Patient reported outcome measures for soft tissue facial reconstruction: a systematic review and evaluation of the quality of their measurement properties

Background: A patient's health-related quality of life (HRQoL) can be significantly impacted by facial scarring and disfigurement. Facial soft tissue reconstruction should aim to improve HRQoL, with outcomes measured from the patient's perspective using patient-reported outcome measures (PROMs). This systematic review identifies PROMs for soft tissue facial reconstruction and appraises their methodological and psychometric properties using up-to-date methods. Methods: A systematic search of MEDLINE, EMBASE, PsychINFO and Cochrane was performed in line with the PRISMA guidelines. Identified PROMs were assessed using the updated COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) checklist. Psychometric properties were also assessed and a modified GRADE analysis was performed to aid in recommendations for future PROM use. Results: Thirty-four studies covering 9 PROMs were included. Methodological quality and psychometric evidence was variable. FACE-Q, Skin Cancer Index (SCI), Patient Outcome of Surgery – Head/Neck (POS-Head/Neck) and the Derriford Appearance Scale 59/24 all demonstrated high enough evidence to be recommended as having potential for inclusion in future studies. Conclusion: This is the first systematic review to identify and critically appraise PROMs for soft tissue facial reconstruction using internationally accepted criteria. Four PROMs were deemed to have adequate levels of methodological and psychometric evidence, although further studies should be conducted before their routine use in patients undergoing facial reconstruction. Through the use of psychometrically well-validated PROMs it is hoped that patients' concerns can be truly appreciated, level of care improved, and the quality of reconstructive options offered progressed. Meetings: This work has not yet been presented at any meetings. Acknowledgements: We would like to acknowledge the help of Anne Powell, retired librarian at Abertawe Bro Morgannwg University Health Board. Conflicts of Interest and Funding: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. This work has received no specific funding. Mr Thomas Dobbs is funded by the Welsh Clinical Academic Training Fellowship. Author role: TD, HH and ISW developed the idea for this systematic review. TD, JG, AT, BP performed the literature review and data extraction. TD and SH assessed all included papers according to the methodology. TD produced the first draft of the manuscript and all authors were then involved in editing to reach the final, submitted version. Corresponding Author: Mr Thomas Dobbs, The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea. SA6 6NL, e: tomdobbs@doctors.org.uk ©2018American Society of Plastic Surgeons