Measurement of Health-Related and Oral Health–Related Quality of Life among Individuals with Nonsyndromic Orofacial Clefts: A Systematic Review and Meta-Analysis

Abstract

Objective To compare health-related quality of life and oral health–related quality of life between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the most affected quality of life dimensions in individuals with cleft lip and/or palate. Design Systematic review and meta-analysis were conducted. Of the 314 identified citations, 23 articles were submitted to quality assessment. Data from nine studies on health-related quality of life and six on oral health–related quality of life were extracted for meta-analysis. Main Outcome Measures Pooled mean differences of health-related quality of life between adults with and without cleft lip and/or palate, pooled means of health-related quality of life dimensions of children and adults with cleft lip and/or palate and oral health–related quality of life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence interval were calculated. Results Quality assessment revealed methodological differences between studies. Lack of subgroup stratification and absence of control for confounders were the main limitations. Heterogeneity was detected on the comparison of oral health–related quality of life and health-related quality of life between children with and without cleft lip and/or palate, and oral health–related quality of life between adolescents with and without cleft lip and/or palate. A random-effect model showed a significant difference on health-related quality of life between adults with and without cleft lip and/or palate (mean difference = 0.10; 95% confidence interval, 0.16 to 0.05). Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1; 95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life dimensions in children and adults with cleft lip and/or palate, respectively. Means of health-related quality of life dimensions in children and adults with cleft lip and/or palate and oral health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did not differ in indirect comparisons. Conclusion The presence of cleft lip and/or palate negatively affected the health-related quality of life of adults, mainly on psychosocial dimensions.