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To the best of our knowledge, there is no ocular motility disorder (OMD)-specific quality of life (QoL) tool, OMD-specific scale or method for patient profiling during treatment. Purpose: To develop an OMD-specific QoL assessment method in an effort to objectify treatment outcomes and to perform patient profiling during treatment.
Material and Methods: We retrospectively analyzed outcomes among 300 patients (140 women and 160 men; aged 14 to 82 years; mean age, 28 ± 3.1 years) with OMD who received inpatient treatment at the Romodanov Neurosurgery Institute between 2004 and 2017. Out of these patients, 134 underwent surgeries for ruptured saccular supraclinoid internal carotid artery aneurysm, 82 underwent tumor removal (including: acoustic neurinoma, n = 36; pituitary adenoma, n = 29; and meningioma, n = 17) and 84 were treated non-surgically for craniocerebral trauma. Rehabilitative treatment was done in all patients (in operated-on patients, it was done early after surgery). Results and Discussion: We developed OMD-specific score assessment method and QoL scale involving a number of indices related to neurological symptoms, as well as to physical, psychic and social status of patients.
Patients and medical personnel (doctors) had been asked to answer the questions of the QoL Scale prior to, just after and 2-3 months following rehabilitative treatment. Points were assigned to each item, total scores were calculated, and post-treatment total scores were compared with pretreatment total scores.
The QoL scale has two subscales, subscale A (15 questions with each question having three possible responses) and subscale B (5 questions with each question having four possible responses), with the questions answered by the patient and the doctor, respectively. As per WHO guidelines, the patient’s status assessment is based on not only the intensity of pathological process but also influence of the disease or of the trauma on the patient’s self-care ability, home and social activities. Comparison of physician’s assessment scores with patient-reported scores makes it possible to deepen understanding of the functional handicap and of the patient’s adaptation to this condition With the testing completed, total scores are calculated. A total OMD-special QOL score of 0–15 is considered a poor (or low) QoL; 16–30, a moderate (or good) QoL; and 31–45, a high QoL. OMD-specific assessment of treatment outcomes and QoL over time is performed by comparison of total pre-treatment and post-treatment scores. Not only the extent of damage to cranial nerves III, IV, and VI, but also the impact of physical handicap on the patient’s activities and on his functional abilities is assessed. The extent of neurological manifestations and the patient’s QoL are identified at different time points.
Example. Ms. M-k, aged 19 years, was operated for left cerebellopontine angle neurinoma. Postoperatively, a left cranial nerve VI palsy was observed. A paralytic esotropia was present, with a left eye turned inward, and were not eye movements outward, toward the central axis and away from the central axis. Soon after operation, the patient was discharged from the inpatient unit for family reasons. Her neurological symptoms persisted, and, 2 months later, she came back to the unit to undergo a course of rehabilitative therapy for OMD. The patient and the doctor were asked to answer the questions of the QoL Scale prior to treatment (i.e., at baseline).
The patient’s baseline present total QOL score was 8, reflecting “poor” (or low) QoL. After she underwent the course of rehabilitative therapy for OMD, positive ocular motility changes were observed in her left eye, and eye movements (outward, toward the central axis and away from the central axis) were restored. The patient was re-examined, and her QoL was re-assessed with the QoL Scale. Just after the course of rehabilitative therapy for OMD, the patient’s total QOL score was 27, reflecting “good” (or moderate) QoL. During the follow-up, she maintained the positive functional changes. At the 3 month follow-up visit, the function of the specific nerve was restored completely, and the patient had no OMD-related complaints. She was re-examined, and her QoL was re-assessed with the QoL Scale.
Three months after the course of rehabilitative therapy for OMD, the patient’s total QOL score was 44, reflecting “high” QoL.
Application of the OMD-specific QoL assessment method involving the QoL scale in clinical practice makes it possible to objectify treatment outcomes and facilitates patient profiling during treatment.
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