The validity and reliability of the occupational contact dermatitis disease severity index

[Hand eczema registries: Background, value and future prospects : Registry data in hand eczema research]

BACKGROUND

Population-based studies on hand eczema (HE) show a 1-year prevalence up to 10.0% of which 5-7% are severe chronic HE (CHE) which can severely impair the life of those affected. Registry data can help to investigate and optimize burden of disease as well as healthcare of HE in a real-life setting.

OBJECTIVES

To assess how data from registries have been used in studies concerning HE. What is the benefit of registry data and which limitations occur when researchers use registry data in their studies?

MATERIALS AND METHODS

This is a review of publications where registry data were used in studies concerning HE. Most of the publications included in this review are from Germany, but some studies are from other countries like Denmark and Switzerland.

RESULTS

Currently, only Germany and Switzerland have established a disease-specific registry for CHE. The chronic hand eczema registry with the acronym CARPE assesses the characteristics of CHE as well as treatment and course of the diseases in a real-life setting. In Denmark, data from public registries (Danish National Board of Industrial Injuries Registry) were used to identify patients with occupational HE in order interview them using a questionnaire. In Saarland and north Bavaria, registries for occupational skin diseases were established in the 1990s, and more than 90% of the patients registered in these had HE.

CONCLUSION

Diseases registries for HE can generate considerable data to describe characteristics of HE patients in a dermatological setting as well as the treatments prescribed. The completeness of data can be assessed in disease registries, while this is not possible when using public registry data.

Translation and Validation of the German New Knee Society Scoring System

BACKGROUND

In 2011 the Knee Society Score (KSS) was revised to include patient expectations, satisfaction, and physical activities as patient-reported outcomes. Since the new KSS has become a widely used method to evaluate patient status after TKA, we sought to translate and validate it for German-speaking populations.

QUESTIONS/PURPOSES

After translation of the new KSS into German using established guidelines, we sought to test the new German version for (1) validity; (2) responsiveness; and (3) reliability.

METHODS

The new KSS form was translated and adapted according to the available guidelines. The final version was used to validate the German version of the new KSS (GNKSS) in 133 patients undergoing TKA, of which 100 patients were included in the study as per inclusion criteria. Patients completed the GNKSS form along with the German WOMAC and the German SF-36 scores preoperatively and at the 2-year postoperative followup. Construct validity was tested by comparing domain scores of the GNKSS with domain scores of the German WOMAC and the SF-36. Responsiveness was evaluated by comparing pre- and postoperative scores in all questionnaires in all patients using standardized response means. To evaluate reliability, every second patient (n = 50) in the whole group was asked to complete the GNKSS form a second time 1 week after their 2-year followup; 39 patients responded. This sample group was considered representative after testing the difference among age, sex, body mass index, operation side, preoperative or postoperative GNKSS, and WOMAC scores with the original group. Intraclass correlation coefficients (ICCs) were used to assess reliability and Cronbach's α was an indicator of internal consistency of each domain score.

RESULTS

Construct validity was excellent pre- and postoperatively between the GNKSS and the WOMAC for domains including symptoms, satisfaction, total functional score, and total score and activity subdomains, except the expectation domain and advanced and discretionary subdomains of the GNKSS and the stiffness domain of WOMAC. The expectation domain showed either no significant correlation or only weak correlations with the domains of WOMAC pre- as well as postoperatively (r ranging between -0.19 and -0.34). Correlation of the function section of the GNKSS as well as the physical function and role-physical domains of the SF-36 pre- and postoperatively were moderate to strong, respectively, with statistically significant (p < 0.001) r values of 0.49 and 0.48 preoperatively and 0.73 and 0.65 postoperatively. Correlation of the symptom section of the GNKSS and bodily pain domain of the SF-36 was also strong pre- and postoperatively. Regarding responsiveness, all domains of the GNKSS showed large changes except the expectation domain. The symptom and functional sections of the GNKSS showed higher responsiveness than the corresponding pain and function domains of the WOMAC and bodily pain and physical function domains of the SF-36. Also, the total score changes were larger for the GNKSS compared with the WOMAC. No floor or ceiling effect was observed. Reliability was excellent with ICCs of 0.83 to 0.97 as an indicator of test-retest reliability and Cronbach's α values of 0.78 to 0.85 preoperatively and 0.92 to 0.94 postoperatively as an indicator of internal consistency for all domains and subdomains.

CONCLUSIONS

The GNKSS is a valid, responsive, reliable, and consistent outcome measurement tool that may be used to evaluate the outcome of TKA.

LEVEL OF EVIDENCE

Level II, diagnostic study.

Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort

Background

In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance.

Methods

The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity.

Results

Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program.

Conclusions

The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a “high-risk” profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining.

Electronic supplementary material

The online version of this article (10.1186/s12895-018-0080-2) contains supplementary material, which is available to authorized users.

A review of the impact of occupational contact dermatitis on quality of life

Occupational contact dermatitis (OCD) is the most common occupational skin disease in many countries. We reviewed the current evidence on how OCD impacts on quality of life (QoL). The three commonly used QoL questionnaires in OCD were the Short-Form Health Survey (SF-36), the Dermatology Life Quality Index (DLQI), and the Skindex. Despite the availability of a variety of validated QoL instruments, none of them is specific to OCD or entirely adequate in capturing the impact of OCD on QoL. Nonetheless, the results of this paper do suggest a significant impact. Use of QoL measures in clinical settings will provide patients with an opportunity to express their concerns and assist clinicians to evaluate the effectiveness of management beyond the clinical outcomes. This paper also highlights the lack of a disease-specific QOL instrument and the importance of developing a validated measure to assess QOL in OCD, enabling comparison across countries and occupational groups.