title: Association of Facial Paralysis-Related Disability With Patient- and Observer-Perceived Quality of Life.
abstract: OBJECTIVE
  The interaction between patient- and observer-perceived quality of life (QOL) and facial paralysis-related disability and the resulting effect of these interactions on social perception are incompletely understood.
  
  
  OBJECTIVE
  To measure the associations between observer-perceived disability and QOL and patient-perceived disability and QOL in patients with facial paralysis.
  
  
  METHODS
  This prospective study in an academic tertiary referral center included 84 naive observers who viewed static and dynamic images of faces with unilateral, House-Brackmann grades IV to VI facial paralysis (n = 16) and demographically matched images of nonparalyzed control individuals (n = 4). Data were collected from June 1 to August 1, 2014, and analyzed from August 2 to December 1, 2014.
  
  
  METHODS
  Observers rated the patient and control images in 6 clinically relevant domains. The patients self-reported their disability and QOL using validated tools, such as the Facial Clinimetric Evaluation Scale. Quality of life, severity of paralysis, and disability were measured on a 100-point visual analog scale.
  
  
  RESULTS
  The 84 observers (59 women [70%] and 25 men [30%]) ranged in age from 20 to 68 years (mean [SD] age, 35.2 [11.9]). Structural equation modeling showed that for each 1-point decrease in a patient's Facial Clinimetric Evaluation Scale score, the patient's visual analog scale QOL improved by 0.36 (SE, 0.03; 95% CI, 0.31-0.42) points. Similarly, from an observer perspective, as the perceived disability (-0.29 [SE, 0.04; 95% CI, -0.36 to -0.22]) and severity (-0.21 [SE, 0.03; 95% CI, -0.28 to -0.14]) decreased, the perceived QOL improved. Furthermore, attractive faces were viewed as having better QOL (disability, severity, and attractiveness regression coefficients, -0.29 [SE, 0.04; 95% CI, -0.36 to -0.22], -0.21 [SE, 0.03; 95% CI, -0.28 to -0.14], and 0.32 [SE, 0.03; 95% CI, 0.26 to 0.39], respectively). An inverse association was found between a paralyzed patient's self-reported QOL rating and the observers' perceived QOL. This association was complex and was mediated through perceived severity and disability. Observers judged the severity of paralyzed faces to be 3.61 (SE, 1.80; 95% CI, 0.09-7.14) points more severe when viewing dynamic rather than static images.
  
  
  CONCLUSIONS
  Observers were more likely to rate QOL lower owing to disability than were the patients with paralysis. This finding may be explained by previous literature reporting that disabled people adjust their values to accommodate their disability, thereby limiting the negative effect on their QOL. Given the importance of QOL on social interaction, the dissonance between observers and patients in this area has important implications for the socialization of patients with facial paralysis.
  
  
  METHODS
  NA.
authors.affiliation: Medical student, Morehouse School of Medicine, Atlanta, Georgia.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Goines
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Ishii
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Dey
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Maria
authors.initials: M
authors.lastname: Phillis
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Byrne
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Kofi D O
authors.initials: KD
authors.lastname: Boahene
authors.affiliation: Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005158:Facial Paralysis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012938:Social Perception