Development of a psychosocial perception scale and comparison of psychosocial perception of patients with extra oral defects before and after facial prosthesis.

STATEMENT OF PROBLEM: Loss of facial organs and subsequent rehabilitation affects a patient's psychological status. Understanding the perceived psychosocial aspects of quality of life among patients with missing organs and after prosthetic rehabilitation is essential, but studies that quantify this aspect are lacking. PURPOSE: The purpose of this clinical study was to develop and validate a psychosocial perception scale and compare psychosocial perception before and after the prosthetic rehabilitation of a missing facial part. MATERIAL AND METHODS: A psychosocial perception scale was developed to quantitatively measure the perceived psychosocial aspects of quality of life among patients with extraoral defects. The instrument was translated in the Hindi and Marathi Indian languages by using a forward and backward translation method. Depending on the responses obtained from the patients in the interview about the interpretation and ease of understanding, the questionnaire was modified and further pilot testing conducted. In the first phase, validation of the questionnaire was carried out with internal consistency, interdomain correlation, and intraclass correlation assessed by using the Cronbach alpha, Pearson correlation, and test retest reliability. Construct validity was established by the exploratory factor analysis. In the second phase, 32 participants were evaluated for their psychosocial response before and 3 months after prosthetic rehabilitation. Responsiveness and change in the domains scores of the psychosocial perception scale were studied by using the Wilcoxon signed-rank sum test (alpha=.05). RESULTS: The Cronbach alpha for internal consistency of overall psychosocial perception was .855 and .809 in the pretreatment and post-treatment visits consecutively. Most of the domains in the psychosocial perception scale had a Pearson correlation (r)>0.40. The domain of esthetics had r=0.84(confidence interval: .43-0.95), indicating good intraclass correlation. The domains of esthetics (P<.005), function (P<.005), positive emotions (P<.005), negative emotions (P=.011), and social and personal relationship P=.003) of the psychosocial perception scale showed statistically significant improvement in the scores after prosthetic intervention and had excellent (r>0.90) intraclass correlation. CONCLUSIONS: The psychosocial perception scale was a reliable tool to assess the patient response toward the prosthetic rehabilitation of extraoral defects. Positive improvements in the domains score (esthetics, function, positive emotions, and social and personal relationship) contributed to better perception after prosthetic rehabilitation.