An International Collaborative Standardizing Patient-Centered Outcome Measures in Pediatric Facial Palsy

Daniel P. Butler, Alethse De La Torre, Gregory H. Borschel, Tessa A. Hadlock, Carien Beurskens, Kathleen Bogart, Alexander Cárdenas Mejía, Christopher Coombs, Jocelyne Copeland, Jacqueline Diels, Teresa González-Otero, Louise Graham, Lisa Ishii, Raman Malhotra, Adelaida Martinez, Lisa McKinley, Mara W. Robinson, Sinikka Suominen, Akihiko Takushima, Evangelina Vazquez CurielFaye L. Wachs, Adriaan O. Grobbelaar

Research output: Contribution to journalArticle


Importance: Standardization of outcome measurement using a patient-centered approach in pediatric facial palsy may help aid the advancement of clinical care in this population. Objective: To develop a standardized outcome measurement set for pediatric patients with facial palsy through an international multidisciplinary group of health care professionals, researchers, and patients and patient representatives. Design, Setting, and Participants: A working group of health care experts and patient representatives (n = 21), along with external reviewers, participated in the study. Seven teleconferences were conducted over a 9-month period between December 3, 2016, and September 23, 2017, under the guidance of the International Consortium for Health Outcomes Measurement, each followed with a 2-round Delphi process to develop consensus. This process defined the scope, outcome domains, measurement tools, time points for measurements, and case-mix variables deemed essential to a standardized outcome measurement set. Each teleconference was informed by a comprehensive review of literature and through communication with patient advisory groups. Literature review of PubMed was conducted for research published between January 1, 1981, and November 30, 2016. Main Outcomes and Measures: The study aim was to develop the outcomes and measures relevant to children with facial palsy as opposed to studying the effect of a particular intervention. Results: The 21 members of the working group included pediatric facial palsy experts from 9 countries. The literature review identified 1628 papers, of which 395 (24.3%) were screened and 83 (5.1%) were included for qualitative evaluation. A standard set of outcome measurements was designed by the working group to allow the recording of outcomes after all forms of surgical and nonsurgical facial palsy treatments among pediatric patients of all ages. Unilateral or bilateral, congenital or acquired, permanent or temporary, and single-territory or multiterritory facial palsy can be evaluated using this standard set. Functional, appearance, psychosocial, and administrative outcomes were selected for inclusion. Clinimetric and psychometric outcome measurement tools (clinician-, patient-, and patient proxy-reported) and time points for measuring patient outcomes were established. Eighty-six independent reviews of the standard set were completed, and 34 (85%) of the 40 patients and patient representatives and 44 (96%) of the 46 health care professionals who participated in the reviews agreed that the standard set would capture the outcomes that matter most to children with facial palsy. Conclusions and Relevance: This international collaborative study produced a free standardized set of outcome measures for evaluating the quality of care provided to pediatric patients with facial palsy, allowing benchmarking of clinicians, comparison of treatment pathways, and introduction of value-based reimbursement strategies in the field of pediatric facial palsy. Level of Evidence: NA.

Original languageEnglish (US)
Pages (from-to)351-358
Number of pages8
JournalJAMA Facial Plastic Surgery
Issue number5
StatePublished - Sep 1 2019


ASJC Scopus subject areas

  • Surgery

Cite this

Butler, D. P., De La Torre, A., Borschel, G. H., Hadlock, T. A., Beurskens, C., Bogart, K., Cárdenas Mejía, A., Coombs, C., Copeland, J., Diels, J., González-Otero, T., Graham, L., Ishii, L., Malhotra, R., Martinez, A., McKinley, L., Robinson, M. W., Suominen, S., Takushima, A., ... Grobbelaar, A. O. (2019). An International Collaborative Standardizing Patient-Centered Outcome Measures in Pediatric Facial Palsy. JAMA Facial Plastic Surgery, 21(5), 351-358.