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Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery.
JAMA Facial Plast Surg. 2017 Sep 01; 19(5):406-412.JF

Abstract

Importance

Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care.

Objectives

To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL.

Design, Setting, and Participants

Prospective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment.

Main Outcomes and Measures

The main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation.

Results

Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P < .01). The VELO scores improved after surgery (P<.001) as did most subscale scores. Caregiver impact did not change after surgery (P = .36). Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P < .01) and to preoperative subscale domains (situational difficulty [VELO-SiD, P = .005] and perception by others [VELO-PO, P = .05]) and postoperative subscale domains (VELO-SiD [P = .03], VELO-PO [P = .003]). Neither the VELO total nor subscale score change after surgery was correlated with change in speech intelligibility.

Conclusions and Relevance

Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the social, emotional, and physical effects of VPI.

Level of Evidence

2.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.Division of Pediatric Otolaryngology, University of Utah, Salt Lake City.Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.Division of Pediatric Otolaryngology, University of Utah, Salt Lake City. Department of Otolaryngology-Head and Neck Surgery, Primary Children's Medical Center, Salt Lake City, Utah.Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento.

Pub Type(s)

Clinical Trial
Journal Article
Validation Study

Language

eng

PubMed ID

28727858

Citation

Bhuskute, Aditi, et al. "Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery." JAMA Facial Plastic Surgery, vol. 19, no. 5, 2017, pp. 406-412.
Bhuskute A, Skirko JR, Roth C, et al. Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery. JAMA Facial Plast Surg. 2017;19(5):406-412.
Bhuskute, A., Skirko, J. R., Roth, C., Bayoumi, A., Durbin-Johnson, B., & Tollefson, T. T. (2017). Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery. JAMA Facial Plastic Surgery, 19(5), 406-412. https://doi.org/10.1001/jamafacial.2017.0639
Bhuskute A, et al. Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery. JAMA Facial Plast Surg. 2017 Sep 1;19(5):406-412. PubMed PMID: 28727858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery. AU - Bhuskute,Aditi, AU - Skirko,Jonathan R, AU - Roth,Christina, AU - Bayoumi,Ahmed, AU - Durbin-Johnson,Blythe, AU - Tollefson,Travis T, PY - 2017/7/21/pubmed PY - 2017/10/17/medline PY - 2017/7/21/entrez SP - 406 EP - 412 JF - JAMA facial plastic surgery JO - JAMA Facial Plast Surg VL - 19 IS - 5 N2 - Importance: Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care. Objectives: To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL. Design, Setting, and Participants: Prospective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment. Main Outcomes and Measures: The main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation. Results: Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P < .01). The VELO scores improved after surgery (P<.001) as did most subscale scores. Caregiver impact did not change after surgery (P = .36). Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P < .01) and to preoperative subscale domains (situational difficulty [VELO-SiD, P = .005] and perception by others [VELO-PO, P = .05]) and postoperative subscale domains (VELO-SiD [P = .03], VELO-PO [P = .003]). Neither the VELO total nor subscale score change after surgery was correlated with change in speech intelligibility. Conclusions and Relevance: Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the social, emotional, and physical effects of VPI. Level of Evidence: 2. SN - 2168-6092 UR - https://www.unboundmedicine.com/medline/citation/28727858/Association_of_Velopharyngeal_Insufficiency_With_Quality_of_Life_and_Patient_Reported_Outcomes_After_Speech_Surgery_ L2 - https://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/10.1001/jamafacial.2017.0639 DB - PRIME DP - Unbound Medicine ER -