Research Gaps - Bell's palsy
This guideline was based on the current body of evidence regarding treatment of Bell's palsy. As determined by the GDG's review of the literature, assessment of current clinical practices, and determination of evidence gaps, research needs were determined as follows:
- Consolidated Standards of Reporting Trials (CONSORT) recommendations should be followed in all RCTs, ensuring valid outcomes measures are employed.139 The evaluation of patients prior to treatment, during treatment, immediately following treatment, and again months later, as well as collection of quality-of-life data prior to and following treatment, are all key components for a comprehensive RCT.
- The timing and outcomes for patients with and without surgical facial nerve decompression need to be compared. More specifically, the surgical approach (ie, middle fossa), age (young vs old), and time to improvement from onset of paresis/ paralysis to recovery (with levels of recovery) need to be compared with traditional medical management groups (ie, steroids and/or antivirals).
- Future clinical trials should compare eye care tactics for patients with Bell's palsy to provide the basis for stronger recommendations (eg, comparison of the frequency of treatment or content of ointment).
- The benefits and risks of steroid use in children with Bell's palsy need to be better elucidated.
- Further study is needed to more comprehensively compare the concurrent use of combined steroids and antiviral therapy on Bell's palsy outcomes. Future trials may benefit from designs that allow subgroup analysis to help identify which patients are more likely to benefit from combination therapy.
- More rigorous randomized controlled trials are needed to address the effectiveness of acupuncture.
- The efficacy of different physical therapy treatment modalities on asymmetry, symmetry of voluntary movement, and synkinesis in patients with Bell's palsy needs to be elucidated.