Relationship between Patient Cooperation and Treatment Result among Orthodontic Patients in Biratnagar, Nepal

Introduction: Orthodontic treatment is a highly technique sensitive process; which takes long duration and its success depend on many factors. Patient cooperation is one of the important determinants of orthodontic treatment. Objective: To investigate the relationship between patients’ cooperation and orthodontic treatment result as rated by the orthodontist. Materials & Method: Orthodontic Patient Cooperation Scale (OPCS) was used to evaluate 57 orthodontic patients’ cooperation who had undergone active orthodontic treatment in Nobel Medical College Hospital, Biratnagar from 2014 January to 2017 June and were under retention phase. Orthodontic treatment results of these patients were graded as good, acceptable and poor by the orthodontist. Independent t-test was applied to test the mean of OPCS score, the treatment result and gender. Result: Mean OPCS score was higher in good treatment result category; as the OPCS score increased treatment result improved, which was statistically significant (p < 0.01). Conclusion: Orthodontic patients’ cooperation is a strong determining factor for positive treatment outcome.


INTRODUCTION
Successful outcome of orthodontic treatment does not only depend on the competency on part of the treating orthodontist but also on patients' obedience towards orthodontist's instructions.The extent to which a patient benefits from orthodontic treatment depends upon patient cooperation in the treatment. 1[3][4][5] Slakter et al introduced Orthodontic Patient Cooperation Scale (OPCS) on the basis of ten patient behaviors. 1This scale has adequate internal consistency to be used as a means to measure the patient cooperation.There are different factors influencing orthodontic treatment.This was given by a fish bone diagram. 6 Revised questionnaire with 5-point Likert scale was used to assess patient's cooperation (Table 1). 1 The assessment was done by trained and calibrated Orthodontists on patients meeting inclusion criteria.Treatment result of each patient was evaluated with the help of pre-and posttreatment records by Orthodontists as good, acceptable and poor (Table 2).5Each patient was rated according to the scale by a different Orthodontist to avoid observer bias.Independent t-test was used to test the mean of OPCS scores, treatment results and gender.SPSS version 11.5 was used to analyze the data, level of significance was set at p<0.05.

Score 1 Poor
Treatment result does not coincide with the treatment goal.
Malocclusion persists and only minor changes have occurred.

Score 2 Acceptable
Result coincides in part with the treatment goal.
Signs of severity of malocclusion have been reduced;

Score 3 Good
Treatment result is substantial and coincides with the treatment goal.
Minor rotations or slight irregularities of single teeth may, however be allowed.
15.29 years (SD 1.92).Good treatment result was seen in 34 subjects and acceptable treatment result was seen in 23 subjects.There was no poor treatment result.
The mean score for good treatment result was 47.46  3).

DISCUSSION
The high mean OPCS score in patients under good treatment result category shows that good patients cooperation is needed for better treatment results which is consistent with the previous research. 7gher mean cooperation score in females, though not statistically significant; is in accordance with the previous research. 8e difference in orthodontic treatment result among gender groups was not statistically significant which shows orthodontic treatment result does not depend on the gender but is determined by the degree of cooperation in following orthodontist's instructions.
Factors that might significantly predict patient's cooperation with orthodontic treatment include Out of the multitude of factors our study used 'patient cooperation during orthodontic treatment' as the factor influencing orthodontic treatment result categorized as good, acceptable and poor.Nepalese studies concerning patient cooperation and orthodontic treatment result are rare.Hence, the objective of our study was to rate orthodontic patients' cooperation in Biratnagar Dr Anand Acharya, 1 Dr Bhushan Bhattarai, 2 Dr Dhirendra Giri, 3 Dr Tarakant Bhagat 4 1,2 Lecturer, Dept of Orthodontics, 3 Asst Prof, Dept of Periodontics, Nobel Medical College, Biratnagar, MATERIALS AND METHOD Orthodontic Patient Cooperation Scale (OPCS) was used to rate 57 orthodontic patients (40 female and 17 male) who had undergone active orthodontic treatment in Nobel Medical College Teaching Hospital, Biratnagar from 2014 January to 2017 June.Ethical clearance was obtained from the Institutional Review Committee and written informed consent was obtained from parent/ guardian and assent from the patient.Inclusion criteria were: orthodontic patients aged 12-19 years accompanied by guardians during diagnosis and treatment plan appointments, patients under retention phase after completing active fixed orthodontic therapy; presence of case history, pre-and post-treatment records; no history of trauma.

* 11 CONCLUSION
Statistically significant at p<0.05 patient's attitude toward the treatment immediately before and during the treatment and the ability to cope with any discomfort during the treatment.9It has been established that orthodontist's behavior influence patient satisfaction, the orthodontist-patient relationship and patient cooperation.10Positive reinforcement by praising the patients verbally when they show good cooperation is generally used in routine clinical practice.Every effort should be undertaken to render the patient as cooperative as possible so as to carry out the orthodontic treatment smoothly and finally obtain the best treatment result.Further research is necessary to include other factors that can affect the orthodontic outcome such as severity of malocclusion, choice of the appliance and competency of the orthodontist.

OJN
Acharya A, Bhattarai B, Giri D, Bhagat T : Relationship between Patient Cooperation and Treatment Result among Orthodontic Patients in Biratnagar, Nepal was higher in good treatment result category and as the OPCS score increased, the treatment result improved which was statistically significant (p<0.01).It was also observed that the mean OPCS score was higher in females compared to males but was not statistically Orthodontic Journal of Nepal, Vol. 8 No. 1, June 2018