Multidimensionality of Patient-Reported Outcome Measures in Rhinoplasty Satisfaction

Abstract

Background The FACE-Q rhinoplasty module (nose and nostrils), Utrecht Questionnaire and NOSE-scale are validated Dutch patient-reported outcome measures (PROMs) to evaluate rhinoplasty satisfaction. The objective of this study was to analyze the dimensionality of the measured variables in these four existing questionnaires. Additionally, we investigated the ability of the PROMS to measure change. Methods A prospective single center study was performed in a consecutive cohort of 106 Dutch-speaking patients. Patients were invited to fill in four PROMs: FACE-Q rhinoplasty module (nose and nostrils), Utrecht Questionnaire and NOSE-scale, preoperatively and 3 months postoperatively. Item quality was calculated in all four questionnaires. The ability of the questionnaires to differentiate between pre-and postoperative patients was determined with a binary logistic regression. Exploratory factor analysis was performed to determine the latent dimensions. Results Item quality was confirmed in all questionnaires. Backward binary logistic regression revealed that NOSE and FACE-Q nose module were the best discriminant factors pre- and postoperatively. Combination of these two questionnaires gave a specificity of 97,33% and a sensitivity of 94.52% to discriminate between pre-and post-operative cases. Exploratory factor analysis identified the presence of 4 dimensions: 1) cosmesis of the nose 2) cosmesis of the nostrils 3) nasal function and 4) psychosocial well-being in rhinoplasty patients. Lack of factorial invariance in the pre- as compared to the postoperative phase was detected, especially with the FACE-Q nose and to a lesser extent with the Utrecht questionnaire.

Persistent cosmetic dissatisfaction in rhinoplasty & management of the difficult patient

“…The information provides feedback to surgeons and can also be used as a tool to create a launching point of discussion for patients who might not otherwise know how to articulate their concerns. Additionally, there are many other PROMs that assess both aesthetic and functional outcomes for rhinoplasty that are beyond the scope of this review, including the Functional Rhinoplasty Outcome Inventory 17, Nasal Obstruction Symptom Evaluation (NOSE), and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) [48,49] , each of which measures different dimensions of rhinoplasty satisfaction [50] . Additionally, numerical data from such ratings have enabled standardized measures of success based on patient satisfaction amenable to systematic review and meta-analysis [51,52] .…”

Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation

“…33 As interest in PROMs has developed, an increasing number of validated instruments have become available, seeking to measure a variety of constructs. 34,35 In a 25-year review of functional rhinoplasty outcomes from 2008, 39% of included studies reported subjective patient responses, 30% of these studies used a visual analog scale (VAS), 14% used a validated patient-reported questionnaire, and 27% used objective measures. In the years following this study, there has been a trend toward increasing evidence levels in rhinoplasty outcomes reporting.…”

The Rhinoplasty Health Care Monitor: An Update on the Practical and Clinical Benefits after 10 Years of Prospective Outcome Measurements

“…The UQ is a validated questionnaire containing five questions using a five-point Likert scale. 13 Patients were categorized as having little concern about body perception in relation to nasal appearance (5)(6)(7)(8)(9)(10), moderate (11)(12)(13)(14)(15), much (16)(17)(18)(19)(20), or very much (21-25). The aesthetic VAS ranged from 0 (very ugly) to 10 (very nice).…”

“…3,4 Another obstacle originates from the selection of appropriate patient-reported outcome instruments to assess both the functional and aesthetic gain of rhinoplasty. 5,6 The absence of an objective outcome instrument as golden standard, and the lack of a global methodological consensus on rhinoplasty outcome measurements, This article is protected by copyright. All rights reserved.…”

“…patient-reported outcome instruments to assess both the functional and aesthetic gain of rhinoplasty. 5,6 The absence of an objective outcome instrument as golden standard, and the lack of a global methodological consensus on rhinoplasty outcome measurements, complicates the compilation of "big data" repositories that are needed to establish higher-quality evidence of the effectiveness of rhinoplasty. 7,8 In response to these challenges, the rhinoplasty health care monitor (RHM) was designed and implemented in 2014.…”