The patient acceptable symptom state in oral lichen planus: identification of cut-off threshold scores in measures of pa
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ORIGINAL ARTICLE
The patient acceptable symptom state in oral lichen planus: identification of cut-off threshold scores in measures of pain and quality of life Paswach Wiriyakijja 1,2 & Stephen Porter 1 & Stefano Fedele 1,3 & Tim Hodgson 4 & Roddy McMillan 4 & Martina Shephard 4 & Richeal Ni Riordain 1,5 Received: 15 July 2020 / Accepted: 10 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To establish thresholds of pain and quality of life scores corresponding to patient acceptable symptom state (PASS) in patients with oral lichen planus (OLP) and to assess demographic and clinical factors associated with achieving the PASS. Methods Prospective data from baseline and 4-month follow-up including Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), 14-item Oral Health Impact Profile (OHIP-14) and 15-item and 26-item Chronic Oral Mucosal Disease Questionnaire (COMDQ-15; COMDQ-26) were collected from 281 patients with OLP. An anchoring approach based upon the patient’s opinion on acceptability of OLP status was applied. Associated factors for achieving the PASS were analysed using multivariate logistic regression. Results About two-thirds (68.7%) of participants rated their OLP status as acceptable. Cut-off thresholds for PASS were as follows: ≤ 28 mm for VAS, ≤ 3 for NRS, ≤ 18 for total OHIP-14, ≤ 26 for total COMDQ-15 and ≤ 48 for total COMDQ-26. Based upon results of multivariate logistic analysis, factors associated with being in PASS were lower pain intensity, lower depressive symptoms and lower disease activity of OLP. Conclusion The present study established PASS cut-off thresholds as a tool facilitating interpretation of pain and quality of life outcomes relevant to individuals with OLP. Clinical relevance Identified PASS estimates could be utilised as clinically important endpoints in clinical practice of OLP as well as eligibility criteria for recruiting participants in clinical trials assessing effectiveness of symptomatic intervention of OLP. Keywords Quality of life . Oral lichen planus . Patient acceptable symptom state
Introduction
* Paswach Wiriyakijja [email protected] 1
UCL Eastman Dental Institute, London, UK
2
Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
3
NIHR University College London Hospitals Biomedical Research Centre, London, UK
4
Royal National ENT & Eastman Dental Hospitals, UCLH Foundation NHS Trust London, London, UK
5
Department of Oral Medicine, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
Oral lichen planus (OLP) is a chronic inflammatory immunemediated condition involving the mucous membranes of the oral cavity [1]. The disease may present with various clinical manifestations, ranging from characteristic white reticular lesions to erythema and ulceration of the oral mucosa [1]. Affected individuals can experience oral discomfort, significant impairment of oral functioning, resulting in poor oral health-related quality of life (OH-Q
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