Background & Aims
Pain after trauma has been solicitude since time immemorial. Maxillofacial trauma(MFT) includes bony facial injuries causing surmountable pain due to its physiological role. Open reduction Internal Fixation and closed reduction are standard treatment protocols. 1-3
Pain quantification in MFT patients as MCID and its role in patients satisfaction will help surgeons to provide patient-centric care. Minimal Clinical Important Difference MCID is meaningful change (improvement or deterioration) of any clinically relevant parameter, in patient’s perspective4. MCID has been established for dyspnoea, pain, and function in orthopedic and pulmonary patients 5, 6 MFT patients form a different sect of population, and their MCID has never been determined. Further pain may predict patients’ satisfaction, this was done by Patient’s Acceptable Symptomatic State (PASS)6. Our study aimed to determine MCID of pain, assessed PASS and evaluated pain as a predictor of patient’s satisfaction in MFT.
Methods
A single-center prospective study was designed and included 120 MFT patients and was rendered standard of care as per AO principles. A detailed structured proforma containing, socio-demographics, type and etiology of fractures, rendered treatment, and relevant clinical and radiographic parameters were assessed. Preoperative (T1) and 4 weeks postoperative (T2) pain scores as VAS-NRS were recorded. All the patients were evaluated by a 4-item question assessing the pain improvement after treatment on a Likert scale at T2, which served as an anchor instrument to determine MCID. Further, a 4-item patient satisfaction Tubach’s anchor instrument was used to assess patient satisfaction at T2. MCID of pain was calculated using Change difference and ROC curve method of anchor-based approach. PASS score was calculated as 75th percentile of VAS NRS pain score who were satisfied with treatment. Further pain was assessed as a predictor of satisfaction using logistic regression analysis.
Results
Study participants mean age was 31.7 ± 11.9 years. The study participants comprised 90 males (94.73%) and 5 females (5.27%) and were managed with closed reduction (9.17%) or ORIF (90.83%). The mean VAS NRS was 8.21± 1.23 T1 which improved to 1.53 ± 0.94 at T2. The MCID of pain on VAS-NRS was 2.4 by the change difference method and 2.5 by the ROC curve method (Sensitivity of 91.7% and specificity of 61.1%). The estimated PASS was 2 on VAS-NRS. The patient satisfaction with treatment was rated as “Good” by 30% (36/120) subjects and “Excellent” by 70% (84/120) subjects. A logistic regression model with patient-reported satisfaction as the outcome revealed pain (p < 0.01) as a significant predictor of patient satisfaction.
Conclusions
With this study we have established MCID of pain by two methods and values have come close enough. Further pain in MFT patients came out to be a significant predictor for patient satisfaction. There is an increasing need to use Patient-related outcome measures(PROs) like MCID, PASS and patient satisfaction predictors as true measures of treatment success in addition to objective clinical and radiographic criteria evaluated by surgeons.
References
1.Agarwal P, Mehrotra D, Agarwal R, Kumar S, Pandey R. Patterns of Maxillofacial Fractures in Uttar Pradesh, India. Craniomaxillofac Trauma Reconstr. 2017 Mar;10(1):48–55.
2. Bakardjiev A, Pechalova P. Maxillofacial fractures in Southern Bulgaria – a retrospective study of 1706 cases. J Craniomaxillofac Surg. 2007 Apr;35(3):147–50.
3. Kieser J, Stephenson S, Liston PN, Tong DC, Langley JD. Serious facial fractures in New Zealand from 1979 to 1998. Int J Oral Maxillofac Surg. 2002 Apr;31(2):206–9.
4.Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989 Dec;10(4):407–15.
5.Ekström, Magnus & Bornefalk, Hans & Sköld, C. & Janson, Christer & Blomberg, Anders & Bornefalk-Hermansson, Anna & Igelström, Helena & Sandberg, Jacob & Sundh, Josefin. (2020). Minimal Clinically Important Differences and Feasibility of Dyspnea-12 and the Multidimensional Dyspnea Profile in Cardiorespiratory Disease. Journal of Pain and Symptom Management. 60. 10.1016/j.jpainsymman.2020.05.028.
6.Kvien TK, Heiberg T, Hagen KB. Minimal clinically important improvement/difference (MCII/MCID) and patient acceptable symptom state (PASS): what do these concepts mean? Ann Rheum Dis. 2007 Nov;66 Suppl 3:iii40-41.
Presenting Author
Kirti Chaudhry
Poster Authors
Topics
- Assessment and Diagnosis