Association of Socioeconomic, Personality, and Mental Health Factors With Health-Related Quality of Life in Patients With Facial Palsy | Facial Nerve | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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    Original Investigation
    February 13, 2020

    Association of Socioeconomic, Personality, and Mental Health Factors With Health-Related Quality of Life in Patients With Facial Palsy

    Author Affiliations
    • 1Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
    • 2Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
    • 3Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
    JAMA Otolaryngol Head Neck Surg. 2020;146(4):331-337. doi:10.1001/jamaoto.2019.4559
    Key Points

    Question  What is the association of socioeconomic, personality, and mental health factors with health-related quality of life in patients with facial palsy?

    Findings  This cross-sectional study found that health-related quality of life among 121 patients with facial palsy at a tertiary referral center for facial reanimation surgery appeared to be associated with age, bilateral facial palsy, severity of facial palsy, mental distress, and the personality traits of extraversion, conscientiousness, and emotional stability.

    Meaning  It is important to assess socioeconomic, personality, and mental health factors when investigating health-related quality of life before and after facial palsy intervention to better interpret the results and evaluate treatment.


    Importance  Knowledge of factors associated with health-related quality of life in patients with facial palsy may aid in better interpreting outcomes of research and treatment.

    Objective  To identify factors associated with health-related quality of life in patients with facial palsy.

    Design, Setting, and Participants  The inclusion period for participants in this cross-sectional study at the University Medical Center Groningen, a tertiary referral center for facial reanimation surgery, was March 1 to June 1, 2019. Patients aged at least 18 years with facial palsy who had undergone surgery for facial palsy between January 1, 2007, and January 1, 2018, and patients visiting the outpatient clinic of the University of Groningen Department of Plastic Surgery for their facial palsy between March 1 and June 1, 2019, were also asked to participate. Of 276 patients invited, 145 gave informed consent. Twenty patients did not respond after consent, 3 patients withdrew from the study, and 1 patient was wrongly included.

    Main Outcomes and Measures  Health-related quality of life was measured using the Facial Clinimetric Evaluation Scale and the Facial Disability Index (physical score and social score). Facial function was assessed with the Sunnybrook Facial Grading System. Other variables were investigated using validated questionnaires, including the Duke University Religion Index, Ten-Item Personality Inventory, and Hospital Anxiety and Depression Scale. Multivariable linear regression analyses with stepwise backward selection were performed to identify associations with health-related quality of life. Because 44 Sunnybrook composite scores were missing, a sensitivity analysis was performed that excluded the Sunnybrook composite scores from the multivariable analysis.

    Results  In total, 121 patients with facial palsy were included; their median age was 62 years (interquartile range, 48-71 years), and 63 (52%) were women. Sunnybrook composite score (β = 0.4; 95% CI, 0.2-0.5), extraversion (β = 2.6; 95% CI, 0.4-4.8), and anxiety (β = −2.4; 95% CI, −4.1 to −0.8) were associated with the Facial Clinimetric Evaluation Scale total score (R2 = 0.380; 95% CI, 0.212-0.548). The Sunnybrook composite score was associated with the Facial Disability Index physical score (β = 0.2; 95% CI, 0.0-0.4) (R2 = 0.084; 95% CI, −0.037 to 0.205). Bilateral facial palsy (β = −21.2; 95% CI, −32.3 to −10.1), extraversion (β = 2.7; 95% CI, 1.3-4.1), conscientiousness (β = 2.7; 95% CI, 0.2-5.2), emotional stability (β = 3.3; 95% CI, 1.7-4.8), and depression (β = −1.3; 95% CI, −2.5 to −0.1) were associated with the Facial Disability Index social score (R2 = 0.400; 95% CI, 0.262-0.538). In the sensitivity analysis, the Sunnybrook composite score was associated with age (Spearman ρ = −0.252).

    Conclusions and Relevance  Bilateral facial palsy, age, severity of facial palsy, mental distress, and personality traits should be taken into account in future research and treatment of patients with facial palsy.