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CLEFT-Q: Detecting Differences in Outcomes among 2434 Patients with Varying Cleft Types
Karen W Y Wong Riff1, Elena Tsangaris1, Christopher R Forrest1
1From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto; the Departments of Pediatrics, Surgery, and Health Research Methods, Evidence and Impact, McMaster University; the Spires Cleft Center, Oxford University Hospitals NHS Foundation Trust; the Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine; the Division of Plastic Surgery, Department of Surgery, University of British Columbia, BC Children's Hospital; the Department of Plastic Surgery, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh; the National Maxillofacial Unit, St. James' Hospital; the Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; West Midlands Cleft Service, Birmingham Children's Hospital; and Fundación Operación Sonrisa Colombia and Division of Plastic Surgery, Universidad el Bosque.
Background:
Measuring the patient perspective is important in evaluating outcomes of cleft care. Understanding how treatment outcomes vary depending on cleft type may allow for better planning of treatments, setting of expectations, and more accurate benchmarking efforts. The CLEFT-Q is a patient-reported outcome measure for patients with cleft lip and/or palate.
Methods:
The 12 CLEFT-Q scales measuring appearance (i.e., face, nose, nostrils, lips, cleft lip scar, teeth, and jaws), function (i.e., speech), and health-related quality of life (i.e., psychological, school, social, and speech-related distress) were field tested in a cross-sectional study in 30 centers in 12 countries. Patients with cleft lip and/or cleft palate aged 8 to 29 years were recruited from clinical settings. Differences in CLEFT-Q scores by cleft subtypes were evaluated using one-way analysis of variance or Kruskal-Wallis H tests, with Tukey or Dunn procedure with Bonferroni corrections post hoc analyses, respectively. Scores are presented using radar charts to visualize all outcomes simultaneously.
Results:
The field test included 2434 patients. Scores on all CLEFT-Q scales varied significantly with cleft subtype. Patients with unilateral or bilateral cleft lip and/or palate scored lower on all appearance scales compared with patients with cleft palate or unilateral incomplete cleft lip. Scores on the speech function and speech-related distress scales decreased with each progressive group in the Veau classification. Patients with complete bilateral cleft lip and palate scored lowest on the social, school, and psychological scales.
Conclusions:
Patient-reported outcomes measured with the CLEFT-Q vary significantly with cleft type. Visualizing multiple outcomes simultaneously with radar charts allows for an understanding of a patient's overall status in a single graph.
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