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Validation of a Patient-Graded Instrument for Facial Nerve Paralysis: The FaCE Scale

Authors

  • Jeffrey B. Kahn MD,

    Corresponding author
    1. Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas
    • Jeffrey B. Kahn, MD, Department of Otolaryngology, Baylor College of Medicine, One Baylor Plaza, Box SM 1727, Houston, TX 77030, U.S.A.

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  • Richard E. Gliklich MD,

    1. The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
    2. The Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • K. Paul Boyev MD,

    1. The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
    2. The Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Michael G. Stewart MD, MPH,

    1. Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas
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  • Ralph B. Metson MD,

    1. The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
    2. The Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Michael J. McKenna MD

    1. The Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
    2. The Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Presented at the 103rd Annual Meeting of the American Laryngological, Rhinological and Otological Society, Inc., Orlando, Florida, May 15–17, 2000.

Abstract

Objective To develop and validate a patient-based instrument to measure both facial impairment and disability, the Facial Clinimetric Evaluation (FaCE) Scale.

Study Design Prospective instrument validation.

Methods Eighty-six patients with a documented history of facial paralysis completed a preliminary, 51-item instrument (alpha FaCE Scale), as well as the previously developed Facial Disability Index (FDI) and the Medical Outcomes Study Short Form 36 Item Questionnaire (SF-36). Two weeks after completing these instruments, 76 patients again completed the alpha FaCE Scale. Forty-one of the patients were also evaluated using the House-Brackmann Grading System (HBGS) and the Facial Grading System (FGS).

Results Exploratory principal component factor analysis grouped 15 FaCE Scale items into 6 impairment and disability categories (domains), forming the beta FaCE Scale. Overall, the test-retest reliability of the FaCE Scale was high (Spearman's correlation coefficient (r) = 0.88, P <.01), as were the reliability coefficients of the individual domains (r = 0.81–0.92, P <.01). The FaCE Scale domains showed appropriate correlation to global visual analogue scale questions posed on the original alpha FaCE Scale (r = 0.65–0.81, P <.01). Overall, the FaCE Scale showed significant correlation with HBGS and FGS scores (r = −0.55 and 0.57, respectively;P <.01). However, not all FaCE Scale domains correlated with the HBGS and FGS scores.

Conclusions A reliable and valid patient-based system to measure impairment and disability in facial paralysis has been developed. This system appears to be better than traditional, physician-graded scales for evaluating quality-of-life issues affected by facial disability.

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