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J Acupunct Res > Volume 31(1); 2014 > Article
Kim, Lee, Nam, and Kim: A Study of Psychological Distress, Anxiety and Depression on Motor Recovery of Acute Bell’s Palsy Patients’ Facial Muscle
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Abstract

Objectives :

The aim of this study is to investigate the influence of anxiety and depression on motor recovery of acute Bell’s palsy to estimate how much psychological factors affect the clinical prognosis.

Methods :

A total of 20 inpatients with acute unilateral Bell’s palsy within 1 week of onset participated in this study. The severity of participants’ facial palsy was measured by Yanagihara(Y-system) score, FDI and House-Brackmann scale at the time of 1 week and 3 weeks from the onset. The motor recovery of acute Bell’s palsy is defined as ΔY-system during 2 weeks. Beck anxiety scale(BAI) and the center for epidermiologic studies depression scale(CES-D) were adopted to assess anxiety and depression, respectively. Correlation analysis and linear regression analysis were conducted between ΔY-system and prognostic factors including anxiety and depression.

Results :

Significant associations were found between ΔY-system and depression(CES-D) but no significant associations were found between ΔY-system and other prognostic factors, hypertension, diabetes, postauricular pain, disgeusia, age, degree of initial palsy and anxiety(BAI). And a regression equation with 0.295 for coefficient of determination was obtained. Through this analysis, the ΔY-system can be predicted using regression equation which cover 29.5 % of depression index(CES-D).

Conclusion :

Depression is a significant clinical prognostic factor on motor recovery of acute Bell’s palsy. So, Bell’s palsy treatment should be combined with psychological care and support.

Fig. 1.
Study flow chart
acupunct-31-1-149-15f1.gif
Table 1.
Yanagihara's Unweighed Grading System
Scale of five rating
At rest 0 1 2 3 4
Wrinkle forehead 0 1 2 3 4
Blink 0 1 2 3 4
Closure of eye lightly 0 1 2 3 4
Closure of eye tightly 0 1 2 3 4
Closure of eye on involved side only 0 1 2 3 4
Wrinkle nose 0 1 2 3 4
Whistle 0 1 2 3 4
Grin 0 1 2 3 4
Depress lower lip 0 1 2 3 4
Table 2.
Gross Grading System of House-Brackmann
Grade Description Characteristics
I Normal Normal facial function all areas
II Mild dysfunction Gross Slight weakness noticeable on close inspection may have very slight synkinesis
At rest Normal symmetry and tone
Motion
  Forehead : Moderate to good function
  Eye : complete closure with minimum effort
  Mouth : Slight asymmetry

III Moderate dysfunction Gross obvious but not disfiguring difference between two sides, noticeable but not severe synkinesis, contracture, and/or hemifacial spasm
At rest normal symmetry and tone
Motion
  Forehead : slight to moderate movement
  Eye : complete closure with effort
  Mouth : slightly weak with maximum effort

IV Moderately severe dysfunction Gross obvious weakness and/or disfiguring asymmetry
At rest normal symmetry and tone
Motion
  Forehead : none
  Eye : incomplete closure
  Mouth : asymmetric with maximum effort

V Severe dysfunction Gross : only barely perceptible
At rest : asymmetry
Motion
  Forehead : none
  Eye : incomplete closure
  Mouth : slight movement

VI Total paralysis No movement
Table 3.
Baseline Characteristics
Total n=20 n %
Sex Male 6 30
Female 14 70
Age(years) 45.45±11.95a (19∼65)b
Period of treatment(days) 15.25±2.57a (12∼20)b

Hypertension existence 4 20
nonexistence 16 80
Diabetes mellitus existence 4 20
nonexistence 16 80
Postauricular pain existence 10 50
nonexistence 10 50
disgeusia existence 6 20
nonexistence 14 80
Initial H-B Gr H-B Gr II 1 5
H-B Gr III 5 25
H-B Gr IV 8 40
H-B Gr V 6 30
Final H-B Gr H-B Gr II 10 50
H-B Gr III 5 25
H-B Gr IV 5 25
H-B Gr V 0 0

BAI* score 8.70±6.54a(0∼23)b
CES-D** score 13.95±7.98a(3∼34)b
ΔY-system 10.13±4.72a(3.0∼21.5)b
ΔFDI***-P 22.50±14.00a (0∼50)b
ΔFDI-S 15.80±15.33a(−4∼60)b

a mean±standard deviation.

b Min ∼ Max.

* beck anxiety inventory.

** the center for epidermiologic studies depression scale.

*** facial disability index − physical / social.

Table 4.
Comparison of ΔY-system* Score According to Existence of HTN, DM, Postauricular Pain, Disgeusia
Existence Nonexistence p**
HTN 8.75±4.50 10.47±4.85 0.617
DM 13.88±5.48 9.19±4.17 0.148

Postauricular pain 9.60±4.01 10.65±5.51 0.739

Disgeusia 11.5±4.10 9.56±4.99 0.207

* final Y mean - initial Y mean.

** p-value of Mann Whitney U test < 0.05.

Values are ΔY-system scores(means ± standard deviation).

Table 5.
Correlation between ΔY-system and Age, Initial Y Mean Score
Correlation coefficient*
Age 0.032
Initial Y mean −0.007

* correlation coefficient is Spearman’s correlation coefficient.

Table 6.
Correlation between Psychological Factors and Improvement of Bell’s Palsy
Correlation coefficient** p*
BAI
  ΔY-system −0.172 0.467
  ΔFDI-P 0.121 0.612
  ΔFDI-S 0.144 0.544

CES-D
  ΔY-system −0.568 0.009*
  ΔFDI-P −0.031 0.898
  ΔFDI-S 0.094 0.694

* correlation is significant at the 0.05 level(2-tailed).

** correlation coefficient is Spearman’s correlation coefficient.

Table 7.
Summary of Simple Linear Regression Analysis
R R2 Unstandardized β p
0.543 0.295 −0.321 0.013*

Coefficients of determinant(R), squared R(R2) regression coefficient(β)

* regression equation is significant (p < 0.05)

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