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Facial palsy affects between 23 to 35 people per 100,000. As well as affecting an individual's appearance, it also can lead to difficulties with: eating, drinking, speaking, eyelid closure, pain and taste.
Facial palsy has been shown to have a significant impact on an individual's psychological wellbeing, including issues with anxiety, depression and low self-esteem. These elevated levels of distress have been thought to be partly due to the impact that facial palsy has on the face's ability to express emotions, which is a crucial aspect of face-to-face communication.
Although not researched yet in a facial palsy population, one type of psychological intervention that has been found to be effective at improving the psychosocial wellbeing of people with visible differences has been psychological self-help. With this in mind, the investigators have developed seven self-guided information and therapy guides (ITGs), for people with facial palsy and/or their friends or relatives. The investigators have written these guides by drawing on interventions with a strong evidence-base in other populations, such as cognitive behavioural therapy, social skills training and acceptance and commitment therapy:
The investigators aim to evaluate the effectiveness, usability and acceptability of these guides to people with facial palsy and/or their friends, family and partners, by piloting their use over a 4-6 week period. Assessment of psychosocial wellbeing will be carried out before and after the 4-6 week period, while participants will be invited to provide usability and acceptability feedback on the guides after the 4-6 week period.
Given that this study represents an initial pilot of the use of self-guided information and therapy guides for people with facial palsy (and/or their friends and relatives), all eligible participants will receive the intervention (i.e. there will be no control group). As a result, this study will have a repeated-measures design.
Eligible participants will be recruited by one of two means:
Potential participants who have expressed an interest in the study will be provided with an information sheet, and be invited to provide written consent. Participants recruited through the Oxford Facial Palsy Service will proved written consent via Survey Hero, either in clinic or remotely online at a later if they wish for longer time to consider their involvement in the study. Participants recruited through Facial Palsy UK/social media will provide written consent via Survey Hero.
Once participants have provided consent, they will be provided with an online screening questionnaire (in order to check for eligibility). Participants recruited in Oxford Facial Palsy Service clinics will complete the screening questionnaire on the researcher's laptop. Alternatively, if participants recruited in clinic wish to have more time to consider whether or not to participate, they will be able to complete online screening (and subsequent baseline assessments) remotely online. Participants recruited on social media will be emailed a link to the screening questionnaire.
Eligible participants will then be invited to complete baseline questionnaires:
People with facial palsy: Hospital Anxiety and Depression Scale; FACE-Q Satisfaction with appearance; FACE-Q Psychological function; FACE-Q Social function and Facial Disability Index. The Facial Disability Index will allow for control of improvement in facial palsy symptoms over time.
Friends, relatives and partners: Hospital Anxiety and Depression Scale and Adult Carer Quality of Life Questionnaire.
Like the screening questionnaires, written consent and baseline questionnaires will be completed online.
Eligible participants will then be administered the relevant self-guided information and therapy guide. For eligible carers/relatives this will be the guide entitled "Facial palsy: Advice for friends, family and partners". For eligible participants with facial palsy, this will be determined by their score on the screening questionnaire.
Participants will then utilise the guide over a period of four-to-six weeks. Half-way through the intervention period (after 2-3 weeks), they will receive an email reminding them to complete the guide and will be provided a web-link to complete a questionnaire, designed for the purpose of the current study, measuring the participants' ratings of acceptability and usability of the guides (participant satisfaction questionnaire).
At the end of the four-to-six week period, participants will be re-administered the baseline questionnaires, along with a questionnaire designed for the purpose of the current study measuring the participants' ratings of acceptability and usability of the guides (participant satisfaction questionnaire). Participants with facial palsy will also be re-administered the initial screening questionnaire. This will indicate whether the participant is eligible to complete a further guide. If this is the case, then their post-intervention questionnaires will serve as a new baseline and the participant will be invited to complete the new guide over a second four-to-six week period (followed by the same follow-up assessments as followed the first guide). This process will occur up to a maximum of six times (reflecting the potential for a participant to trial all six guides). If they do not wish to complete further guides then the participant will be thanked for their involvement in the study and their involvement will be registered as 'complete'.
Friends, relatives and partners of people with facial palsy will only be required to complete pre and post questionnaires if they are actively involved in the study due to completing the friend, relative or partner ITG. Likewise, individuals with facial palsy are not required to complete questionnaires if they are not actively involved in the study (i.e. not trialing and ITG), but their friend or relative is.
The investigators aim to trial the guides over a period of one year (May 2019 - May 2020). This will lead to the predicted sample size of 140 participants (120 with facial palsy, 20 per each of the 6 guides; 20 friends and family). This target is based on there being approximately 3000 people who have access to the Facial Palsy UK website. Given that approximately one-third of people with facial palsy experience a significant level of distress; the investigators hope that our guides would be relevant to, and accessible by, around 1000 people. 140 is therefore a conservative estimate of the number of participants that the investigators will be able to recruit.
Participants recruited from OUH NHS Foundation trust will be provided with an information sheet during their clinic appointment with the Oxford Facial Palsy Service. Written consent will be obtained in the clinic by a member of the research team.
Participants recruited from social media will be provided with an information sheet via email and will provide written consent online.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Facial Palsy - Trial of ITG | Experimental | In this arm of the trial individuals with facial palsy will trial the use of information and therapy guides over a 4-6 week period. They will complete measures at the start and end of this period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Information and Therapy Guides | Behavioral | We have developed seven self-guided information and therapy guides (ITGs), for people with facial palsy and/or their friends or relatives. We have written these guides by drawing on interventions with a strong evidence-base in other populations, such as cognitive behavioural therapy, social skills training and acceptance and commitment therapy:
|
| Measure | Description | Time Frame |
|---|---|---|
| FACE-Q Psychological Function | This 10-item scale measures psychological wellbeing using a series of positively worded statements, with participants invited to rate how much they agree/disagree with each statement. There is a minimum score of 10 and a maximum score of 40. Scores are Rasch transformed to a 0-100 scale. A high score indicates greater psychological wellbeing. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 1: Baseline |
| FACE-Q Psychological Function | This 10-item scale measures psychological wellbeing using a series of positively worded statements, with participants invited to rate how much they agree/disagree with each statement. There is a minimum score of 10 and a maximum score of 40. Scores are Rasch transformed to a 0-100 scale. A high score indicates greater psychological wellbeing. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 2: 4-6 week follow-up |
| FACE-Q Social Function | In this scale there are 8 statements pertaining to measuring social functioning. Scores on this scale range from 8 to 32, with scores Rasch transformed to a 0-100 scale. Higher scores indicate better social function. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 1: Baseline |
| FACE-Q Social Function | In this scale there are 8 statements pertaining to measuring social functioning. Scores on this scale range from 8 to 32, with scores Rasch transformed to a 0-100 scale. Higher scores indicate better social function. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 2: 4-6 week follow-up |
| Facial Disability Index (Social Function) |
| Measure | Description | Time Frame |
|---|---|---|
| Adult Carer Quality of Life Questionnaire | 40 item questionnaire assessing carer quality of life. Possible scores range from 0-120, with higher scores indicating higher quality of life | Time 1: Baseline |
| Adult Carer Quality of Life Questionnaire |
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Inclusion Criteria:
Participant with Facial Palsy:
Participant who is a friend, family member or partner of someone with facial palsy:
Exclusion Criteria:
Participant with Facial Palsy:
Participant who is a friend, family member or partner of someone with facial palsy:
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| Name | Affiliation | Role |
|---|---|---|
| Matthew Hotton | Oxford University Hospitals NHS Trust | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| John Radcliffe Hospital | Oxford | Oxon | OX3 9DU | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21720412 | Background | Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye (Lond). 2011 Oct;25(10):1322-6. doi: 10.1038/eye.2011.158. Epub 2011 Jul 1. | |
| 15547436 | Background | Coulson SE, O'dwyer NJ, Adams RD, Croxson GR. Expression of emotion and quality of life after facial nerve paralysis. Otol Neurotol. 2004 Nov;25(6):1014-9. doi: 10.1097/00129492-200411000-00026. |
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No plan to make data available
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The aim of this project was for participants to test a total of 140 Information and Therapy Guides. Because many participants were eligible to test multiple guides, the number of participants enrolled is lower than 140.
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| ID | Title | Description |
|---|---|---|
| FG000 | Facial Palsy - Trial of ITG | In this arm of the trial individuals with facial palsy will trial the use of information and therapy guides over a 4-6 week period. They will complete measures at the start and end of this period. Information and Therapy Guides: We have developed seven self-guided information and therapy guides (ITGs), for people with facial palsy and/or their friends or relatives. We have written these guides by drawing on interventions with a strong evidence-base in other populations, such as cognitive behavioural therapy, social skills training and acceptance and commitment therapy:
|
| FG001 | Friends and Family - ITG | In this arm of the trial friends and famileis of individuals with facial palsy will trial the use of information and therapy guides over a 4-6 week period. They will complete measures at the start and end of this period. Information and Therapy Guides: Facial palsy: Advice for friends, family and partners. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Trial of ITG 1 |
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| Trial of ITG 2 |
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| Trial of ITG 3 |
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| Trial of ITG 4 |
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| Trial of ITG 5 |
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| ID | Title | Description |
|---|---|---|
| BG000 | Facial Palsy - Trial of ITG | In this arm of the trial individuals with facial palsy will trial the use of information and therapy guides over a 4-6 week period. They will complete measures at the start and end of this period. Information and Therapy Guides: We have developed seven self-guided information and therapy guides (ITGs), for people with facial palsy and/or their friends or relatives. We have written these guides by drawing on interventions with a strong evidence-base in other populations, such as cognitive behavioural therapy, social skills training and acceptance and commitment therapy:
|
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | FACE-Q Psychological Function | This 10-item scale measures psychological wellbeing using a series of positively worded statements, with participants invited to rate how much they agree/disagree with each statement. There is a minimum score of 10 and a maximum score of 40. Scores are Rasch transformed to a 0-100 scale. A high score indicates greater psychological wellbeing. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 1: Baseline | Data points | Data points |
|
Four to six weeks
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Facial Palsy - Trial of ITG | In this arm of the trial individuals with facial palsy will trial the use of information and therapy guides over a 4-6 week period. They will complete measures at the start and end of this period. Information and Therapy Guides: We have developed seven self-guided information and therapy guides (ITGs), for people with facial palsy and/or their friends or relatives. We have written these guides by drawing on interventions with a strong evidence-base in other populations, such as cognitive behavioural therapy, social skills training and acceptance and commitment therapy:
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr Matthew Hotton | Oxford University Hospitals NHS Foundation Trust | 01865 234714 | matthew.hotton@ouh.nhs.uk |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 15, 2020 | Dec 16, 2021 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D005158 | Facial Paralysis |
| ID | Term |
|---|---|
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |
| D010243 | Paralysis |
| D009461 | Neurologic Manifestations |
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One single group will be trialling a new self-guided psychological intervention
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|
A 5-item self-report measure of social function in people with facial palsy. The scale is scored out of 100 (100 = high function). As some participants were eligible to trial multiple guides, some participants contributed multiple data points. |
| Time 1: Baseline |
| Facial Disability Index (Social Function) | A 5-item self-report measure of social function in people with facial palsy. The scale is scored out of 100 (100 = high function). As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 2: 4-6 week follow-up |
| FACE-Q Appearance-Related Psychosocial Distress | An eight-item scale assessing an individual's concerns regarding their facial appearance on a scale of 8-32, which is then Rasch transformed to a 0-100 scale. The higher the score, the greater the patient's dissatisfaction with their appearance. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 1: Baseline |
| FACE-Q Appearance-Related Psychosocial Distress | An eight-item scale assessing an individual's concerns regarding their facial appearance on a scale of 8-32, which is then Rasch transformed to a 0-100 scale. The higher the score, the greater the patient's dissatisfaction with their appearance. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | Time 2: 4-6 week follow-up |
| Hospital Anxiety and Depression Scale | A 14-item scale with two seven-item subscales looking at anxiety and depression. A score equal-to-or-lower-than 7 on a subscale falls below the clinical cut-off, a score of 8-10 indicates probably clinically significant anxiety or depression, while a score of 11 or more indicates clinically significant anxiety or depression. Scores range from 0-52, with a higher score indicating higher severity. As some participants with facial palsy were eligible to trial multiple guides, some participants with facial palsy contributed multiple data points. | Time 1: Baseline |
| Hospital Anxiety and Depression Scale | A 14-item scale with two seven-item subscales looking at anxiety and depression. A score equal-to-or-lower-than 7 on a subscale falls below the clinical cut-off, a score of 8-10 indicates probably clinically significant anxiety or depression, while a score of 11 or more indicates clinically significant anxiety or depression. Scores range from 0-52, with a higher score indicating higher severity. As some participants with facial palsy were eligible to trial multiple guides, some participants with facial palsy contributed multiple data points. | Time 2: 4-6 week follow-up |
40 item questionnaire assessing carer quality of life. Possible scores range from 0-120, with higher scores indicating higher quality of life
| Time 2: 4-6 week follow-up |
| 23962642 | Background | Muftin Z, Thompson AR. A systematic review of self-help for disfigurement: effectiveness, usability, and acceptability. Body Image. 2013 Sep;10(4):442-50. doi: 10.1016/j.bodyim.2013.07.005. Epub 2013 Aug 17. |
| 9120441 | Background | Martyn CN, Hughes RA. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1997 Apr;62(4):310-8. doi: 10.1136/jnnp.62.4.310. No abstract available. |
| 26634395 | Background | Hultcrantz M. Rehabilitation of Bells' palsy from a multi-team perspective. Acta Otolaryngol. 2016;136(4):363-7. doi: 10.3109/00016489.2015.1116124. Epub 2015 Dec 4. |
| 6880820 | Background | Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x. |
| 27222106 | Background | Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. Self-Report Scales to Measure Expectations and Appearance-Related Psychosocial Distress in Patients Seeking Cosmetic Treatments. Aesthet Surg J. 2016 Oct;36(9):1068-78. doi: 10.1093/asj/sjw078. Epub 2016 May 24. |
| 8959998 | Background | VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther. 1996 Dec;76(12):1288-98; discussion 1298-300. doi: 10.1093/ptj/76.12.1288. |
| 35623976 | Derived | Hotton M, Johnson D, Kilcoyne S, Dalton L. Evaluating the effectiveness and acceptability of information and therapy guides for improving the psychosocial well-being of people with facial palsy. J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3356-3364. doi: 10.1016/j.bjps.2022.04.022. Epub 2022 Apr 25. |
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| BG001 | Friends and Family - Trial of ITG | In this arm of the trial friends and family of individuals with facial palsy will trial the use of information and therapy guides over a 4-6 week period. They will complete measures at the start and end of this period. ITG: Facial palsy: Advice for friends, family and partners. |
| BG002 | Total | Total of all reporting groups |
| years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| FACE-Q Psychological Function | This 10-item scale measures psychological wellbeing using a series of positively worded statements, with participants invited to rate how much they agree/disagree with each statement. There is a minimum score of 10 and a maximum score of 40. Scores are Rasch transformed to a 0-100 scale. A high score indicates greater psychological wellbeing. | Friends and family members did not complete this measure | Mean | Standard Deviation | units on a scale |
|
| FACE-Q Social Function | In this scale there are 8 statements pertaining to measuring social functioning. Scores on this scale range from 8 to 32, with scores Rasch transformed to a 0-100 scale. Higher scores indicate better social function. | Friends and family members did not complete this measure at baseline | Mean | Standard Deviation | units on a scale |
|
| Facial Disability Index (Social Function) | A 5-item self-report measure of social function in people with facial palsy. The scale is scored out of 100 (100 = high function). | Friends and family members did not complete this measure at baseline | Mean | Standard Deviation | units on a scale |
|
| FACE-Q Appearance-Related Psychosocial Distress | An eight-item scale assessing an individual's concerns regarding their facial appearance on a scale of 8-32, which is then Rasch transformed to a 0-100 scale. The higher the score, the greater the patient's dissatisfaction with their appearance. | Friends and family members did not complete this measure at baseline | Mean | Standard Deviation | units on a scale |
|
| Hospital Anxiety and Depression Scale | A 14-item scale with two seven-item subscales looking at anxiety and depression. A score equal-to-or-lower-than 7 on a subscale falls below the clinical cut-off, a score of 8-10 indicates probably clinically significant anxiety or depression, while a score of 11 or more indicates clinically significant anxiety or depression. Scores range from 0-52, with a higher score indicating higher severity. | Friends and family members did not complete this measure at baseline | Mean | Standard Deviation | units on a scale |
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| Primary | FACE-Q Psychological Function | This 10-item scale measures psychological wellbeing using a series of positively worded statements, with participants invited to rate how much they agree/disagree with each statement. There is a minimum score of 10 and a maximum score of 40. Scores are Rasch transformed to a 0-100 scale. A high score indicates greater psychological wellbeing. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 2: 4-6 week follow-up | Data points | Data points |
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| Primary | FACE-Q Social Function | In this scale there are 8 statements pertaining to measuring social functioning. Scores on this scale range from 8 to 32, with scores Rasch transformed to a 0-100 scale. Higher scores indicate better social function. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 1: Baseline | Data points | Data points |
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| Primary | FACE-Q Social Function | In this scale there are 8 statements pertaining to measuring social functioning. Scores on this scale range from 8 to 32, with scores Rasch transformed to a 0-100 scale. Higher scores indicate better social function. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 2: 4-6 week follow-up | Data points | Data points |
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| Primary | Facial Disability Index (Social Function) | A 5-item self-report measure of social function in people with facial palsy. The scale is scored out of 100 (100 = high function). As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 1: Baseline | Data points | Data points |
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| Primary | Facial Disability Index (Social Function) | A 5-item self-report measure of social function in people with facial palsy. The scale is scored out of 100 (100 = high function). As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 2: 4-6 week follow-up | Data points | Data points |
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| Primary | FACE-Q Appearance-Related Psychosocial Distress | An eight-item scale assessing an individual's concerns regarding their facial appearance on a scale of 8-32, which is then Rasch transformed to a 0-100 scale. The higher the score, the greater the patient's dissatisfaction with their appearance. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 1: Baseline | Data points | Data points |
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| Primary | FACE-Q Appearance-Related Psychosocial Distress | An eight-item scale assessing an individual's concerns regarding their facial appearance on a scale of 8-32, which is then Rasch transformed to a 0-100 scale. The higher the score, the greater the patient's dissatisfaction with their appearance. As some participants were eligible to trial multiple guides, some participants contributed multiple data points. | This measure was not collected for friends and family | Posted | Mean | Standard Deviation | units on a scale | Time 2: 4-6 week follow-up | Data points | Data points |
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| Primary | Hospital Anxiety and Depression Scale | A 14-item scale with two seven-item subscales looking at anxiety and depression. A score equal-to-or-lower-than 7 on a subscale falls below the clinical cut-off, a score of 8-10 indicates probably clinically significant anxiety or depression, while a score of 11 or more indicates clinically significant anxiety or depression. Scores range from 0-52, with a higher score indicating higher severity. As some participants with facial palsy were eligible to trial multiple guides, some participants with facial palsy contributed multiple data points. | Posted | Mean | Standard Deviation | units on a scale | Time 1: Baseline | Data points | Data points |
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| Primary | Hospital Anxiety and Depression Scale | A 14-item scale with two seven-item subscales looking at anxiety and depression. A score equal-to-or-lower-than 7 on a subscale falls below the clinical cut-off, a score of 8-10 indicates probably clinically significant anxiety or depression, while a score of 11 or more indicates clinically significant anxiety or depression. Scores range from 0-52, with a higher score indicating higher severity. As some participants with facial palsy were eligible to trial multiple guides, some participants with facial palsy contributed multiple data points. | Posted | Mean | Standard Deviation | units on a scale | Time 2: 4-6 week follow-up | Data points | Data points |
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| Secondary | Adult Carer Quality of Life Questionnaire | 40 item questionnaire assessing carer quality of life. Possible scores range from 0-120, with higher scores indicating higher quality of life | This measure was not collected for people with facial palsy | Posted | Mean | Standard Deviation | units on a scale | Time 1: Baseline |
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| Secondary | Adult Carer Quality of Life Questionnaire | 40 item questionnaire assessing carer quality of life. Possible scores range from 0-120, with higher scores indicating higher quality of life | This measure was not collected for people with facial palsy | Posted | Mean | Standard Deviation | units on a scale | Time 2: 4-6 week follow-up |
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| 0 |
| 88 |
| 0 |
| 88 |
| 0 |
| 88 |
| EG001 | Friends and Family | Friends, family and carers of people with facial palsy, testing the guide: Facial palsy: Advice for friends, family and partners. | 0 | 9 | 0 | 9 | 0 | 9 |
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| D009422 |
| Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |