Abstract
This study describes the validation process for the Persian language version of a tool for assessing the functional and cosmesis outcomes of rhinoplasty.
The 10-item Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) has recently been introduced as an instrument for describing the severity of nasal obstruction and the extent of aesthetic dissatisfaction.1 The SCHNOS has demonstrated psychometric validity using both item-response theory and factor analysis.2,3 The instrument is easy to complete and has promising application for both screening and clinical assessment, especially among patients undergoing rhinoplasty.
In Iran, rhinoplasty is the most common aesthetic procedure,4 but no validated measures were available in the Persian language to enable the assessment of rhinoplasty outcomes. The objective of this study was to validate the Persian version of SCHNOS before it can be recommended for clinical use.
Methods
This study received approval from the institutional review board of Tehran University of Medical Sciences. Written informed consent was obtained from all patients.
In total, 25 patients undergoing rhinoplasty and 25 healthy asymptomatic volunteers were included in the study. The SCHNOS scale consists of 2 domains, producing 2 separate scores: SCHNOS-O (obstruction) and SCHNOS-C (cosmesis). Each item is scored on a 6-point Likert scale, with the highest score indicating an extreme problem.
A standard back-translation method was applied.5 Ten patients (20%) were asked about the clarity and relevancy of the questions.6 The 2-sample Wilcoxon rank sum test was used to identify the differences between the rhinoplasty and non-rhinoplasty groups, and an unpaired 2-tailed t test was used to assess the difference in SCHNOS-O and SCHNOS-C total scores between the 2 groups. Cronbach α was calculated to assess the internal consistency of the instrument. Spearman rank correlation and Pearson correlation coefficient calculated the strength of association between the 2 repeated measures.
Results
Of the 50 study participants, 23 (46%) were male and 27 (54%) were female, with a mean (SD) age of 34.5 (8.4) years. The analysis of face validity led to the translation to the Persian language of item 7 as “How much of a problem was the unstraightness of your nose?” and of item 10 as “The difference between right and left side of my nose.” For the entire test, Cronbach α was good at 0.87, with a lower 95% CL of 0.82. Cronbach α for SCHNOS-O was 0.82 (lower 95% CL, 0.75) and for SCHNOS-C was 0.88 (lower 95% CL, 0.83). The correlations between the before and after measures for each item were either strong or very strong, ranging from 0.64 to 0.93 (Table). As expected, the association between SCHNOS-O and SCHNOS-C scores was 0.40 (95% CI, 0.13-0.61), with a lower 95% CI indicating a very weak correlation. The rhinoplasty and non-rhinoplasty groups were different and had a P < .05 for all single items and total scores.
Table. Correlations Between 2 Repeated Measures of the Persian Standardized Cosmesis and Health Nasal Outcomes Surveya.
| Item | Correlation Coefficient (95% CI) |
|---|---|
| 1 | 0.78 (0.65-0.87) |
| 2 | 0.64 (0.43-0.78) |
| 3 | 0.78 (0.64-0.87) |
| 4 | 0.68 (0.50-0.81) |
| 5 | 0.86 (0.76-0.92) |
| 6 | 0.86 (0.76-0.92) |
| 7 | 0.85 (0.75-0.91) |
| 8 | 0.67 (0.48-0.80) |
| 9 | 0.89 (0.81-0.93) |
| 10 | 0.69 (0.51-0.81) |
| SCHNOS domain | |
| Obstruction | 0.81 (0.69-0.89) |
| Cosmesis | 0.93 (0.88-0.96) |
Abbreviation: SCHNOS, Standardized Cosmesis and Health Nasal Outcomes Survey.
Spearman rank correlation was used in single items, and Pearson correlation was used in the SCHNOS obstruction and cosmesis domains.
Discussion
The Persian language version of SCHNOS was internally consistent and demonstrated test-retest reliability and discriminant validity. This version can be recommended for assessing both functional and cosmesis outcomes in patients who undergo rhinoplasty. Future research may reveal the precise factor structure of the SCHNOS scale, its responsiveness to changes, and its minimal clinically important difference.
References
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