Development of the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire

• Published in: International forum of allergy & rhinology 2017-11, Vol.7 (11), p.1076-1084
• Main Authors: ten Dam, Ellen, Feijen, Robert A., den Berge, Minke J.C., Hoving, Eelco W., Kuijlen, Jos M., der Laan, Bernard F.A.M., Vermeulen, Karin M., Krabbe, Paul F.M., Korsten‐Meijer, Astrid G.W.
• Format: Article
• Language: English
• Subjects: Adult; Aged; anterior skull base; chronic rhinosinusitis; endoscopic sinus surgery; endoscopic skull base surgery; Endoscopy; Endoscopy - psychology; Factor analysis; Female; Humans; Male; Middle Aged; Morbidity; Nasal Surgical Procedures - psychology; paranasal sinus diseases; Paranasal Sinuses - surgery; Patients; patient‐reported outcome measure; Quality of Life; Quantitative psychology; Sinuses; Skull; Skull Base - surgery; Surgery; Surveys and Questionnaires
• ISSN: 2042-6976; 2042-6984
• DOI: 10.1002/alr.22000

Background The patients’ perspective of health outcomes has become important input for assessing treatment effects. However, existing endoscopic endonasal surgery (EES) instruments are not fully aligned with the concept of health‐related quality of life (HRQoL). A prospective cohort study was therefore conducted to develop a suitable quality‐of‐life tool to assess nasal morbidity after EES: the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES‐Q). Methods The study included 300 patients: 207 with sinus pathology and 93 with anterior skull base pathology. The EES‐Q was administered prior to surgery and postoperatively (2 weeks, 3 months, and 1 year). Psychometric instrument properties were tested and relevant health domains were formulated. Seventy‐two items were generated by the conventional psychometric approach. An exploratory factor analysis was used to test construct validity. The optimal number of factors to retain was determined by using the eigenvalues‐greater‐than‐1 rule and scree plot. Orthogonal varimax rotation was used to enhance interpretability. Internal consistency was assessed using the Cronbach α. Results The factor analysis yielded a 3‐factor solution, representing physical, psychological, and social functioning. The final version of the instrument consisted of 30 items with a high internal consistency (>0.80) for all 3 HRQoL domains. Conclusions The EES‐Q is a comprehensive, multidimensional, disease‐specific instrument. A distinguishing characteristic is that, apart from the physical and psychological domains, the EES‐Q also encompasses a social domain. Understanding different HRQoL aspects in patients undergoing EES may help caregivers restore, improve, or preserve the patient's health through individualized care, which depends on identifying their specific needs.