Patient reported outcome measures for soft tissue facial reconstruction: a systematic review and evaluation of the quality of their measurement properties
Authors:
Dobbs, T. D., Gibson, J. A. G., Hughes, S., Thind, A., Patel, B., Hutchings, H. A., and Whitaker, I.
Abstract:
BACKGROUND: A patient's health-related quality of life (HRQoL) can be significantly impacted by facial scarring and disfigurement. Facial soft tissue reconstruction should aim to improve HRQoL, with outcomes measured from the patient's perspective using patient-reported outcome measures (PROMs). This systematic review identifies PROMs for soft tissue facial reconstruction and appraises their methodological and psychometric properties using up-to-date methods.
METHODS: A systematic search of MEDLINE, EMBASE, PsychINFO and Cochrane was performed in line with the PRISMA guidelines. Identified PROMs were assessed using the updated COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist. Psychometric properties were also assessed and a modified GRADE analysis was performed to aid in recommendations for future PROM use.
RESULTS: Thirty-four studies covering 9 PROMs were included. Methodological quality and psychometric evidence was variable. FACE-Q, Skin Cancer Index (SCI), Patient Outcome of Surgery - Head/Neck (POS-Head/Neck) and the Derriford Appearance Scale 59/24 all demonstrated high enough evidence to be recommended as having potential for inclusion in future studies.
CONCLUSION: This is the first systematic review to identify and critically appraise PROMs for soft tissue facial reconstruction using internationally accepted criteria. Four PROMs were deemed to have adequate levels of methodological and psychometric evidence, although further studies should be conducted before their routine use in patients undergoing facial reconstruction. Through the use of psychometrically well-validated PROMs it is hoped that patients' concerns can be truly appreciated, level of care improved, and the quality of reconstructive options offered progressed.
