducing an improved objectively cosmetic goal, an appropriate outcome measure would be to assess what the general public considers a normal or acceptable head shape in children with craniosynostosis. METHOD Twenty-two unique images were presented via an online crowdsourcing survey of a severe case of non-syndromic sagittal craniosynosis gradually corrected to an age and gender matched normalized head shape. Participants were recruited via the Sick Kids Twitter account. Participants were invited to rate the head shapes as "normal" or "abnormal." RESULTS The 538 participants completed the online survey. Participants were able to reliably and consistently identify normal and abnormal head shapes with a Kappa Score >0.775. Furthermore, participants indicated that a correction of 70% is required in order for the cranial deformity to be regarded as "normal." This threshold closely reflects a normal Cranial Index, which is a widely used morphometric outcome in craniosynostosis. CONCLUSION Crowdsourcing provides an ideal method for capturing the general population's perspective on what constitutes a normal and acceptable head shape in children with sagittal craniosynostosis. Laypersons are able to reliably and consistently distinguish cranial deformities from a "normal" head shape. The public indicates a threshold correction of 70% in sagittal craniosynosis to regard it as a "normal" head shape.
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Tan RA, Schipper IE, de Vet HCW, Griot JPWD. The Submental Nasal Appearance Scale for the Assessment of Repaired Unilateral Complete Cleft Lip: A Validation Study. Cleft Palate Craniofac J 2020; 58:637-643. [PMID: 33021103 PMCID: PMC8044622 DOI: 10.1177/1055665620961968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To reassess reliability and validity of the Submental Nasal Appearance Scale (SNAS) compared to the preliminary pilot study, for assessment of patient photographs with repaired unilateral cleft lip and palate (UCLP). When utilizing the SNAS, 3 nasal features (1. nasal outline; 2. alar base position; 3. nostril axis) must be graded according to symmetry between the cleft and noncleft side using a 5-point scale with reference photographs for each feature. The mean score calculated from the graded features reflects the overall degree of nasal symmetry, which is considered an important goal when repairing UCLP. Design: Fifty patient photographs were selected and cropped, displaying the submental view. Six raters assessed these photographs using the SNAS and a separate 5-point scale to assess the overall submental appearance. Interrater reliability was determined for both methods and correlation was calculated between these as an indication of construct validity. Setting: Amsterdam UMC, location VUmc, Amsterdam, The Netherlands. Patients: Six- to 9-year-old patients with repaired UCLP. Results: Interrater reliability of 0.73 and 0.48 was found for the SNAS and overall appearance assessment, respectively, while in the pilot study values of 0.79 and 0.69 were found. Correlation of 0.59 and 0.74 was found in the current and pilot study, respectively, between the SNAS and overall appearance assessment. Conclusions: The SNAS is a reliable tool to assess nasal symmetry from the submental perspective. Reliability of the SNAS is higher compared to grading overall appearance, but validity of the SNAS was less well supported.
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Affiliation(s)
- R A Tan
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | - I E Schipper
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | - H C W de Vet
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, 1209Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - J P W Don Griot
- Department of Plastic, Reconstructive and Hand Surgery, 1209Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
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Implementing Patient-Reported Outcome Measures in Routine Cleft-Craniofacial Practice. J Craniofac Surg 2020; 32:366-367. [PMID: 32956315 DOI: 10.1097/scs.0000000000007015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Denadai R, Chen YR, Lo LJ. Three-Dimensional Computer-Assisted Single-Splint 2-Jaw Cleft Orthognathic Surgery: Toward Patient-Centered Surgical Rationale. Cleft Palate Craniofac J 2020; 57:1428-1433. [PMID: 32815390 DOI: 10.1177/1055665620949113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Skeletally mature patients with cleft lip and palate commonly present with skeletofacial deformities characterized by varying degrees of intrinsic and acquired dentoskeletal and soft tissue abnormalities. These abnormalities are associated with scarring from previous surgeries and the asymmetric midline and facial contour that impose challenges for adequate reconstruction. These patients frequently require 2-jaw orthognathic surgery to improve occlusal function and for correction of facial deformities. In this article, we have detailed a 3-dimensional computer-assisted single-splint 2-jaw orthognathic surgery technique as a surgical approach for cleft skeletofacial reconstruction, allowing for the surgery to be tailored according to the specific needs and requests of the patients. Further, we have addressed the multidimensionality and specificities of cleft treatment, the wide versatility, adaptability, and applicability of this technique, and the patient-centered rationale for the adoption of this method.
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Affiliation(s)
- Rafael Denadai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo, Brazil
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
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Identifying Factors Most Important to Lower Extremity Trauma Patients: Key Concepts from the Development of a Patient-Reported Outcome Instrument for Lower Extremity Trauma, The LIMB-Q. Plast Reconstr Surg 2020; 145:1292-1301. [PMID: 32332555 DOI: 10.1097/prs.0000000000006760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe lower extremity injuries are challenging to treat. The aspects of limb salvage and amputation most important to patients are not well-defined. This study's aim is to develop a conceptual framework for a patient-reported outcome instrument for lower extremity trauma patients, by defining issues and concepts most important to this patient population. METHODS This is an interpretative description of transcripts collected from semistructured qualitative interviews at a single institution. High-energy lower extremity trauma patients were recruited by means of purposeful sampling to maximize variability. Thirty-three participant interviews were needed to reach content saturation. These participants were aged 19 to 79 years; 21 were men (63.6 percent); participation was after reconstruction [n= 15 (45.5 percent)], after amputation [n = 11 (33.3 percent)], or after amputation after failed reconstruction [n = 7 (21.2 percent)]. Interviews were recorded, transcribed, and coded line-by-line. Concepts were labeled with major and minor themes and refined through a process of constant comparison. Analysis led to the development of a conceptual framework and item pool to inform the development of a patient-reported outcome measure. RESULTS In total, 2430 unique codes were identified and used to generate the conceptual framework covering 10 major themes: appearance, environment, finances, physical, process of care, prosthesis, psychological, sexual, social, and treatment. CONCLUSIONS This study establishes a comprehensive set of concepts, identifying what is most important to severe lower extremity trauma patients. These findings can be used to inform and focus research and clinical care, and provides the framework to develop a lower extremity trauma-specific patient-reported outcome instrument: the LIMB-Q.
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Flannery H, Jacob J. Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives. Clin Child Psychol Psychiatry 2020; 25:594-603. [PMID: 32046508 DOI: 10.1177/1359104520904120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing drive to develop and implement patient-reported outcome measures within paediatric health services, particularly for young people living with chronic health conditions; however, there is little consensus on how best to do this in meaningful ways within psychological services working alongside medical teams. This reflective commentary considers some of the challenges of collecting psychological outcome measures in paediatric services and considers alternative approaches to making outcome measurement meaningful. All measures have their limitations; however, they become meaningless if they are not used in meaningful and considered ways with young people. Client-defined outcome measurement, such as goal-based outcome measures, alongside other types of measurement, can capture outcomes of meaning to young people living with chronic health conditions, and can enable them to feed into a shared decision-making process.
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Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, University College London, UK
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Kassam SN, Perry JL, Ayala R, Stieber E, Davies G, Hudson N, Hamdan US. World Cleft Coalition International Treatment Program Standards. Cleft Palate Craniofac J 2020; 57:1171-1181. [PMID: 32573279 DOI: 10.1177/1055665620928779] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To present preliminary efforts to establish an internationally agreed set of minimum core practice and best practice guidelines, along with overarching principles to promote safe and comprehensive cleft care globally. DESIGN Representatives from 6 national and international organizations collaborated to form a World Cleft Coalition. Representatives met monthly/bimonthly to compile standards for safe, comprehensive, and sustainable cleft care. Outcomes were circulated within each organization and to a small subset of external constituents for feedback. RESULTS A series of overarching principles were established for those involved in International Cleft Treatment Programs, based on the experience of participating organizations. The overarching principles are followed by a structured and detailed Recommended Practice for Ensuring Safe, Comprehensive and Sustainable Cleft Care, which includes minimum core and best practice for the following areas: surgical safety, quality control, patient education, patient selection, patient follow-up, comprehensive care, partnership with the host nations and professionals, training and exchanges for sustainability, and local capacity building. CONCLUSIONS Outcomes aimed to provide a working document to define core principles for safe comprehensive cleft care, while balancing various levels of resources, geographic locations, appropriately trained health care professional specialists, and training limitations. The study highlights the process and benefits to a collaborative international working group not only to establish best practice but also to solicit and engage others in discussion of their experiences with building and supporting safe, high-quality, comprehensive, sustainable, worldwide cleft care.
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Affiliation(s)
- Serena N Kassam
- Dental and Pre-Surgical Division, Global Smile Foundation, Norwood, MA, USA.,Department of Pediatric Dentistry, New York University College of Dentistry, New York, NY, USA.,Clinical Assistant Professor, Division of Pediatric Dentistry, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.,Clinical Attending, Department of Pediatric Dentistry, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, CA, USA
| | - Ruben Ayala
- Operation Smile, Virginia Beach, VA, USA.,The Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (the G4 Alliance), Chicago, IL, USA
| | | | - Gareth Davies
- European Cleft Organisation, Rijswijk ZH, the Netherlands
| | - Nan Hudson
- Transforming Faces, Toronto, Ontario, Canada
| | - Usama S Hamdan
- Global Smile Foundation, Norwood, MA, USA.,Tufts University School of Medicine, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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Moi AL, Gjengedal H, Lybak K, Vindenes H. "I smile, but Without Showing My Teeth": The Lived Experience of Cleft, Lip, and Palate in Adults. Cleft Palate Craniofac J 2020; 57:799-807. [PMID: 32351124 PMCID: PMC7297502 DOI: 10.1177/1055665620922096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: To explore and describe the experience of growing up with unilateral cleft lip and palate (CLP) in adults. Design: Face-to-face interviews. Giorgi’s phenomenological method was used for analysis. Participants: Twenty-one (mean age: 40.8 years) adults treated for unilateral CLP during childhood and adolescence participated in the study. Results: Growing up with CLP meant to become aware of bodily otherness. The possible reactions from peers early in life complicated the striving for inclusion outside the close family. Being self-confident, clever in school, physically fit, and having trusted friends represented barriers against teasing and bullying. Nevertheless, the reflected image, in mirrors, windows, and photos, reminded the participants of the objectifying looks from others and often led to bodily adjustments that persisted into adulthood. The trajectory of treatment was not questioned during childhood, and the participants accepted the decisions on care made by experts and parents. Although problems related to the cleft could persist or return after the termination of ordinary treatment, a more hesitant view on the possible benefits of additional surgery was typical in adulthood. Conclusions: In retrospect, growing up with a unilateral CLP was found to have been an unquestioned part of the adult participants’ childhood, a burden that they feared would, to some extent, also be passed to their own children. However, the CLP had not prevented them from achieving goals and satisfaction in life. The occurrence of persisting psychological, functional, and esthetic challenges in adults suggests the need for an individualized, lifelong, and multidisciplinary perspective on CLP follow-up.
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Affiliation(s)
- Asgjerd Litleré Moi
- Department of Plastic, Hand and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Harald Gjengedal
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Kari Lybak
- Department of Plastic, Hand and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway
| | - Hallvard Vindenes
- Department of Plastic, Hand and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Outcomes of Surgical Management of Palatal Fistulae in Patients With Repaired Cleft Palate. J Craniofac Surg 2020; 31:e45-e50. [PMID: 31609947 DOI: 10.1097/scs.0000000000005852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The palatal fistula is an important surgical challenge within the longitudinal follow-up of patients with repaired cleft palate as the success rate of palatal fistula reconstruction by adopting several surgical techniques is variable and often unsatisfactory. The purpose of this retrospective study was to report the clinical outcomes of an algorithm for the surgical management of palatal fistulae in patients with repaired cleft palate. METHODS Consecutive patients (n = 101) with repaired cleft palate and palatal fistula-related symptoms who were treated according to a specific algorithm between 2009 and 2017 were included. Based on the anatomical location (Pittsburgh fistula types II-V), amount of scarring (minimal or severe scarred palate), and diameter of the fistula (≤5 mm or >5 mm), 1 of 3 approaches (local flaps [62.4%], buccinator myomucosal flaps [20.8%], or tongue flaps [16.8%]) was performed. For clinical outcome assessment, symptomatic and anatomical parameters (fistula-reported symptoms and residual fistula, respectively) were combined as follows: complete fistula closure with no symptoms; asymptomatic narrow fistula remained; or failure to repair the fistula ("good," "fair," or "poor" outcomes, respectively). Surgical-related complication data were also collected. RESULTS Most patients (91.1%) presented "good" clinical outcomes, ranging from 86.2% to 100% (86.2%, 100%, and 100% for local flaps, buccinator flaps, and tongue flaps, respectively). All (8.9%) "fair" and "poor" outcomes were observed in fistulae reconstructed by local flaps. All "poor" (5%) outcomes were observed in borderline fistulae (4-5 mm). No surgical-related complications (dehiscence, infections, or necrosis) were observed, except for an episode of bleeding after the 1st stage of tongue flap-based reconstruction (1.0%). CONCLUSION A high rate of fistula resolution was achieved using this algorithm for surgical management of palatal fistulae in patients with repaired cleft palate.
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Acum M, Mastroyannopoulou K, O'Curry S, Young J. The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review. Cleft Palate Craniofac J 2020; 57:990-1007. [PMID: 32174163 DOI: 10.1177/1055665620911328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify and review the literature on the psychosocial patient-reported outcomes (PROs) of surgery at the end of the cleft treatment pathway. DESIGN A systematic literature search was performed using electronic databases (Medline, PubMed, EMBASE, PsycInfo, Web of Science, and Science Direct) from database inception to September 2017, to identify studies measuring and reporting the psychosocial PROs of end of pathway cleft surgery. RESULTS Of 263 identified papers, 22 studies were eligible for inclusion. Apart from one randomized controlled study, studies were largely observational and adopted a cross-sectional or retrospective design. The majority (n = 16) were small-scale studies. The methodological quality was variable in terms of what, how, and when psychosocial outcomes were measured and reported. None of the studies utilized a psychosocial PRO measure validated in the cleft population, and few studies measured outcomes prospectively. A high proportion of studies utilized bespoke measures of patient satisfaction. Taken together, findings from the included studies are tentative but seem to suggest patients derive some benefit from undergoing end of pathway cleft surgery, in terms of increased satisfaction, quality of life, social interactions, and decreased appearance-related distress. CONCLUSIONS Due to methodological challenges and the heterogeneity of what, how, and when outcomes are measured and currently reported, it is difficult to determine the psychosocial PROs of end of pathway cleft surgeries. Consequently, this review advocates the conduct of well-designed, longitudinal studies using cleft-sensitive tool/s to capture the psychosocial PROs of end of pathway cleft surgery at various time points.
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Affiliation(s)
- Michelle Acum
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, United Kingdom.,University of East Anglia, Norwich, United Kingdom
| | - Kiki Mastroyannopoulou
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Sara O'Curry
- Psychological Medicine for Children, Young People and their Families, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Judith Young
- University of East Anglia, Addenbrooke's Cambridge University Hospital Trust, Cambridge, United Kingdom
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Klassen AF, Dalton L, Goodacre TEE, Harman KE, Slator R, Tsangaris E, Courtemanche DJ, Goldstein J, Allen GC, Mahony AO, Riff KWYW. Impact of Completing CLEFT-Q Scales That Ask About Appearance on Children and Young Adults: An International Study. Cleft Palate Craniofac J 2020; 57:840-848. [PMID: 32048868 DOI: 10.1177/1055665620902877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the impact of completing the CLEFT-Q appearance scales on patients with cleft lip and/or palate and to identify demographic and clinical characteristics and CLEFT-Q scores associated with reporting a negative impact. DESIGN International cross-sectional survey. SETTING Recruitment took place between October 2014 and November 2016 at 30 craniofacial clinics located in 12 countries. PATIENTS Aged 8 to 29 years with cleft lip and/or palate. MAIN OUTCOME MEASURE(S) Participants were asked 4 questions to evaluate the impact of completing the field test version of a patient-reported outcome measure (the CLEFT-Q) that included 154 items, of which 79 (51%) asked about appearance (of the face, nose, nostrils, teeth, lips, jaws, and cleft lip scar). RESULTS The sample included 2056 participants. Most participants liked answering the CLEFT-Q (88%) and the appearance questions (82%). After completing the appearance scales, most participants (77%) did not feel upset or unhappy about how they look, and they felt the same (67%) or better (23%) about their appearance after completing the questionnaire. Demographic and clinical variables associated with feeling unhappy/upset or worse about how they look included country of residence, female gender, more severe cleft, anticipating future cleft-specific surgeries, and reporting lower (ie, worse) scores on CLEFT-Q appearance and health-related quality-of-life scales. CONCLUSION Most participants liked completing the CLEFT-Q, but a small minority reported a negative impact. When used in clinical practice, CLEFT-Q scale scores should be examined as soon as possible after completion in order that the clinical team might identify patients who might require additional support.
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Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Louise Dalton
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Timothy E E Goodacre
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Karen E Harman
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rona Slator
- West Midlands Cleft Service, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Elena Tsangaris
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas J Courtemanche
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse Goldstein
- Plastic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory C Allen
- Department of Otolaryngology-Head & Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Aisling O Mahony
- Restorative Dentistry, National Maxillofacial Unit, St James's Hospital, Dublin, Ireland
| | - Karen W Y Wong Riff
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Rothermel A, Loloi J, Long RE, Samson T. Patient-Centered Satisfaction After Secondary Correction of the Cleft Lip and Nasal Defect. Cleft Palate Craniofac J 2020; 57:895-899. [PMID: 31983238 DOI: 10.1177/1055665619901183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate patient-reported aesthetic and psychosocial outcomes of secondary cleft lip and nose revision procedures. DESIGN Single-center cohort study. SETTING Tertiary care pediatric hospital. PATIENTS/PARTICIPANTS Patients who underwent secondary revision procedures for cleft lip and nasal defect (N = 42). INTERVENTIONS Patients were administered a survey during a routine postoperative clinic visit. MAIN OUTCOME MEASURE(S) Outcome measures were planned prior to data collection and included improvement in appearance seen in lip and nose, satisfaction with revision procedure, changes in self-confidence, likelihood to participate in social activities, and effect on teasing by peers. RESULTS Patients agreed that an improvement was seen in the appearance of their lip (1.93) and nose (1.98) following surgery. Overall, patients felt satisfied with the results of their revision procedure (1.76). An improvement in confidence and decrease in feelings of self-consciousness was reported. Patients were teased less by their peers and more likely to participate in social activities. CONCLUSIONS Secondary revision procedures of the cleft lip and nasal defect provide a patient-reported improvement in appearance and a positive psychosocial impact on patient's lives.
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Affiliation(s)
- Alexis Rothermel
- Division of Plastic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Justin Loloi
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Ross E Long
- Lancaster Cleft Palate Clinic, Lancaster, PA, USA
| | - Thomas Samson
- Division of Plastic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Stock NM, Hammond V, Hearst D, Owen T, Edwards Z, Ridley M, Rumsey N. Achieving Consensus in the Measurement of Psychological Adjustment to Cleft Lip and/or Palate at Age 8+ Years. Cleft Palate Craniofac J 2020; 57:746-752. [PMID: 31973561 DOI: 10.1177/1055665619898596] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consensus regarding optimal outcome measurement has been identified as one of the most important, yet most challenging developments for the future of cleft lip and/or palate (CL/P) services. In 2011, a process began to adopt a shared conceptual framework and to identify a set of core outcome measures for the comprehensive assessment of psychological adjustment. OBJECTIVES The aim of the current article is to outline the collaborative process used to achieve consensus in the academic and clinical measurement of psychological adjustment to CL/P from the age of 8 years onward. RESULTS A conceptual framework and corresponding parent- and self-reported outcome measures for use at ages 8, 10, 12, 15, 18, 20, and 25 years have been agreed upon by clinicians, researchers, and patient and parent representatives. All measures have been evaluated according to their psychometric properties, clinical utility, ability to produce meaningful longitudinal data, and a range of pragmatic considerations. CONCLUSIONS Although the collaborative process has been challenging and has required ongoing dedication from multiple stakeholders, consistency in data collection over time will allow for key research questions in CL/P to be addressed, both in the United Kingdom (UK) and internationally. The process has also demonstrated the clinical utility of the measures and the potential for the gradual integration of the measures into clinical practice. UK progress has sparked global interest, and the adaptation of the framework and its corresponding measures for worldwide use is now a prominent focus.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Vanessa Hammond
- South Wales Cleft Service, Morriston Hospital, Swansea, United Kingdom
| | - Daniela Hearst
- Cleft Lip and Palate Service, Great Ormond Street Hospital, London, United Kingdom
| | - Tina Owen
- South West Cleft Service, University of Bristol Dental Hospital, Bristol, United Kingdom
| | - Zoe Edwards
- Cleft Lip and Palate Service, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Pfeifauf KD, Snyder-Warwick AK, Scheve S, Grellner CL, Skolnick GB, Wilkey A, Foy J, Naidoo SD, Patel KB. One Multidisciplinary Cleft and Craniofacial Team's Experience in Shifting to Family-Centered Care. Cleft Palate Craniofac J 2020; 57:909-918. [PMID: 31950854 DOI: 10.1177/1055665619899518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Family-centered care is a high-priority focus area in health care and is associated with increased family satisfaction and quality of life, better health outcomes and family follow-up, decreased burden of care, and improved efficiency of resource utilization. Motivated by our aim to improve clinic efficiency and patient retention, our multidisciplinary cleft palate and craniofacial center has been undergoing a complex family-centered reorganization over the past 3 years. We seek to share our experience in hope the information will be a useful starting point to other teams in structuring their own family-centered improvements. We suggest the following stepwise method to achieve a more family-centered process: (1) gathering preintervention data, (2) brainstorming challenges with stakeholders, (3) brainstorming solutions with stakeholders, (4) implementation, (5) follow-up and troubleshooting, (6) further implementation, and (7) gathering postintervention data. Additionally, we found the use of institutional resources added substantial value to our efforts.
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Affiliation(s)
- Kristin D Pfeifauf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sibyl Scheve
- St. Louis Children's Hospital, St. Louis, MO, USA
| | | | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jordan Foy
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
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