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Validation of five patient-reported outcomes for atopic dermatitis severity in adults.
Br J Dermatol. 2020 01; 182(1):104-111.BJ

Abstract

BACKGROUND

Structured patient-reported outcomes of atopic dermatitis (AD) severity are not standardized in clinical practice.

OBJECTIVES

To determine the construct validity, internal consistency, cross-cultural validity and floor or ceiling effects of multiple AD severity assessments.

METHODS

This is a cross-sectional, population-based study of 2893 adults, including 602 adults who met a modified set of U.K. diagnostic criteria for AD. AD severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) and its objective and subjective components, and numerical rating scale (NRS)-itch. Quality of life was assessed using Short-Form (SF)-12 mental and physical health scores, Short-Form Six Dimensions (SF-6D) health utility scores and Dermatology Life Quality Index (DLQI). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS).

RESULTS

PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM all had moderate-to-strong correlations with each other and DLQI, fair-to-moderate correlations with HADS-anxiety and HADS-depression, and inverse correlations with SF-12 mental component score and SF-6D (Pearson correlations, P < 0·001). All scores showed good criterion validity as judged by anova and receiver operator characteristics. PO-SCORAD, PO-SCORAD objective subscore and POEM had similarly good internal consistency (Cronbach's alpha = 0·84, 0·82 and 0·86); the PO-SCORAD subjective subscore was less internally consistent (alpha = 0·57). All scores showed potentially poor cross-cultural validity as demonstrated by uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity for multiple items. There were floor effects for POEM, but not for the other assessments.

CONCLUSIONS

PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM appear to be valid for assessing AD severity in clinical practice. What's already known about this topic? Few studies have demonstrated the validity of the atopic dermatitis severity assessments Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), PO-SCORAD subscores, numerical rating scale (NRS)-itch and Patient-Oriented Eczema Measure (POEM). What does this study add? This study demonstrates that PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all had good construct validity in the assessment of atopic dermatitis severity in adults. Only POEM demonstrated floor effects. What are the clinical implications of this work? PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all appear to have sufficient validity to be used as assessments of atopic dermatitis severity in clinical practice.

Authors+Show Affiliations

Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, U.S.A.National Jewish Health and University of Colorado School of Medicine, Denver, CO, U.S.A.NYU Winthrop Hospital, Mineola, NY, U.S.A.Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, OH, U.S.A.Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, U.S.A.University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, U.S.A.Oregon Health & Science University, Portland, OR, U.S.A.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30972740

Citation

Silverberg, J I., et al. "Validation of Five Patient-reported Outcomes for Atopic Dermatitis Severity in Adults." The British Journal of Dermatology, vol. 182, no. 1, 2020, pp. 104-111.
Silverberg JI, Margolis DJ, Boguniewicz M, et al. Validation of five patient-reported outcomes for atopic dermatitis severity in adults. Br J Dermatol. 2020;182(1):104-111.
Silverberg, J. I., Margolis, D. J., Boguniewicz, M., Fonacier, L., Grayson, M. H., Ong, P. Y., Fuxench, Z. C., & Simpson, E. L. (2020). Validation of five patient-reported outcomes for atopic dermatitis severity in adults. The British Journal of Dermatology, 182(1), 104-111. https://doi.org/10.1111/bjd.18002
Silverberg JI, et al. Validation of Five Patient-reported Outcomes for Atopic Dermatitis Severity in Adults. Br J Dermatol. 2020;182(1):104-111. PubMed PMID: 30972740.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of five patient-reported outcomes for atopic dermatitis severity in adults. AU - Silverberg,J I, AU - Margolis,D J, AU - Boguniewicz,M, AU - Fonacier,L, AU - Grayson,M H, AU - Ong,P Y, AU - Fuxench,Z C, AU - Simpson,E L, Y1 - 2019/07/24/ PY - 2019/04/08/accepted PY - 2019/4/12/pubmed PY - 2021/5/15/medline PY - 2019/4/12/entrez SP - 104 EP - 111 JF - The British journal of dermatology JO - Br J Dermatol VL - 182 IS - 1 N2 - BACKGROUND: Structured patient-reported outcomes of atopic dermatitis (AD) severity are not standardized in clinical practice. OBJECTIVES: To determine the construct validity, internal consistency, cross-cultural validity and floor or ceiling effects of multiple AD severity assessments. METHODS: This is a cross-sectional, population-based study of 2893 adults, including 602 adults who met a modified set of U.K. diagnostic criteria for AD. AD severity was assessed using self-reported global AD severity, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) and its objective and subjective components, and numerical rating scale (NRS)-itch. Quality of life was assessed using Short-Form (SF)-12 mental and physical health scores, Short-Form Six Dimensions (SF-6D) health utility scores and Dermatology Life Quality Index (DLQI). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS). RESULTS: PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM all had moderate-to-strong correlations with each other and DLQI, fair-to-moderate correlations with HADS-anxiety and HADS-depression, and inverse correlations with SF-12 mental component score and SF-6D (Pearson correlations, P < 0·001). All scores showed good criterion validity as judged by anova and receiver operator characteristics. PO-SCORAD, PO-SCORAD objective subscore and POEM had similarly good internal consistency (Cronbach's alpha = 0·84, 0·82 and 0·86); the PO-SCORAD subjective subscore was less internally consistent (alpha = 0·57). All scores showed potentially poor cross-cultural validity as demonstrated by uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity for multiple items. There were floor effects for POEM, but not for the other assessments. CONCLUSIONS: PO-SCORAD, PO-SCORAD objective and subjective subscores, NRS-itch and POEM appear to be valid for assessing AD severity in clinical practice. What's already known about this topic? Few studies have demonstrated the validity of the atopic dermatitis severity assessments Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD), PO-SCORAD subscores, numerical rating scale (NRS)-itch and Patient-Oriented Eczema Measure (POEM). What does this study add? This study demonstrates that PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all had good construct validity in the assessment of atopic dermatitis severity in adults. Only POEM demonstrated floor effects. What are the clinical implications of this work? PO-SCORAD, PO-SCORAD subscores, NRS-itch and POEM all appear to have sufficient validity to be used as assessments of atopic dermatitis severity in clinical practice. SN - 1365-2133 UR - https://www.unboundmedicine.com/medline/citation/30972740/Validation_of_five_patient_reported_outcomes_for_atopic_dermatitis_severity_in_adults_ L2 - https://doi.org/10.1111/bjd.18002 DB - PRIME DP - Unbound Medicine ER -