Patient Experiences and Emergency Appointments Associated with Orthodontic Appliance Treatment

  • Author / Creator
    Phuong, Ashley C
  • OBJECTIVE: To investigate patient experience and emergency visits during treatment with the Xbow appliance compared to the Forsus Fatigue Resistant Device (FFRD) used concomitant to full fixed appliances using an existing questionnaire from the literature, and to use the information gained to begin to develop the questionnaire into a common valid and reliable instrument to capture patients’ experiences with orthodontic appliances. METHODS: First study: Paper questionnaires were administered to 48 adolescent patients with mild-moderate Class II malocclusion randomly allocated into 2 treatment groups: Xbow and FFRD. Patients were instructed to complete the questionnaires at 1 week after insertion of the appliance, and 2 months after insertion of the appliance. Amount of time required to become accustomed to the appliance, side effects experienced, breakage occurrence, as well as the sources of discomfort were explored. Second study: Modifications were made to the original questionnaire based on findings from the first study. The modified instrument was used in think-aloud cognitive interviews with 9 patients (pre-adolescent, adolescent and adult) currently in treatment with any orthodontic appliance other than full fixed braces for at least 1 month to test the understandability and interpretability of the questions. RESULTS: First study: The overall experience with the appliance was similar between the Xbow group and the FFRD group. The majority of the FFRD group felt that insertion of the appliance was quick and easy, compared to the Xbow group which tended to disagree with that statement. The Xbow group reported the appliance was noticeable, and also some difficulty to open wide/yawn compared the FFRD group. The majority of patients were accustomed to the appliances within 2 months, with the reported mean time to “get used to” the Xbow being 3.95 weeks, and 2.25 weeks for the FFRD. Within the first 2 months, 50% of Xbow patients and 31.57% of FFRD patients reported experiencing a breakage that required an additional appointment. There was no difference in questionnaire responses after 1 week or 2 months. Second study: Reading comprehension was difficult for younger patients (age 12 and under). Several participants failed to follow written instructions within the questionnaire resulting in response error. Questions regarding eating or drinking with the appliance should be modified for patients treated with removable appliances. Wording of some questions needed improvement to make the questions more understandable, and wording of some response options/Likert scales needed improvement to better match the question. Valuable information elucidating patient experiences was gained from open-ended questions. CONCLUSIONS: The Xbow and the FFRD are similar in terms of additional appointments and overall patient experiences. Any differences are likely due to the fact that the FFRD is inserted after patients have already become accustomed to full fixed braces. Patients’ experiences do not change significantly between 1 week and 2 months. Questionnaires can provide valuable information to orthodontic clinicians and researchers regarding patient experiences associated with orthodontic appliances. This study has begun the process of establishing validity evidence using response processes for a common instrument to capture patient experiences with orthodontic appliances. A rough second draft of the instrument has been developed. Further testing of the second draft of the instrument is recommended before large-scale administration of the instrument is done.

  • Subjects / Keywords
  • Graduation date
    Fall 2018
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
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