Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
e1006
Jou nal sec ion: O al Su ge y
Publica ion Types: Resea ch
Facial disabili y index (FDI): Adap a ion o Spanish, eliabili y and alidi y
Edua do Gonzalez-Ca de o 1, Ped o In an e-Cossio 2, Au elio Cayuela 3, Manuel Acos a-Fe ia 4, Jose-Luis
Gu ie ez-Pe ez 2
1 Residen , Depa men o O al and Maxillo acial Su ge y, Vi gen del Rocio Uni e si y Hospi al, Se ille, Spain
2 P o esso , Depa men o O al and Maxillo acial Su ge y, Vi gen del Rocio Uni e si y Hospi al, Se ille, Spain
3 Public Heal h Technician, Sou h Heal h Dis ic , Se ille, Spain
4 S a Su geon, Depa men o O al and Maxillo acial Su ge y, San a Lucia Uni e si y Hospi al, Ca agena (Mu cia), Spain
Co espondence:
Depa men o O al y Maxilo acial Su ge y
Vi gen del Rocio Uni e si y Hospi al
A . Manuel Siu o . 41013-Se ille, Spain
pin an [email protected]
Recei ed: 06/11/2011
Accep ed: 07/02/2012
Abs ac
Objec i es: To adap o Spanish he acial disabili y index (FDI) desc ibed by VanSwea ingen and B ach in 1995
and o assess i s eliabili y and alidi y in pa ien s wi h acial ne e pa esis a e pa o idec omy.
S udy Design: The p esen s udy was conduc ed in wo di e en s ages: a) c oss-cul u al adap a ion o he ques-
ionnai e and b) c oss-sec ional s udy o a con ol g oup o 79 Spanish-speaking pa ien s who su e ed acial
pa esis a e supe icial pa o idec omy wi h acial ne e p ese a ion. The c oss-cul u al adap a ion p ocess com-
p ised he ollowing s ages: (I) ini ial ansla ion, (II) syn hesis o he ansla ed documen , (III) e o- ansla ion,
(IV) e iew by a boa d o expe s, (V) pilo s udy o he p e- inal d a and (VI) analysis o he pilo s udy and
inal d a .
Resul s: The eliabili y and in e nal consis ency o e e y one o he a ing scales included in he FDI (C onbach’s
alpha coe icien ) was 0.83 o he comple e scale and 0.77 and 0.82 o he physical and he social well-being
subscales. The analysis o he ac o ial alidi y o he main componen s o he adap ed FDI yielded simila esul s
o he o iginal ques ionnai e. Bi a ia e co ela ions be ween FDI and House-B ackmann scale we e posi i e. The
a iance pe cen age was calcula ed o all FDI componen s.
Conclusions: The FDI ques ionnai e is a speci ic ins umen o assessing acial neu omuscula dys unc ion which
becomes a use ul ool in o de o de e mine quali y o li e in pa ien s wi h acial ne e pa alysis. Spanish adap ed
FDI is equi alen o he o iginal ques ionnai e and shows simila eliabili y and alidi y. The p o en ep oducibi-
li y, eliabili y and alidi y o his ques ionnai e make i a use ul addi ional ool o e alua ing he impac o acial
ne e pa alysis in Spanish-speaking pa ien s.
Key wo ds: Pa o idec omy, acial ne e pa alysis, acial disabili y.
Gonzalez-Ca de o E, In an e-Cossio P, Cayuela A, Acos a-Fe ia M, Gu ie-
ez-Pe ez JL. Facial disabili y index (FDI): Adap a ion o Spanish, eliabili y
and alidi y. Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12.
h p://www.medicinao al.com/medo al ee01/ 17i6/medo al 17i6p1006.pd
A icle Numbe : 18054 h p://www.medicinao al.com/
© Medicina O al S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946
eMail: [email p o ec ed]
Indexed in:
Science Ci a ion Index Expanded
Jou nal Ci a ion Repo s
Index Medicus, MEDLINE, PubMed
Scopus, Embase and Emca e
Indice Médico Español
doi:10.4317/medo al.18054
h p://dx.doi.o g/doi:10.4317/medo al.18054
Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
e1007
In oduc ion
Facial ne e pa alysis is he main complica ion o su gi-
cal ea men o pa o id gland umo s. As a esul , p e-
se a ion o acial ne e unc ion is a key objec i e in
his ype o in e en ion. Se e al s udies on acial ne e
unc ion ollowing pa o idec omy show ha a empo-
a y pa alysis o pa esis is common and occu s in be-
ween 17 and 64.4% o pa ien s (1-5), wi h an incidence
o pe manen pa alysis anging be ween 0 and 5.5%.
Al hough he acial ne e is kep in ac a e su ge y, pa-
ien s expe ience a acial pa esis o ansien ne e pa aly-
sis which usually has a s ong unc ional and socio-labo al
impac in hem. Pa ien s equen ly complain o impai ed
speech, di icul y ea ing, di icul y closing eyelids and/o
lips, aes he ic de o mi y o he ace, d ibbling, e c. Symp-
oms imp o e g adually in days o weeks un il comple e
eco e y o acial ne e unc ion is achie ed. Quali y o
li e in ela ion o acial ne e pa alysis e e s o he subjec-
i e assessmen pa ien s make o di e en aspec s o hei
daily li e which a ec hei heal h condi ion be o e hey
ge he ull unc ionali y o he acial ne e.
Quali y o li e is assessed by means o a se ies o ques-
ionnai es o scales which include i ems o ques ions dis-
ibu ed in o domains o ields and which a e analysed
ei he indi idually o globally. Gene al ques ionnai es
o measu e quali y o li e like he SF-36 (Sho Fo m 36
Heal h Su ey) o he HRLQ (Heal h Rela ed Quali y o
Li e) and e en o he head and neck-speci ic su eys ha e
no p o ed use ul o disc imina e he ue di icul ies ex-
pe ienced by pa ien s wi h acial mobili y diso de s.
The Facial Disabili y Index (FDI; in Spanish IDF, Ín-
dice de Discapacidad Facial) (6) is an ins umen wide-
ly used in a g ea numbe o s udies which has no been
adap ed o Spanish and whose aim is o assess speci ic
quali y o li e seconda y o al e a ions o acial mimi-
c y. The FDI is a sho , sel - epo ques ionnai e deal-
ing wi h psychosocial and physical impai men aspec s
associa ed wi h acial neu omuscula unc ion. The e
is no o he speci ic ins umen in he Spanish language
o e alua e pa ien s wi h acial pa alysis a e pa o id
su ge y which allows physicians o ca y ou bo h he
diagnosis o pa esis e ec s and he ea ly and long- e m
ollow up o such impai men . Taking in o accoun his
scena io, he aim o ou s udy has been o adap he
o iginal FDI de ised by VanSwea ingen and B ach in
1995 (6) o ou linguis ic and cul u al milieu, ansla -
ing i in o Spanish and pe o ming he anscul u al a-
dap a ion in o de o p o ide, no only a speci ic ool o
assess acial pa esis a e pa o id gland su ge y bu also
o e alua e i s impac on he quali y o li e o pa ien s
and e alua e he neu omuscula diso de s a ec ing a-
cial mimic y.
Ma e ial and Me hods
In a p elimina y s age we pe o med a li e a u e sea ch
o he 10 yea s p e ious o he onse o ou s udy in o -
de o es ablish a ansla ion p o ocol consis en wi h
he la es epo s published on his subjec . The main
esea che con ac ed ia e-mail he c ea o s o he ques-
ionnai e and ob ained hei consen o ca y ou he
s udy.
-S udy s ages
The p esen s udy was conduc ed in wo di e en s ag-
es: 1) c oss-cul u al adap a ion o he FDI ques ionnai e
and 2) c oss-sec ional s udy in a con ol g oup o assess
i s eliabili y and alidi y.
The anscul u al adap a ion was ca ied ou using he
ansla ion- e o ansla ion echnique (7-10). P io o
any s ep in he p ocess, he c ea o s o he FDI ga e
hei consen o he de elopmen o he p esen s udy
and we e in i ed o ake pa in i . The wo ansla o s
en olled o he s udy we e wo bilingual ce i ied ans-
la o s whose i s o mo he ongue is Spanish and ha e
Ame ican English as second language. They we e es-
ponsible o ansla ing he o iginal FDI om Ame i-
can English in o Spanish (s ep 1). Bo h ansla o s a ed
he di icul y o ind he concep ual equi alen s in he
ansla ion in a scale om 1 (minimum di icul y) o 10
(maximum di icul y). Then, one o he esea che s and
an ex e nal expe econciled bo h ansla ions, ha is,
hey analysed and compa ed he di e ences be ween
hem in o de o app o e a inal Spanish d a (s ep 2).
In o de o assess he co ec ness o he ansla ion, he
ag eed e sion was in u n e o ansla ed in o Ame i-
can English (s ep 3) by a bilingual speake (Ame ican
English as mo he ongue and Spanish as second lan-
guage), who did no know abou he ques ionnai e in i s
o iginal ongue. T ansla o s we e asked o make a con-
cep ual and no a li e al ansla ion. In a ollowing s ep,
he e o ansla ion and he o iginal we e compa ed
(s ep 4) analysing di e ences and con adic ions and an
almos de ini i e Spanish e sion was w i en. The com-
pa ison c i e ia we e: di e en , when he esul ing i em
los i s o iginal meaning; li e al, when he esul was
iden ical o he o iginal and simila o concep ual, when
some wo d changed i s meaning bu he concep o he
ques ionnai e was main ained. I ems we e e ised and
modi ied acco ding o he esea che s’ c i e ia in o de
o sol e disc epancies. The nex s ep was o pe o m an
analysis o he comp ehensibili y and equi alence o he
inal e sion submi ing i o he es o 20 pa ien s wi h
acial pa esis a e pa o idec omy (s ep 5). A e he eal
applica ion in pa ien s, he las equi ed modi ica ions
we e made and he de ini i e adap ed FDI was ob ained
(s ep 6).
The ield su ey was conduc ed om 2008 h ough
2010 on a se ies o pa ien s admi ed in he O al and
Maxillo acial Su ge y Depa men , Vi gen del Rocio
Uni e si y Hospi al, Se ille (Spain). The Resea ch and
E hics Commi ee o he hospi al ga e hei consen o
Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
e1008
pe o m he s udy. Inclusion c i e ia we e: inciden ca-
ses co esponding o diagnosed pa ien s no ye ea ed
o a benign umo in he supe icial lobe o he pa o id
gland con i med by means o his ological examina ion
by a ine needle aspi a ion biopsy o he umo al issue
and an imaging s udy (CT/MRI), and pa ien s eligible
o abla i e umo su ge y by means o supe icial pa-
o idec omy wi h p ese a ion o he acial ne e. Ex-
clusion c i e ia we e: pa ien s wi h a p e ious his o y
o idiopa hic acial pa alysis o who su e ed om i a
he momen o he s udy, su gical sec ion o one o mo e
b anches o he acial ne e du ing su ge y esul ing in
pe manen pa alysis, p e ious his o y o ce eb o as-
cula acciden s, psychia ic o psychomo o diso de s
which p e en he in e iew wi h he pa ien , illi e acy
and egula esidence ou side he in luence a ea o he
hospi al ( empo a y esiden s); we did no conside he
le el o educa ion. Du ing he p e-su ge y isi , pa ien s
we e in o med o hei pa icipa ion in he s udy; hey
ecei ed he ques ionnai es, an acknowledgemen le e ,
w i en in o ma ion abou he p ojec and he in o med
consen .
-Ques ionnai e
The FDI (Fig. 1) is in e na ionally alida ed sho - o m
PHYSICAL FUNCTION SUBSCORE
ITEM 1 How much di icul y did you ha e keeping ood in you mou h mo ing ood a ound in you mou h o ge ing ood
s uck in you cheek while ea ing?
ITEM 2 How much did you ha e d inking om a cup?
ITEM 3 How much di icul y did you ha e saying speci ic sounds while speaking?
ITEM 4 How much di icul y did you ha e wi h you eye ea ing excessi ely o becoming d y?
ITEM 5 How much di icul y did you ha e wi h b ushing you ee h o insing you mou h?
SOCIAL FUNCTIONING AND WELL-BEING SUBSCORE
ITEM 6 How much o he ime ha e you el calm and peace ul?
ITEM 7 How much o he ime did you isola e you sel om people a ound you?
ITEM 8 How much o he ime did you ge i i able owa ds hose a ound you?
ITEM 9 How o en did you wake up ea ly o wake up se e al imes du ing you nigh ime sleep?
ITEM 10 How o en has you acial unc ion kep you om going ou o ea shop o pa icipa e in amily o social ac i i-
ies?
Fig. 1. O iginal e sion o he FDI.
ques ionnai e ga he ing in o ma ion ela ed o he im-
pac o acial pa alysis and he physical and social well-
being impai men i p o okes. I is a speci ic, sho and
simple ques ionnai e easy o be illed in by pa ien s,
comp ising 10 i ems o ques ions dis ibu ed in o wo
subscales: physical and social well-being (6). The high-
e he sco e ob ained in he ques ionnai e, he be e he
quali y o li e o he pa ien . The aim is o assess dis-
abili y and he ou come o any in e en ion in e ms o
a signi ican change in he physical disabili y and social
well-being o pa ien s.
-Analysis
Conside ing ha all pa ien s esponded o 100% o he
i ems, he easibili y and accep abili y o he ins umen
we e aken o g an ed. We analyzed he ollowing as-
pec s o he ansla ed ques ionnai e:
The alidi y o he ques ionnai e was analysed using
he ac o ial analysis o he main componen s. The aim
was o iden i y eme ging and unde lying ac o s which
become e iden when we y o g oup he i ems o ques-
ions answe ed by pa ien s in he same di ec ion (11).
We analysed he co ela ions ound in he answe s o he
ansla ed ques ionnai e. This s a is ical analysis was
used o iden i y he numbe o dimensions in a g oup
o mul i a ia e i ems showing he con ibu ion o each
i em o he speci ic dimension unde s udy.
Reliabili y was de ined as in e nal consis ency (homo-
genei y) o he o e all ques ionnai e and o i s subscales,
calcula ing C onbach’s alpha coe icien o e e y one o
hem. C onbach’s alpha coe icien is he adjus ed mean
o he co ela ions be ween i ems o ques ions included
in he scale. The expec ed alpha coe icien was es ima-
ed a 0.70; so i was conside ed ha alpha alues abo e
han his alue we e su icien o ensu e he eliabili y
o he scale and o conside ha he ins umen would
calcula e consis en and s able measu emen s.
In o de o es he cons uc alidi y o he ansla ed
ques ionnai e, we assessed he ela ionship be ween he
esul s o he ansla ed ques ionnai e which e alua ed
pa ien s’ disabili y and hei ue physical impai men
using he in e na ional House-B ackmann scale (H-B)
(12). This scale is a widely- alida ed s anda d me hod
Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
e1009
(13) o measu e acial ne e unc ion, con ol i s e o-
lu ion o e ime, and assess eco e y and e ec s a e
ea men . H-B scale classi ies he deg ee o pa esis in o
6 le els, om I (no pa esis) o VI ( o al pa esis). The
o al sco e is ob ained by adding he esul o each o he
5 b anches in he acial ne e, hus ob aining an in e al
o alues which may ange om 6 o 36. Pea son’s co -
ela ion coe icien was used o de e mine such bi a ia e
co ela ion. The esul o each o he subscales ob ained
in he ac o ial analysis o he main componen s was
compa ed wi h he physical examina ion.
Finally, we de e mined whe he he speci ic ansla ed
ques ionnai e p o ed mo e alid han o he gene al ins-
umen s measu ing quali y o li e which ha e al eady
been ansla ed in o Spanish and a e widely alida ed
and employed. In o de o do so, we compa ed he FDI
and he SF-36 su ey (14) once we had asked he © 2011
Quali yMe ic o he equi ed pe mission. The SF-36
su ey is a s anda dized sel - epo ins umen includ-
ing 8 dimensions. We used he physical dimension o
compa e i wi h he H-B scale. Pea son’s co ela ion co-
e icien was used o such pu pose.
Ou hypo hesis was o es ablish he lack o co ela ion
o a sligh co ela ion be ween he SF-36 su ey and he
H-B scale, compa ing i wi h he co ela ion be ween
he FDI, he physical subscale o he SF-36 su ey and
he H-B scale. A alue o p<0.05 was conside ed s a is-
ically signi ican . Da a we e analysed using he so -
wa e package SPSS .15.0 o Windows.
Resul s
F om Janua y 2008 h ough Decembe 2010 we ca ied
ou a p ospec i e s udy o he da a co esponding o 79
SUBESCALA FUNCIONAMIENTO FÍSICO
ITEM 1 ¿Cuán a di icul ad ha enido pa a gua da la comida en la boca, mo e la comida den o de la
boca o man ene comida a ni el de los ca illos mien as come?
ITEM 2 ¿Cuán a di icul ad ha enido en bebe de un aso?
ITEM 3 ¿Cuán a di icul ad ha enido en deci sonidos especí icos mien as habla?
ITEM 4 ¿Cuán a di icul ad ha enido espec o al lag imeo excesi o o sequedad en sus ojos?
ITEM 5 ¿Cuán a di icul ad ha enido en la a se los dien es o en enjuaga se la boca?
SUBESCALA FUNCIONAMIENTO SOCIAL Y BIENESTAR
ITEM 6 ¿Cuán o iempo se sien e anquilo o calmado?
ITEM 7 ¿Cuán o iempo se aísla de la gen e que le odea?
ITEM 8 ¿Cuán o iempo se ha no ado i i ado hacia la gen e que es á a su al ededo ?
ITEM 9 ¿Con qué ecuencia se le an a p on o o se despie a a ias eces du an e el sueño?
ITEM 10 ¿En cuán as ocasiones su unción acial e i a que salga a come , de iendas, o le impide su pa ici-
pación en ac i idades amilia es o sociales?
Fig. 2. Spanish adap ed e sion o he FDI.
pa ien s who had unde gone conse a i e supe icial
pa o idec omy wi h p ese a ion o he acial ne e o
pleomo phic adenoma o he pa o id gland supe icial
lobe and me he inclusion c i e ia. Mean age o pa ien s
was 40 y s in an in e al be ween 24 and 81 y s. Pa-
ien s we e handed he FDI ques ionnai e h ee mon hs
a e he in e en ion.
The di icul y o he ansla ion was a ed by 2 ansla-
o s wi h a mean sco e o 3. In he end, once he de ini-
i e adap a ion was e alua ed we ob ained he comple e
equi alence in all he i ems in he ques ionnai e. Figu e
2 shows he inal ansla ion o each o he ques ions in
he FDI. Fo example, some changes we e in oduced in
i em 1, “How much di icul y did you ha e keeping ood
in you mou h, mo ing ood a ound in you mou h o
ge ing ood s uck in you cheek while ea ing?”, which
was ansla ed in o Spanish as “¿Con qué di icul ad ha
man enido la comida en la boca, ha mo ido la comida
en el in e io de u boca o ha apa ado la comida a un
lado de la boca mien as comías?”. Ne e heless, he
inal adap a ion was: “¿Cuán a di icul ad ha enido pa a
gua da la comida en la boca, mo e la comida den o
de la boca o man ene comida a ni el de los ca illos
mien as come?”. Likewise, i em 4: “How much di -
icul y did you ha e wi h you eye ea ing excessi ely
o becoming d y?”, was ansla ed as “¿Con qué di i-
cul ad sus ojos han lag imeado excesi amen e o se han
secado?”, bu he inal adap a ion: “¿Cuán a di icul ad
ha enido espec o al lag imeo excesi o o sequedad
en sus ojos?”, was less con using o pa ien s and ex-
plained mo e clea ly he physical diso de i a emp ed
o measu e (eye hyd a ion in pa ien s wi h pa esis o he
oph halmic b anch o he acial ne e).
Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
e1010
Reliabili y was measu ed using C onbach’s alpha co-
e icien bo h o he comple e scale and o he wo
dimensions (physical and social well-being unc ions)
es ablished by he analysis o he main componen s. The
da a ob ained showed adequa e eliabili y a 3 mon hs
a e su ge y. C onbach’s alpha coe icien was 0.83 o
he comple e scale and 0.77 and 0.82 o he physical and
social well-being subscales, espec i ely. In an a emp
o imp o e homogenei y, we calcula ed C onbach’s co-
e icien excluding in each case one o he i ems. Fo all
and e e y one o he i ems we ob ained lowe eliabili y
le els han o he global scale (Table 1).
Excluded i em C onbach´s alpha
coe icien
10,82
20,82
30,81
40,80
50,82
60,79
70,78
80,78
90,81
10 0,82
Table 1. Assessmen o eliabili y and in e -
nal consis ency (C onbach’s alpha coe icien )
o he adap ed FDI, excluding each one o he
i ems.
As ega ds he analysis o he main componen s, we
ca ied ou a ac o ial analysis wi h Va imax o a ion
and ac o ex ac ion wi h an eigen alue >1; ha is, he
analysis o he componen s should show mo e a iance
in he o e all ins umen han any o he i ems in he
ques ionnai e. This analysis con i med ha he i ems
included in he physical subscale o med a homogene-
ous g oup, clea ly apa om he social well-being sub-
scale. Table 2 highligh s hose alues >0.5 showing he
sepa a ion be ween he i s componen (physical sub-
scale) and he second one (social well-being subscale).
The SF-36 su ey was illed in by 34 pa ien s. Table
3 shows bi a ia e co ela ions be ween FDI and H-B
scale, and be ween SF-36 su ey (physical unc ion
dimension) and H-B scale. As we expec ed, when we
compa ed he esul s o he FDI wi h he ue physical
dys unc ion o he pa ien measu ed by means o he
H-B scale, we obse ed a s a is ically signi ican co -
ela ion be ween he physical subscale and he clinical
diagnosis o acial pa esis measu ed by means o he
H-B scale (Table 3, i em a). The analysis o he co ela-
Componen
1 2
IDF 1 -,053 ,876
IDF 2 ,271 ,788
IDF 3 ,156 ,647
IDF 4 ,415 ,677
IDF 5 ,245 ,592
IDF 6 ,823 ,183
IDF 7 ,719 ,428
IDF 8 ,804 ,282
IDF 9 ,739 ,291
IDF 10 ,626 -,026
Table 2. Analysis o he main componen s o he FDI us-
ing o a ed componen ma ix ( ac o ex ac ion me hod
wi h analysis o main componen s and Kaise Va imax
o a ion).
Componen 1: physical subscale.
Componen 2: social well-being subscale
Values > 0.5 a e indica ed in bold
ion be ween he o al FDI and he H-B scale e ealed a
lowe co ela ion han he one obse ed wi h he physi-
cal subscale on i s own (Table 3, i em b). As we hypo h-
esized, a di ec ela ion was no obse ed be ween he
physical scale in he SF-36 su ey and he ue physical
unc ion o he pa ien measu ed by means o he H-B
scale (Table 3, i em c), he way i is obse ed in he case
o FDI (physical subscale).
Table 4 shows he analysis o a iance pe cen age e-
ealed by each o he FDI componen s, which coincides
wi h he alida ion o he o iginal ins umen . The a i-
ance pe cen ages o he i s and second componen s
we e 31.12 and 29.96, espec i ely.
Discussion
The esul s o he p esen s udy sugges ha he Spanish
adap ed FDI is equi alen o he o iginal ques ionnai e
and shows simila eliabili y and alidi y as well as simi-
la limi a ions. C onbach’s alpha coe icien s o he scales
and dimensions o he adap ed FDI a e simila o hose o
he o iginal ques ionnai e wi h alues anging om 0.70
o 0.90. In o de o boos he esea ch we ha e conduc ed
a p ospec i e s udy o homogeneous inciden cases, all o
hem wi h he same ype o umo in he same ana omical
loca ion and ea ed wi h he same su gical echnique.
As ega ds eliabili y, he FDI assessed quali y o li e
accu a ely and wi h adequa e in e nal alidi y. Reliabil-
i y su passes 0.7 (0.83), a le el conside ed adequa e o
ca y ou compa isons and o moni o ize acial disabil-
i y in he same pa ien wi h sel - epo ins umen s and
shows a deg ee o in e nal consis ency simila o ha
ob ained by means o o he ques ionnai es which com-

Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
e1011
To al H-B FDI: physical
subscale
FDI: social
well-being
subscale
To al H-B Pea son’s co ela ion
(bila e al) signi icance 1(a) ,405(**)
,001 …
FDI: physical subscale Pea son’s co ela ion
(bila e al) signi icance
,405(**)
,001 1,464(**)
,000
FDI: social well-being subscale Pea son’s co ela ion
(bila e al) signi icance
1,41
,272
,464(**)
,000 1
O e all FDI Pea son’s co ela ion
(bila e al) signi icance
(b) ,264**
,001 --- ---
SF-36 Pea son’s co ela ion
Physical dimension (0-100) (bila e al) signi icance
(c) ,134
,449 (n=34)
,435(*)
,010 (n=34)
,361(*)
,036 (n=34)
Table 3. Bi a ia e co ela ions be ween he FDI, H-B scale and SF-36 su ey.
** 0,01 (bila e al) accoun s o signi ican co ela ion
FDI
Componen
Ini ial sel - alues Sums o squa es o
ac o ex ac ion
sa u a ions
Sum o squa es o a ion sa u a ions
To al Va iance
%
Accumula ed
%
To al Va iance
%
Accumula ed
%
To al Va iance
%
Accumula ed
%
14,635 46,345 46,345 4,635 46,345 46,345 3,112 31,123 31,123
21,475 14,747 61,092 1,475 14,747 61,092 2,997 29,969 61,092
Table 4. Va iance pe cen age exp essed o each one o he FDI componen s.
Componen 1: physical subscale. Componen 2: social well-being subscale
p ise he same numbe o i ems (15). This con i ms ha
he in e nal alidi y o he ques ionnai e has no been
al e ed by he ansla ion p ocess. Unlike he o iginal
ins umen (6), we obse e a sligh ly lowe eliabili y
in he physical dimension (0.77) han in he social well-
being dimension (0.82), al hough in iew o he small
di e ence i is no conside ed ele an . In any case, bo h
alues a e alid o s a e he eliabili y o he FDI.
To ca y ou ac o ial analysis, we ha e used a di e en
sample han o pe o m he alida ion o he o iginal
ins umen , as a as size, sampling echnique, language
and cul u e a e conce ned. Bo h samples a e he e oge-
neous and comp ise di e en ypes o people and he
sampling echnique has been non p obabilis ic, as i is
no a equi emen o alida ion. The e o e, as he e-
sul s ob ained a e simila o hose ob ained in he analy-
sis o he o iginal ques ionnai e, we can a i m ha he
ques ionnai es measu e he same, despi e he di e-
ences be ween he samples. Simila i y is obse ed in
bo h ac o g oups, almos iden ical, which con i ms he
hypo hesis ha he c oss-cul u al adap a ion does no
al e he ques ionnai e. A e calcula ing C onbach’s al-
pha coe icien disca ding 1 i em in each case, we ound
ha he global scale o he FDI was e en mo e eliable
o he o e all ins umen han o each isola ed i em.
Taking in o accoun he lack o a s anda dized measu e-
men o acial pa esis, we used H-B scale o alida e
he cons uc (12). Such alidi y has been p o ed o he
co ela ion be ween he FDI and he clinical measu e-
men o acial mo emen (Table 3). This co ela ion also
con i med he concep ual ela ionship be ween dys-
unc ion and disabili y, which unde lies acial unc ion
eco e y. The expec ed co ela ion was highe be ween
he physical subscale and he H-B scale (0.405) (Table 3,
i em a) in compa ison wi h a global measu emen o he
FDI and he H-B scale (0.264) (Table 3, i em b), which
suppo s he alidi y in he subscales o ma .
Howe e , ag eeing wi h ou hypo hesis, unlike he case
wi h he ansla ed ques ionnai e, no co ela ion was
obse ed be ween he physical dimension o he SF-36
Med O al Pa ol O al Ci Bucal. 2012 No 1;17 (6):e1006-12. Facial disabili y index
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su ey and he clinical measu emen o acial pa esis.
This may be explained by he lack o speci ici y o his
la e su ey o e alua e acial neu omuscula dys unc-
ion (Table 3, i em c). The SF-36 su ey has no p o ed
use ul in he e alua ion and ollow-up o pa ien s as i
measu es di e en aspec s o physical disabili y and
ocuses on o he heal h p oblems apa om acial neu-
omuscula dys unc ion.
The Spanish ansla ed and adap ed FDI ope a es as a
speci ic ques ionnai e p o iding aluable in o ma ion
o e alua e acial neu omuscula dys unc ion. The ob-
jec i e assessmen o quali y o li e in ela ion o acial
unc ion using alida ed ins umen s may play a key
ole in he diagnosis and ollow up o ou pa ien s (16).
In his sense, he FDI can be i s ly used as a diagnos ic
ins umen and in a subsequen s age as a ollow-up ool
a e ea men o su ge y (6). The FDI is a sho , simple
and easy sel - epo ins umen which can be adminis-
e ed in abou 4 minu es. I has been widely accep ed
by pa ien s, as he ansla ion is comp ehensible and is
adap ed o Spanish language. Resea che s ha e ne e
been equi ed o explain he i ems o ques ions du ing
he comple ion o he ques ionnai e and physicians ha e
ne e complained abou incomp ehensible exp essions
o di icul y in i s use.
Due o he simplici y o mos o he i ems in he ques-
ionnai e, a li e al ansla ion was p e e ed o hal o
hem (i ems numbe 2,3,5,7 and 8) and a concep ual one
o he o he hal (i ems numbe 1,4,6,9 and 10). The
ansla ions made sepa a ely by he bilingual ansla-
o s showed almos no di e ences when compa ed. The
desc ip i e, clea and concise language o he o iginal
ques ionnai e a o ed he almos comple e ag eemen
be ween ansla o s. Unde no ci cums ance has he
meaning o he ques ions been modi ied in o de o
main ain he objec o he ques ion in he o iginal ins-
umen . Nei he has i been conside ed app op ia e o
c ea e any new i em o modi y he meaning o any o
hem. Du ing he pilo s udy and du ing he alida ion
p ocess, we ha e no ound any p oblem wi h he ques-
ions; none o hem we e misleading o di icul o un-
de s and. None o he pa ien s has equi ed any u he
explana ion o ill in he o e all ques ionnai e.
To sum up, he esul s o he p esen s udy show ha
he Spanish adap ed FDI is eliable and alid ins umen
bo h o esea ch and o applica ion in daily clinical
p ac ice. I is a use ul ool o assess he impac o acial
disabili y associa ed o acial pa alysis /pa esis ollow-
ing pa o idec omy; i is accessible o Spanish speaking
pa ien s and physicians in ol ed in he ea men and
ollow-up o hese pa ien s. Fu u e wo k in his ield
should ocus on he applica ion o his ins umen o an-
alyze he di e en acial neu omuscula diso de s and
o op imize he managemen , ea men and ehabili a-
ion o acial pa esis o pa alysis in he long e m.
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Acknowledgmen s
The au ho s wish o hank o Rocio Valdes-Galla do and Vic o ia
P a s-Golcze o hei coope a ion wi h he collec ion o da a and
especially o Jessi VanSwea ingen (Uni e si y o Pi sbu gh) o he
aluable help in he e iew o he p esen pape .
The p esen s udy has been gi en inancial suppo by he Ins i u o
de Salud Ca los III-Fondo de In es igación Sani a ia (070048/2007),
Minis e io de Sanidad y Consumo, España.