Comparing Patient, Casual Observer, and Expert Perception of Permanent Unilateral Facial Paralysis.
Comparing Patient, Casual Observer, and Expert Perception of Permanent Unilateral Facial Paralysis.
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DOI：
10.1001/jamafacial.2016.1630
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发表时间：
2017-12-01
影响因子：
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通讯作者：
Ishii M
中科院分区：
文献类型：
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作者：
Dey JK;Ishii LE;Nellis JC;Boahene KDO;Byrne PJ;Ishii M
面瘫患者，不经意的观察者和专家之间的感知差异可能对结果研究和患者护理产生影响。比较临时观察者和专家感知的多个领域与永久性单侧面瘫患者的实际经验。这项研究是一项前瞻性队列研究，在学术三级转诊中心进行。从约翰霍普金斯大学面部整形和重建外科诊所随机选择永久性单侧面瘫患者（House-Brackmann IV至VI级）。招募了一组不同的临时观察者和专家来评估他们对每个面瘫患者的看法。研究日期为2014年7月至2015年7月。患者使用已建立的指标评估他们的瘫痪严重程度、吸引力、生活质量和影响。临时观察员和专家观看了每位患者的标准化面部视频，然后使用相同的指标来评估每位患者的瘫痪严重程度，吸引力，生活质量和影响。该分析为研究中的每个结局指标提供了40个患者观察结果、6400个临时观察结果和200个专家观察结果。与患者的自我感知相比，随意的观察者和专家在所有测量领域中对面瘫患者的评价更负面。多变量混合效应回归显示，观察者认为患者的瘫痪严重程度更高（8.49 [95%CI，-0.65至17.64]/100点; SE，4.67），吸引力较低（-7.71 [95%CI，-14.92至-0.50]，100分; SE，3.68），生活质量较差（-7.76 [95%CI，-14.18至-1.34]/100分; SE，3.28）与患者的感知相比。Logistic回归分析显示，与患者的自我评定相比，观察者不太可能将患者的情感评定为积极的（比值比，0.28 [95%CI，0.14-0.58]; SE，0.10）。原始数据和回归分析还表明，患者，不经意的观察者，和专家认为更高的豪斯-Brackmann等级的脸更负面的面部知觉的所有测量域。这项研究发现，不经意的观察者和专家通常对面瘫患者的看法比患者对自己的看法更消极。这些发现对患者和面部整形外科医生都有意义。他们还强调了从所有三个角度评估结果的重要性。这项试点研究为开发新的工具来评估面部畸形的社会感知奠定了基础，这可能会导致面瘫结果研究的进步，并改善面瘫患者的护理。NA.
Differences in perception of facial paralysis among patients, casual observers, and experts may have implications for outcomes research and patient care. To compare multiple domains of casual observer and expert perception with the actual experience of patients with permanent unilateral facial paralysis. This investigation was a prospective cohort study conducted at an academic tertiary referral center. Patients with permanent unilateral facial paralysis (House-Brackmann grades IV to VI) were randomly selected from The Johns Hopkins University Division of Facial Plastic and Reconstructive Surgery clinic. A diverse group of casual observers and experts were recruited to rate their perception of each patient with facial paralysis. The study dates were July 2014 to July 2015. Patients rated their paralysis severity, attractiveness, quality of life, and affect using established metrics. Casual observers and experts viewed standardized facial videos of each patient and then used the same metrics to rate each patient’s paralysis severity, attractiveness, quality of life, and affect. The analysis yielded 40 patient observations, 6400 casual observer observations, and 200 expert observations for each outcome metric in the study. Compared with the patients’ self-perception, casual observers and experts rated patients with facial paralysis more negatively in all measured domains. A multivariable mixed-effects regression showed that observers perceived patients as having greater paralysis severity (8.49 [95% CI, −0.65 to 17.64] of 100 points; SE, 4.67), being less attractive (−7.71 [95% CI, −14.92 to −0.50] of 100 points; SE, 3.68), and having a worse quality of life (−7.76 [95% CI, −14.18 to −1.34] of 100 points; SE, 3.28) compared with the patients’ perceptions. Logistic regression demonstrated that observers were less likely to rate patients’ affect as positive (odds ratio, 0.28 [95% CI, 0.14–0.58]; SE, 0.10) compared with the patients’ self-rating. The raw data and regression analyses also showed that patients, casual observers, and experts perceived faces with higher House-Brackmann grades more negatively in all measured domains of facial perception. This study found that casual observers and experts generally perceive patients with facial paralysis more negatively than patients perceive themselves. These findings have implications for patients and facial plastic surgeons alike. They also emphasize the importance of assessing outcomes from all 3 perspectives. This pilot study lays the groundwork for developing new tools to assess the social perception of facial deformity that could lead to advancement in facial paralysis outcomes research and improved care for patients with facial paralysis. NA.