Synkinesis assessment in facial palsy: validation of the Dutch Synkinesis Assessment Questionnaire.

Ingrid J Kleiss,Koen J A O Ingels,Carien H G Beurskens,Henri A M Marres,Peep F M Stalmeier

doi:10.1007/s13760-015-0528-7

Abstract

The objective of this study is to validate an existing health-related quality of life questionnaire for patients with synkinesis in facial palsy for implementation in the Dutch language and culture. The Synkinesis Assessment Questionnaire was translated into the Dutch language using a forward–backward translation method. A pilot test with the translated questionnaire was performed in 10 patients with facial palsy and 10 normal subjects. Finally, cross-cultural adaption was accomplished at our outpatient clinic for facial palsy. Analyses for internal consistency, test–retest reliability, and construct validity were performed. Sixty-six patients completed the Dutch Synkinesis Assessment Questionnaire and the Dutch Facial Disability Index. Cronbach’s α, representing internal consistency, was 0.80. Test–retest reliability was 0.53 (Spearman’s correlation coefficient, P < 0.01). Correlations with the House-Brackmann score, Sunnybrook score, Facial Disability Index physical function, and social/well-being function were −0.29, 0.20, −0.29, and −0.32, respectively. Correlation with the Sunnybrook synkinesis subscore was 0.50 (Spearman’s correlation coefficient). The Dutch Synkinesis Assessment Questionnaire shows good psychometric values and can be implemented in the management of Dutch-speaking patients with facial palsy and synkinesis in the Netherlands. Translation of the instrument into other languages may lead to widespread use, making evaluation, and comparison possible among different providers.

Highlights

Patients with facial palsy experience several problems; brow ptosis, incomplete eye closure, nasal valve collapse, oral incompetence, articulation difficulties, overall facial asymmetry, and psychosocial problems
The Synkinesis Assessment Questionnaire was translated into the Dutch language using a forward–backward translation method
The aim of this study was to create a Dutch version of the Synkinesis Assessment Questionnaire and to test its internal consistency, test–retest reliability, and construct validity for a valid use in the Dutch language and culture

Summary

Introduction

Patients with facial palsy experience several problems; brow ptosis, incomplete eye closure (leading to exposure keratopathy), nasal valve collapse, oral incompetence, articulation difficulties, overall facial asymmetry, and psychosocial problems. Facial nerve injury and recovery is often accompanied with secondary effects; crocodile tears, eye dryness, taste disturbances, and synkinesis. Three possible mechanisms for the development of synkinesis are described. The first, and most widely accepted, proposed mechanism is that of aberrant regeneration. During regeneration axons might regrow in endoneural tubes other than their original ones, innervating different muscle groups. A second mechanism is the stimulation of neighbor axons due to loss of myelin. A last possibility is hyper excitability of the facial nucleus itself [1]

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