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The Americleft Project: A Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort.
J Craniofac Surg. 2017 Nov; 28(8):1911-1917.JC

Abstract

The purpose of this study was to investigate ways to improve rater reliability and satisfaction in nasolabial esthetic evaluations of patients with complete unilateral cleft lip and palate (UCLP), by modifying the Asher-McDade method with use of Q-sort methodology. Blinded ratings of cropped photographs of one hundred forty-nine 5- to 7-year-old consecutively treated patients with complete UCLP from 4 different centers were used in a rating of frontal and profile nasolabial esthetic outcomes by 6 judges involved in the Americleft Project's intercenter outcome comparisons. Four judges rated in previous studies using the original Asher-McDade approach. For the Q-sort modification, rather than projection of images, each judge had cards with frontal and profile photographs of each patient and rated them on a scale of 1 to 5 for vermillion border, nasolabial frontal, and profile, using the Q-sort method with placement of cards into categories 1 to 5. Inter- and intrarater reliabilities were calculated using the Weighted Kappa (95% confidence interval). For 4 raters, the reliabilities were compared with those in previous studies. There was no significant improvement in inter-rater reliabilities using the new method. Intrarater reliability consistently improved. All raters preferred the Q-sort method with rating cards rather than a PowerPoint of photos, which improved internal consistency in rating compared to previous studies using the original Asher-McDade method. All raters preferred this method because of the ability to continuously compare photos and adjust relative ratings between patients.

Authors+Show Affiliations

*Lancaster Cleft Palate Clinic, Lancaster, PA †Ohio State University, Columbus, OH ‡Sick Kids Hospital, and University of Toronto, Toronto, Canada §Peyton Manning Children's Hospital at St. Vincent, Indianapolis, IN ||Dalhousie University/IWK Health Centre, Halifax, NS ¶Albert Einstein Medical Center, Philadelphia, PA #University of Toronto, Toronto, Canada **University of Manchester, Manchester, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28906328

Citation

Stoutland, Alicia, et al. "The Americleft Project: a Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort." The Journal of Craniofacial Surgery, vol. 28, no. 8, 2017, pp. 1911-1917.
Stoutland A, Long RE, Mercado A, et al. The Americleft Project: A Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort. J Craniofac Surg. 2017;28(8):1911-1917.
Stoutland, A., Long, R. E., Mercado, A., Daskalogiannakis, J., Hathaway, R. R., Russell, K. A., Singer, E., Semb, G., & Shaw, W. C. (2017). The Americleft Project: A Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort. The Journal of Craniofacial Surgery, 28(8), 1911-1917. https://doi.org/10.1097/SCS.0000000000003787
Stoutland A, et al. The Americleft Project: a Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort. J Craniofac Surg. 2017;28(8):1911-1917. PubMed PMID: 28906328.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Americleft Project: A Modification of Asher-McDade Method for Rating Nasolabial Esthetics in Patients With Unilateral Cleft Lip and Palate Using Q-sort. AU - Stoutland,Alicia, AU - Long,Ross E,Jr AU - Mercado,Ana, AU - Daskalogiannakis,John, AU - Hathaway,Ronald R, AU - Russell,Kathleen A, AU - Singer,Emily, AU - Semb,Gunvor, AU - Shaw,William C, PY - 2017/9/15/pubmed PY - 2018/5/17/medline PY - 2017/9/15/entrez SP - 1911 EP - 1917 JF - The Journal of craniofacial surgery JO - J Craniofac Surg VL - 28 IS - 8 N2 - The purpose of this study was to investigate ways to improve rater reliability and satisfaction in nasolabial esthetic evaluations of patients with complete unilateral cleft lip and palate (UCLP), by modifying the Asher-McDade method with use of Q-sort methodology. Blinded ratings of cropped photographs of one hundred forty-nine 5- to 7-year-old consecutively treated patients with complete UCLP from 4 different centers were used in a rating of frontal and profile nasolabial esthetic outcomes by 6 judges involved in the Americleft Project's intercenter outcome comparisons. Four judges rated in previous studies using the original Asher-McDade approach. For the Q-sort modification, rather than projection of images, each judge had cards with frontal and profile photographs of each patient and rated them on a scale of 1 to 5 for vermillion border, nasolabial frontal, and profile, using the Q-sort method with placement of cards into categories 1 to 5. Inter- and intrarater reliabilities were calculated using the Weighted Kappa (95% confidence interval). For 4 raters, the reliabilities were compared with those in previous studies. There was no significant improvement in inter-rater reliabilities using the new method. Intrarater reliability consistently improved. All raters preferred the Q-sort method with rating cards rather than a PowerPoint of photos, which improved internal consistency in rating compared to previous studies using the original Asher-McDade method. All raters preferred this method because of the ability to continuously compare photos and adjust relative ratings between patients. SN - 1536-3732 UR - https://www.unboundmedicine.com/medline/citation/28906328/The_Americleft_Project:_A_Modification_of_Asher_McDade_Method_for_Rating_Nasolabial_Esthetics_in_Patients_With_Unilateral_Cleft_Lip_and_Palate_Using_Q_sort_ L2 - http://dx.doi.org/10.1097/SCS.0000000000003787 DB - PRIME DP - Unbound Medicine ER -