Effectiveness of the combination of the Facial Physical Rehabilitation Program plus physical activity and nutritional guidance in the recovery of facial symmetry in patients with Bell's palsy and metabolic comorbidity (preliminary report).

Abstract

Despite multiple studies indicating the presence of type 2 diabetes mellitus (T2DM), systemic arterial hypertension (SAH), and metabolic syndrome (MS) as negative prognostic factors for post-treatment recovery from Bell's palsy (BP), there is still a long way to go in reaching a consensus on the role of these factors not only in the prognosis of recovery but also in the probable pathophysiology of the disease. Objective. Report preliminary results on the effectiveness of rehabilitation treatment combined with physical activity and ad-hoc nutritional guidance in the recovery of facial symmetry in PB and the corresponding changes in anthropometric, metabolic, immunological, and electrical bioimpedance measurements. Materials and Methods. Derived from the broad project (90/22 PA) and the subproject (90-22 SP-1) of the PB research line, in a preliminary sample of 25 cases (females 52.0%, age 45.2 +/- 11.2, with SM or some of its components), angular facial asymmetries (AnAs) were measured before and after the interventions. Correlatively, changes in the House-Brackmann clinical scale (H-B), physical anthropometry, metabolism, blood biometrics, immunological markers, and parameters obtained by electrical bioimpedance were measured. The change in total AnAs dichotomized into High/Moderate effectiveness (group 2) vs Low/None (group 1) was taken as the primary outcome. To compare the groups, the Fisher discriminant analysis model was applied prior to a bivariate analysis to select the variables with statistically significant differences at p <0.05. Results. The variables HDL (high-density lipoproteins), FINDRISC (10-year risk of DM2), NLR (neutrophil/lymphocyte ratio), SII (Systemic Inflammation Index), uric acid, muscle (kg), MME (muscle in extremities), and hydration had significant before-after changes. When comparing the means of the changes between the AsAn groups (1 vs 2), four final variables were found to be discriminative (age, decrease in HDL, decrease in IIS, and decrease in muscle) with a canonical correlation coefficient of 0.654, Wilks' lambda of 0.57, X2 11.7 (p = 0.02). The set of the four variables achieved a sensitivity of 84.6%, specificity of 83.3%, and accuracy of 84.0%. Conclusions. The effectiveness of combined treatments (nutritional guidance plus physical activity) on the reduction of AsAn in patients with PB and SM or any of its components, depended significantly on the changes observed in metabolic, inflammatory, immunological, and bioimpedance markers. In other words, these changes predict quite well the level of recovery of facial symmetry with the prescribed treatment. An interesting finding was the decrease in HDL, which prompts a review of the concept of dysfunctional HDL in these cases.