2017-18 HSC Section 4 Green Book

Reprinted by permission of Laryngoscope. 2015; 125(12):2672-2676.

The Laryngoscope V C 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Creation of a Head and Neck Keloid Quality of Life Questionnaire

W. Marshall Guy, MD; Prasanth Pattisapu, MD, MPH; Julina Ongkasuwan, MD, FAAP; Anthony E. Brissett, MD, FACS

Objectives: Create a head-and-neck keloid quality of life (QOL) questionnaire. Demonstrate the reliability of the keloid- specific QOL scale according to test-retest and internal consistency standards. Study Design: Prospective cohort study. Methods: Patients presenting to a keloid clinic in a tertiary referral institution between April 2012 and February 2013 were enrolled on their first visit. They were administered a questionnaire assessing demographics and a 21-item Likert keloid-specific survey assessing symptomatology, self-esteem, social functioning, and therapeutic motivation during their first three visits. Reliability of the keloid questionnaire was assessed for internal consistency (Cronbach’s alpha) and test-retest correlations. Patients were treated with Kenalog steroid injections at each visit. The 126-point total score from the question- naire was then compared to each subscale (physical symptoms, self-esteem, social function, and medical motivation) using a Pearson coefficient. Results: The keloid QOL questionnaire showed a Cronbach’s alpha of 0.87 for the overall questionnaire and ranged from 0.66 to 0.86 for individual questions. The test-retest Pearson’s R was 0.70 between visits 1 and 2 and 0.77 between vis- its 2 and 3. The Pearson correlation between symptoms, self-esteem, social functioning, and medical motivation subscales and the overall scale were 0.77, 0.73, 0.72, and 0.57, respectively. Conclusion: This head and neck keloid-specific QOL questionnaire proved to be a reproducible method of reliably

assessing QOL burden on patients with head and neck keloids. Key Words: Keloid, quality of life, hypertrophic scar, scar. Level of Evidence: N/A.

Laryngoscope , 125:2672–2676, 2015

show the greatest impact on the QOL. 7 The purpose of this study is to 1) design a keloid questionnaire that bet- ter represents the QOL burden suffered by head and neck keloid patients and 2) assess the reliability of this questionnaire using test-retest correlation and internal consistency methodologies. MATERIALS AND METHODS Patients who presented to a monthly keloid clinic within a facial plastic surgery clinic between April 2012 and February 2013 were recruited for enrollment. The institutional review board at both Baylor College of Medicine and The Methodist Hospital approved the study. Inclusion criteria included new patients to the clinic with a keloid present in the head and neck region and over the age of 15. There were no exclusion criteria. At the first visit and the two subsequent visits spaced 1 month apart, patients were administered a 21-item keloid-specific QOL Likert scale questionnaire (Fig. 1). The items were created from expert opinion derived from previous patients’ concerns regard- ing their keloids, including physical symptoms, impact on self- esteem, social impact, and their varied reasons for seeking treatment, as well as findings in a previous study. 7 From these items, the Physical Symptoms Subscale (PSS), Self-Esteem Sub- scale (SES), Social Functioning Subscale (SFS), and Medical Motivation Subscale (MMS) were developed, with eight, three, six, and four questions, respectively. All items that were created were included in the final instrument, and each item contrib- uted to exactly one subscale. During the initial and subsequent office visits, patients received nonsurgical treatment of their keloids (Kenalog injection). The results of the keloid-specific QOL questionnaire were then evaluated for test-retest correla- tions using Pearson coefficients and internal consistency using

INTRODUCTION Keloids represent an exaggerated healing response of the body to an insult, resulting in irregular deposition of collagen beyond the edges of the original injury. In addition to the cosmetic effects from this scarring, they can be painful, pruritic, and give a burning sensation. 1,2 Most studies regarding keloids focus on the various treatment options available, 3 but keloids have a signifi- cant effect on the quality of life (QOL). To assess disease burden, validated QOL scales including the short form- 36 (SF-36) and SF-12 have been developed. 4,5 Previous work by our group has shown the SF-12 to be poorly responsive to the QOL burden of head and neck keloid patients. 6 A whole body keloid-specific QOL question- naire also failed to represent the burden of visible keloids, although it did find the physical questions to From the Dr. Guy Facial Plastic Surgery ( W . M . G .), Shenandoah, Texas; and the Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery ( P . P ., J . O ., A . E . B .), Baylor College of Medicine, Houston, Texas, U.S.A. Presented at the Triological Society 117th Annual Meeting at Com- bined Otolaryngology Spring Meetings in Las Vegas, Nevada, U.S.A, on May 15, 2014. The authors have no funding, financial relationships, or conflicts of interest to disclose. Editor’s Note: This Manuscript was accepted for publication on March 10, 2015. Send correspondence to Anthony E. Brissett, MD FACS, 6550 Fan- nin Street, Suite 1701, Houston, Texas 77030. E-mail: brissett@bcm.edu

DOI: 10.1002/lary.25309

Laryngoscope 125: December 2015

Guy et al.: Head and Neck Keloid QOL Questionnaire

184