Multidimensionality of Patient-Reported Outcome Measures in Rhinoplasty Satisfaction

Overview

The FACE-Q rhinoplasty module for nose and nostrils, the Utrecht questionnaire and the NOSE scale are validated Dutch instruments for measuring rhinoplasty satisfaction. The study analysed what these four questionnaires actually measure and how well they detect change. It was a prospective single centre study in a consecutive group of Dutch speaking patients completing all four before surgery and at three months.

Sections of note

• Prospective single centre study; 106 Dutch speaking patients.
• Item quality was confirmed in all four questionnaires.
• Backward binary logistic regression found NOSE and the FACE-Q nose module were the best at distinguishing before from after surgery.
• Combining those two gave a specificity of 97.33 percent and a sensitivity of 94.52 percent for that distinction.
• Exploratory factor analysis identified four dimensions: appearance of the nose, appearance of the nostrils, nasal function, and psychosocial wellbeing.
• A lack of factorial invariance was detected before surgery compared with after, especially in the FACE-Q nose module and to a lesser extent the Utrecht questionnaire.
• The authors conclude the questionnaires measure different dimensions and are complementary.

What it means for a patient

• Satisfaction after rhinoplasty is not one thing; it splits into four measurable components including psychological wellbeing.
• No single questionnaire captures all four, so surgeons using only one see part of the picture.
• The lack of factorial invariance means the questionnaires may not measure quite the same thing before and after surgery, which complicates comparing the two.
• The study covers 106 patients at one centre with three month follow up.

Why this paper matters

Rhinoplasty outcome research relies on these questionnaires, and their pooled use assumes they measure comparable things. This study shows they measure different dimensions and behave differently before and after surgery. That instability before surgery is a caution for how such scores are interpreted.

Terms

• Patient reported outcome measure: a questionnaire completed by the patient rather than the clinician.
• FACE-Q: a validated set of questionnaires on satisfaction with facial appearance.
• NOSE scale: the Nasal Obstruction Symptom Evaluation questionnaire.
• Factor analysis: a statistical method identifying the underlying dimensions a set of questions measures.
• Factorial invariance: whether a questionnaire measures the same construct across different conditions.
• Sensitivity and specificity: how well a measure identifies true cases and true non cases.