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Mirror-Confrontation Distress After Rhinoplasty: Development and Validation of a Patient-Reported Outcome Measure
1Department of Plastic, Reconstructive and Aesthetic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkiye.
Background:
Rhinoplasty patients may experience acute psychological distress when they first see their postoperative appearance after cast removal. Although this phenomenon is widely recognized in clinical practice, it lacks a precise conceptual definition. We conceptualized this response as mirror-confrontation distress, a transient early postoperative state for which no validated patient-reported measure exists.
Objectives:
To develop and validate the Mirror-Confrontation and Early Adaptation Distress Scale (MEADS-25), a patient-reported outcome measure assessing early mirror-confrontation-related distress following rhinoplasty.
Methods:
This study was conducted in three phases. Phase 1 involved qualitative item generation through semi-structured interviews, identifying a five-domain conceptual framework. Phase 2 included cognitive debriefing to evaluate item clarity and acceptability. Phase 3 consisted of psychometric validation of the MEADS-25 in 260 patients who had undergone primary rhinoplasty. Exploratory and confirmatory factor analyses assessed structural validity. Internal consistency and test-retest reliability were evaluated. Convergent, discriminant, criterion-related, and known-groups validity were examined through correlations with established psychological and appearance-related patient-reported measures.
Results:
Exploratory factor analysis supported a five-factor structure explaining a substantial proportion of total variance. Confirmatory factor analysis demonstrated excellent model fit, supporting a second-order structure. Internal consistency and test-retest reliability were high. Convergent and discriminant validity were supported. MEADS-25 scores showed strong associations with appearance-related distress and social appearance anxiety, and moderate associations with general emotional distress measures. Known-groups analysis confirmed significant discrimination between levels of postoperative appearance-related distress.
Conclusions:
The MEADS-25 is a reliable and valid instrument for assessing early mirror-confrontation-related adaptation distress following rhinoplasty.
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