Evaluating the Reliability and Validity of the Persian Version of the Rhinoplasty Satisfaction Questionnaire (ROE)

mouseout="msoCommentHide('_com_1')" onmouseover="msoCommentShow('_anchor_1','_com_1')">Background: Rhinoplasty is one of the most popular types of cosmetic surgeries performed by otorhinolaryngologists. Rhinoplasty is a challenging and complex surgery because it is designed according to the unique needs of each patient (1). In 2013, men accounted for approximately 20 percent of all rhinoplasty procedures and non-whites accounted for nearly 30 percent of the patient population. In addition, the age of candidates for rhinoplasty was wide and about half of the patients were between 19 and 34 years old and the other half of the patients were under 19 years old or older (2). The existence of tools to measure patients' satisfaction with the results of their surgery can give surgeons a better view to optimize the methods and quality of their surgeries. One of the common methods for evaluating surgical results in terms of patients satisfaction is through the quality of life questionnaires. Especially in rhinoplasty, this method of evaluation aims to examine the direct effect of surgery on patient satisfaction with self-image and consequently self-esteem (3-5). As a result, the validity of such questionnaires is significant. Researchers can use these tools to assess the quality of surgery and optimize methods based on individual characteristics (6). Rhinoplasty Outcome Evaluation (ROE) is one of the questionnaires used today to assess patients' willingness and satisfaction with rhinoplasty (7, 8). In 2021, Mulafikh et al. published a study in Arabic aimed at translating, intercultural matching, and validating the outcome of ROE. This non-randomized prospective study included 50 patients and a control group of 89 healthy individuals who underwent primary rhinoplasty from January to October 2020 in the Department of Otolaryngology, King Saud University, Riyadh, Saudi Arabia. There was a significant difference in ranking between rhinoplasty patients and the control group on both individual questions and total scores. Significant improvement in patient group ranking was observed in 2 weeks and 3 months after surgery compared to preoperative score (P <0.0001). Based on the conclusion of this study, the Arabic version ROE showed good internal consistency, reliability, and credibility and can be used to evaluate the results of rhinoplasty in the Arab population (9). The questionnaire has been translated into German, Turkish, Arabic, and many other languages, but so far in Iran, there is no scale to measure patients' satisfaction with rhinoplasty (10-12). It can be used for many Iranian patients and surgeons. This study aimed to evaluate the validity and reliability of the translated ROE Questionnaire. Methods: The ROE questionnaire was translated by two independent translators and then it was translated back into English and was compared with the original one. With the expert panel reviews, its Content Validity Ratio (CVR) and Content Validity Index (CVI) ​​were calculated. Then, patients who underwent rhinoplasty in Firoozgar Hospital and a private center in Tehran in 2016, for the first time and without any simultaneous facial surgeries, were included in this study, and again two weeks after the operation. This research was done with the approval of the ethics committee of the research vice-chancellor of the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.849). Results: Expert panel consisted of 10 experts that expressed their views on the questionnaire items. The CVR coefficient for all items except the second item was above 0.62, for which the coefficient was measured to be 0.564. The CVI coefficient was also reported to be 0.8 for all items. The mean total score of 87 patients at the first completion was 43.14 (±15.32), which two weeks later reached 41.58 (±15.60) (p-value> 0.05), this indicates that the Persian version of ROE has good reliability. The postoperative score was 68.48 (±12.49) which was significantly improved (p-value <0.05). Discussion In our study, differences in gender, age, and education had did not affect postoperative satisfaction scores using ROE. The results of our study are consistent with previous studies (3, 7, 10, 11). This study had a lower item-total correlation coefficient for question 2 like the Arabic version of ROE because unlike the rest of the questions, the second question was related to the functional aspect of rhinoplasty and patients were worried about aesthetic aspects of rhinoplasty (10).  Despite this, as the only question about nasal obstruction, and high total post-operative scores we found this question important and applicable for the Persian version of ROE. Izu et al. Introduced a cut-off point of 12 out of 24 or 50% for ROE to be used as a tool to evaluate surgical outcomes and to help predict outcomes (12). In our study, the mean total ROE score in individuals at the first time of completing the questionnaire and after surgery was significantly different (p-value <0.05). Patients reported a score lower than this incision point before surgery and more than 50% after surgery. This indicates the high satisfaction of patients with the surgical outcome. Other studies have used ROE to demonstrate the results of rhinoplasty and its high impact on quality of life, and have concluded that long-term follow-up increases patient satisfaction with rhinoplasty. For this reason, follow-up is important to help evaluate outcomes and long-term patient satisfaction (7, 13, 14). The limitations of the present study were the inability to examine patients in different medical centers, a relatively small sample size, and a short follow-up period. Also, the patients' satisfaction after long-term and medium-term surgery was not evaluated. To increase the accuracy of this questionnaire, this questionnaire should be repeated at different times and places. Also, the surgeon using this questionnaire should pay attention to long-term follow-up of rhinoplasty and ways to improve patients' quality of life. Conclusion: So far, no tool has been introduced to measure patients' satisfaction with the shape of the nose and the outcome of surgery after rhinoplasty, in Iran. The results of our study showed that the Persian version of ROE has good reliability, validity, and credibility, and its results are comparable to ROE questionnaires that have already been translated, adapted, and published in the literature review, as well as the original ROE. Therefore, this tool can be used to evaluate the results of rhinoplasty and many applications can be imagined for it. mouseout="msoCommentHide('_com_1')" onmouseover="msoCommentShow('_anchor_1','_com_1')">