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Vyas J, Johns JR, Abdelrazik Y, Ali FM, Ingram JR, Salek S, Finlay AY. The Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality-of-life instruments: A systematic review. J Eur Acad Dermatol Venereol 2024. [PMID: 39269008 DOI: 10.1111/jdv.20321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 08/20/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND The validation of psychometric measures requires use of other established and standardized validated measures. The Dermatology Life Quality Index (DLQI) is the most widely used tool to measure the burden of skin diseases and assess effectiveness of interventions based on patients' perspective. OBJECTIVES The objective of this study was to systematically analyse peer-reviewed publications describing use of the DLQI in validation of other patient-reported outcome (PRO) and quality-of-life (QoL) measures. METHODS Seven databases were searched for papers published between January 1994 and December 2022 for articles containing data using DLQI in the validation of other PRO/QoL measures. The methodology followed PRISMA guidelines. The protocol was prospectively registered on PROSPERO. RESULTS Of 1717 screened publications, 122 articles including 30,727 patients from 34 different countries with 41 diseases met the inclusion criteria. The DLQI was used in validation of 101 measures: 80 dermatology-specific QoL measures, mostly disease-specific, and 21 generic measures. Of these studies, 47 were cross-cultural adaptations, 116 single arm, 100 were cross-sectional, 18 longitudinal and six randomized placebo controlled. DLQI was used for 14 known group, and correlation for 10 construct, 101 convergent, 10 concurrent, 10 divergent/discriminant and three criterion validity tests using Mann-Whitney (2), Spearman's (80), Pearson's correlation (26) and Student's t-test (1). The DLQI was used in responsiveness analysis in 13 studies. CONCLUSIONS This review identified widespread use of the DLQI in validation of other dermatology PRO/QoL measures and confirmed the central role that the DLQI plays as a benchmark in instrument development and validation across dermatology and beyond. The use of the DLQI by so many developers of other instruments has provided a common standard for comparability.
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Affiliation(s)
- J Vyas
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - J R Johns
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Y Abdelrazik
- University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - S Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Brandão GVC, Pereira EG, Haddad GR, Miot LDB, Marques SA, Miot HA. Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study. An Bras Dermatol 2024; 99:19-26. [PMID: 37612180 DOI: 10.1016/j.abd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. OBJECTIVES To characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. METHODS Cross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. RESULTS In the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls. STUDY LIMITATIONS The study was carried out in a public reference service for patients with psoriasis, all of which were undergoing treatment. CONCLUSIONS Elderly people with psoriasis from a tertiary service showed greater affective impairment, metabolic comorbidities, and physical frailty than elderly controls.
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Affiliation(s)
- Giovana Viotto Cagnon Brandão
- Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Elizandra Gomes Pereira
- Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Gabriela Roncada Haddad
- Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Luciane Donida Bartoli Miot
- Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Silvio Alencar Marques
- Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Hélio Amante Miot
- Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil.
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Chen SY, Zhao FM, Yu R, Sun L, Yin YD, Zhang GCX, Yang JY, Shu QJ. Clinical Experience of External Application of Clearing Heat and Removing Dampness in Relieving Grade 2 to 3 Rash Caused by Programed Cell Death Protein 1 (PD-1)/Programed Cell Death Ligand 1 (PD-L1) Inhibitors: A Single-Center Retrospective Study. Integr Cancer Ther 2024; 23:15347354231226108. [PMID: 38240227 PMCID: PMC10799584 DOI: 10.1177/15347354231226108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/05/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE In China, grade 2 to 3 immune-related rash will probably lead to the interruption of immunotherapy. Corticosteroid (CS) is the main treatment, but not always effective. The external application of clearing heat and removing dampness, which is represented by Qing-Re-Li-Shi Formula (QRLSF), has been used in our hospital to treat immune-related cutaneous adverse events (ircAEs) for the last 5 years. The purpose of this study was to discuss its efficacy and safety in the treatment of grade 2 to 3 rash. METHODS A retrospective study of patients with grade 2 to 3 immune-related rash in our hospital from December 2019 to December 2022 was conducted. These patients received QRLSF treatment. Clinical characteristics, treatment outcome, and health-related quality of life (HrQoL) were analyzed. RESULTS Thirty patients with grade 2 to 3 rash (median onset time: 64.5 days) were included. The skin lesions of 24 cases (80%) returned to grade 1 with a median time of 8 days. The accompanying symptoms were also improved with median time of 3 to 4 days. The addition of antihistamine (AH) drug didn't increase the efficacy of QRLSF (AH + QRLSF: 75.00% vs QRLSF: 83.33%, P = .66). No significant difference was observed in the efficacy of QRLSF treatment regardless of whether patients had previously received CS therapy (untreated population: 88.24% vs treated population: 69.23%, P = .36). During 1-month follow-up, 2 cases (8.33%) underwent relapses. In terms of HrQoL, QRLSF treatment could significantly reduce the median scores of all domains of Skindex-16, including symptoms (39.58 vs 8.33, P < .0001), emotions (58.33 vs 15.48, P < .0001), functioning (46.67 vs 13.33, P < .0001) and composite (52.60 vs 14.06, P < .0001). CONCLUSION External application of clearing heat and removing dampness was proven to be an effective and safe treatment for such patients. In the future, high-quality trials are required to determine its clinical application in the field of ircAEs.
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Affiliation(s)
- Shu-yi Chen
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Fang-min Zhao
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rui Yu
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lin Sun
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu-dan Yin
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Gao-chen-xi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Jia-yao Yang
- The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qi-jin Shu
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
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Fertitta L, Sarin KY, Bergqvist C, Patel E, Peiffer B, Moryousef S, Armand ML, Jannic A, Ferkal S, Ravaud P, Tran VT, Blakeley JO, Romo CG, Ezzedine K, Wolkenstein P. cNF-Skindex in Adults Living with Neurofibromatosis 1: Severity Strata in France and Validation in United States Adults. J Invest Dermatol 2023; 143:2226-2232.e1. [PMID: 37149083 DOI: 10.1016/j.jid.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/08/2023]
Abstract
Cutaneous neurofibromas (cNF) contribute to the impairment of QOL in individuals with neurofibromatosis 1. The cNF-Skindex, validated in a French population, specifically assesses the cNF-related QOL. In this study, we first defined severity strata using an anchoring approach on the basis of patient's burden. In total, 209 patients answered the anchor question and the cNF-Skindex. We tested the agreement among the three strata, generated by all potential couples of cut-off values of the cNF-Skindex and the three strata defined in the anchor question. The cut-off values 12 and 49 provided the highest Kappa value (κ = 0.685, 95% confidence interval = 0.604-0.765). Second, we validated the score and the strata in a United States population using the answers provided by 220 French and 148 United States adults. In the multivariable linear regression analysis, the country of origin was not a factor associated with the score (P = 0.297). The number of cNF along the different severity strata was similar between the French and the United States populations. In conclusion, stratification constitutes a powerful tool to better interpret the cNF-Skindex in daily practice and in clinical trials. This study validates its use in two populations that together constitute a large cohort of patients willing to participate in clinical research.
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Affiliation(s)
- Laura Fertitta
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Inserm U955, Mondor Institute for Biomedical Research, Creteil, France.
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Christina Bergqvist
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Ekshika Patel
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Bastien Peiffer
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Sabine Moryousef
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Marie-Laure Armand
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Arnaud Jannic
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Salah Ferkal
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France
| | - Philippe Ravaud
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics, Paris, France
| | - Viet-Thi Tran
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and Statistics, Paris, France
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carlos G Romo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khaled Ezzedine
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Université Paris Est Créteil, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, National Referral Center for Neurofibromatosis, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Clinical Investigation Center, Inserm 1430, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Creteil, France; Inserm U955, Mondor Institute for Biomedical Research, Creteil, France; Université Paris Est Créteil, Créteil, France
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Ramos Rocha S, da Costa Ferreira SA, Ramalho A, Conceição Gouveia Santos VL, Cristina Nogueira P. Photobiomodulation Therapy in the Prevention and Treatment of Radiodermatitis in Breast Cancer Patients: Systematic Review. J Lasers Med Sci 2022; 13:e42. [PMID: 36743146 PMCID: PMC9841382 DOI: 10.34172/jlms.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/17/2022] [Indexed: 01/27/2023]
Abstract
Introduction: Radiodermatitis (RD) is the most common side-effect of radiation therapy, yet its prevention and treatment through photobiomodulation therapy (PBMT) have demonstrated promising results. This study aimed to synthesize the evidence concerning the use of PBMT in managing RD among breast cancer patients undergoing radiation therapy. Methods: This is a systematic review with no time restrictions, based on the methodology proposed by the Joanna Briggs Institute (JBI), including such databases as PubMed, Cochrane, Web of Science, Scopus, and CINAHL. The studies were selected based on the following inclusion criteria: female participants over 18 years of age and females having breast cancer and undergoing radiation therapy using a three-dimensional technique or an intensity-modulated radiation therapy (IMRT) technique. Two reviewers assessed the methodological quality using the JBI Critical Appraisal Checklist, and the report was described based on PRISMA guidelines. Results: Red and infrared wavelengths were used. Device power ranged from 1.1 W to 0.08 W for continuous modes and 25 W for pulsed mode, resulting in a 3 and 4 J/cm2 fluence, applied throughout radiation therapy, leading to a reduced severity in cutaneous reactions. Conclusion: PBMT can reduce the severity of RD. New clinical trials are required to standardize protocols, given the scarcity of studies for the adopted site and methodological diversity.
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Affiliation(s)
- Suzy Ramos Rocha
- Correspondence to Suzy Ramos Rocha, 14 Bis Square, n 18, apartment 52, Bela Vista, São Paulo, SP, Brazil. CEP 01312-010.
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Pollo CF, Meneguin S, Miot HA, de Oliveira C. Translation, cultural adaptation and validation of the Somatic Symptom Scale-8 (SSS-8) for the Brazilian Portuguese language. BMC PRIMARY CARE 2022; 23:222. [PMID: 36064343 PMCID: PMC9442982 DOI: 10.1186/s12875-022-01836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Assessment tools are commonly used in different fields of health to assist in the diagnosis, the evaluation of the response to treatment, the measurement of quality of life and the establishment of the prognosis. OBJECTIVES Translate, culturally adapt and perform the psychometric validation of the Somatic Symptom Scale (SSS-8) for use in the Brazilian population. METHODS Cross-cultural adaptation followed a combination of guidelines and for psychometric evaluation a sample of 300 patients was recruited. All recommended measurement properties by the Consensus-based Standards for the selection of health status Measurement Instruments were evaluated, including analysis by an expert committee and analysis by the target public. The Skindex-16 was used for the evaluation of convergent validity and Cronbach's alpha was used for the determination of the internal consistency of the translated version of the SSS-8. RESULTS The final version received approval from five experts and the agreement index was 100% for all items. During the pretest, the scale was administered to 300 patients with psoriasis and none of the items needed to be altered. A moderate correlation was found between the Skindex-16 and SSS-8-BRA. In the analysis of internal consistency, Cronbach's alpha for the SSS-8-BRA was 0.81. CONCLUSION The SSS-8 is a valid and reliable tool for the assessment of somatic symptoms in the Brazilian population.
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Affiliation(s)
- Camila Fernandes Pollo
- Nursing Department, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (FMB-Unesp), Emilio Garcia, 464, Jardim Bom Pastor, Botucatu, SP CEP 18603-440 Brazil
| | - Silmara Meneguin
- Nursing Department, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (FMB-Unesp), Emilio Garcia, 464, Jardim Bom Pastor, Botucatu, SP CEP 18603-440 Brazil
| | - Hélio Amante Miot
- Department of Infectology, Dermatology, Radiotherapy and Imaging Diagnosis, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (FMB-Unesp), Botucatu, SP Brazil
| | - César de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
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Meneguin S, Mourão IB, Pollo CF, Miot HA, Garuzi M, de Oliveira C. Comparison of generic and specific instruments to assess the quality of life in patients with melasma. BMC Med Res Methodol 2022; 22:117. [PMID: 35443616 PMCID: PMC9020068 DOI: 10.1186/s12874-022-01599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To compare the psychometric performance of a generic and specific instruments in assessing melasma-related quality of life. Methods A cross-sectional study was conducted with 150 patients with melasma attending an outpatient dermatology clinic of a public hospital in São Paulo state, Brazil. Data were collected using a questionnaire containing sociodemographic and clinical data as well as the generic WHOQOL-BREF, and the dermatological-specific Skindex-16 and HRQ-Melasma. Results The overall internal consistency of the domains of the three instruments was ≥ 0.7. A strong positive correlation was identified between the Skindex-16 and HRQ-Melasma domains (0.68-0.78). Item-response theory showed that most Skindex-16 and HRQ-Melasma domains were more informative than WHOQOL-BREF. Conclusion The three instruments for assessing QOL tested presented good psychometric performance, with satisfactory internal consistency values. Only the two dermatological instruments, however, demonstrated a strong correlation between the domains that assess social, emotional, and functional aspects of QOL, indicating that both were able to identify impairments in other QOL dimensions in addition to the physical domain.
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Affiliation(s)
- Silmara Meneguin
- Nursing Department, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil.
| | - Ioana Bitencourt Mourão
- Department of Dermatology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | - Camila Fernandes Pollo
- Nursing Department, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | - Helio Amante Miot
- Department of Dermatology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | - Miriane Garuzi
- Department of Dermatology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
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Mahdavi Nejad T, Mohammadi F, Gorgulu O, Motalebi SA, Hosseinkhani Z. Validation of the Persian version of Skindex-16 among older patients with skin diseases. BMC Geriatr 2021; 21:724. [PMID: 34922470 PMCID: PMC8684253 DOI: 10.1186/s12877-021-02635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Skin conditions often considerably impact the older patients’ psycho-social health and quality of life (QoL). The present study was aimed to examine the validity and reliability of the Persian version of Skindex-16 among older people with skin diseases. Methods In this validation study, 260 older patients suffering from a range of skin conditions were recruited from a dermatology clinic in Rasht, Iran. Data were collected using a checklist for demographic and clinical characteristics and the Skindex-16 questionnaire. In this study, validity (face, content, and construct) and reliability (Cronbach’s alpha) of the Skindex-16 were assessed and reported. Results The mean age of participants was 64.51 ± 5.04 years. The results of confirmatory factor analysis showed that the model had acceptable fitness into the expected three-factor structure [χ 2 /df = 249.363, P < 0.001; GFI = 0.961; TLI =0.952; RMSEA = 0.078 (90% CI = 0.06, 0.09) and SRMR = 0.06]. The reliability analysis results confirmed that the values of Cronbach’s alpha coefficient for Skindex-16 were in the acceptable range (0.923). Conclusions Our evaluation of the Skindex-16 indicates that it is reliable and a valid instrument that can be used for measuring QoL for Iranian dermatologic patients.
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Affiliation(s)
- Tahereh Mahdavi Nejad
- Student Research Committee, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Mohammadi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ozkan Gorgulu
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ahi Evran University, Kırşehir, Turkey
| | - Seyedeh Ameneh Motalebi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Zahra Hosseinkhani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Szabó Á, Brodszky V, Rencz F. A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI-Relevant and Skindex-16. Br J Dermatol 2021; 186:485-495. [PMID: 34724199 DOI: 10.1111/bjd.20765] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dermatology Life Quality Index (DLQI) and Skindex-16 are among the most commonly used dermatology-specific health-related quality-of-life (HRQoL) instruments. DLQI has two common scoring methods, the original and the DLQI-Relevant (DLQI-R) modification. Head-to-head comparisons of the measurement properties of the DLQI, DLQI-R and Skindex-16 are currently lacking. OBJECTIVES We aim to compare the measurement properties of the DLQI, DLQI-R and Skindex-16. METHODS We analysed data from 618 patients with self-reported physician-diagnosed dermatological conditions from a cross-sectional survey carried out in Hungary in early 2020. DLQI, DLQI-R and Skindex-16 were compared in terms of ceiling and floor effects, informativity, convergent validity and known-group validity. RESULTS Mean DLQI, DLQI-R and Skindex-16 total scores were 3·76 ± 5·03, 4·11 ± 5·34 and 29·36 ± 26·62, respectively. Among patients with a DLQI/DLQI-R total score of zero, 64% reported problems on Skindex-16. Overall, 23-38% of patients with 'not relevant' responses on DLQI items 3 (shopping/home/gardening), 7 (working/studying), 8 (interpersonal problems) and 9 (sexual difficulties) reported problems on their corresponding Skindex-16 items. Average relative informativity (Shannon's evenness index) was the highest for Skindex-16 (0·85), followed by DLQI-R (0·66) and DLQI (0·54). DLQI, DLQI-R and Skindex-16 demonstrated similar convergent validity. DLQI was able to better discriminate between known groups of patients based on overall skin-related HRQoL impairment, whereas DLQI-R and Skindex-16 performed better with respect to self-perceived health status. CONCLUSIONS Skindex-16 seems to be more sensitive than DLQI/DLQI-R in capturing mild impairment in HRQoL. Our findings help to provide a fuller understanding of the difference between DLQI, DLQI-R and Skindex-16 and support the informed choice of instrument for clinical and research purposes.
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Affiliation(s)
- Á Szabó
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary.,Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 26 Üllői út, H-1085, Budapest, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, 8 Fővám tér, H-1093, Budapest, Hungary
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Meneguin S, de Souza Matos TD, Pollo CF, Garuzi M, Miot HA, de Oliveira C. Psychometric characteristics of DLQI-BRA and Skindex-16 to measure the impact of dermatological diseases on quality of life in Brazilian patients. PLoS One 2021; 16:e0254882. [PMID: 34388159 PMCID: PMC8362944 DOI: 10.1371/journal.pone.0254882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare the psychometric performance of the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16 to assess quality of life (QoL) in Brazilian patients with dermatological diseases. METHODS This was a cross-sectional study carried out in a dermatology outpatient clinic of the São Paulo State University, with 188 patients with dermatological diseases. QoL was evaluated using the Dermatology Life Quality Index (DLQI-BRA) and Skindex-16. Cronbach's alpha and Intraclass Correlation for Perfect Concordance (ICC) were used to analyse the reliability and temporal stability, respectively. RESULTS A positive correlation was found between the total Skindex-16 score and DLQI-BRA (0.75). Both instruments showed a significant (p< 0.01) reduction in their scores at the second assessment, demonstrating that they were sensitive in detecting changes in responsiveness in cases where there was a clinical change. Cronbach alpha coefficients for the instruments showed satisfactory performance (>0,7), but Skindex-16 displayed the highest Cronbach alpha (0.94; CI = 0.93-0.95). CONCLUSION Both instruments tested showed a good psychometric performance assessing QoL in patients with skin dermatoses. The instruments displayed reliability and temporal stability as well as responsiveness.
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Affiliation(s)
- Silmara Meneguin
- Nursing Department, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | | | - Camila Fernandes Pollo
- Nursing Department, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - Miriane Garuzi
- Program in Pathophysiology in Medical Practice, Botucatu Medical School, São Paulo State University, São Paulo, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, São Paulo State University, Botucatu Medical School, São Paulo, Brazil
| | - César de Oliveira
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
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Jorge MFS, Mourão IB, Pollo CF, Sousa TDD, Meneguin S, Miot HA. Validation of the Skindex-17 quality of life assessment instrument for a Brazilian population. An Bras Dermatol 2021; 96:51-58. [PMID: 33281012 PMCID: PMC7838104 DOI: 10.1016/j.abd.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/02/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health-related quality of life assesses how diseases affect the daily life of people; there are several generic instruments for this assessment in dermatology. Skindex was created in 1996; it is a multidimensional instrument, aiming to encompass some psychological and social aspects not yet addressed by other questionnaires. Among its versions (Skindex-29, 16, and 17), Skindex-17 had not been validated in Brazil. OBJECTIVES To validate Skindex-17 for use in Brazilians with dermatological diseases. METHODS This was a methodological, cross-sectional, and prospective study of 217 patients attended at the Dermatology Service Outpatient Clinic, Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (Botucatu, SP, Brazil), from December 2017 to September 2019. The following were evaluated: content validity, filling time, internal consistency, dimensional structure, concurrent validity (DLQI), temporal stability, and responsiveness. RESULTS The sample consisted of 71% women, mean age (SD) of 45 (16) years; phototypes II-IV accounted for 95% of the cases. Cronbach's alpha coefficients were 0.82 and 0.93 for the symptoms and psychosocial conditions, respectively. A high correlation was observed with the DLQI score: symptoms (rho = 0.69) and psychosocial conditions (rho = 0.75). The instrument's two-dimensional structure was confirmed through confirmatory factor analysis. Temporal stability (ICC > 0.9) and score responsiveness (p ≤ 0.02) were verified. The instrument was shown to be feasible in clinical practice due to the content validation performed by professionals and patients, as well as the low time spent completing it (< 5 min). STUDY LIMITATIONS Single-center study, with patients exclusively from the public healthcare system. CONCLUSIONS Skindex-17 was shown to be a valid and consistent instrument for assessing quality of life among patients with dermatological diseases, in Brazil. Its two-dimensional structure was confirmed.
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Affiliation(s)
| | | | | | | | - Silmara Meneguin
- Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Jorge MFS, Sousa TD, Pollo CF, Paiva BSR, Ianhez M, Boza JC, Meneguin S, Schmitt JV, Nunes DH, Lastoria JC, Miot HA. Dimensionality and psychometric analysis of DLQI in a Brazilian population. Health Qual Life Outcomes 2020; 18:268. [PMID: 32758227 PMCID: PMC7409396 DOI: 10.1186/s12955-020-01523-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background The Dermatology Life Quality Index (DLQI) is the most commonly used instrument for clinical evaluation of the impact on health-related quality of life (HRQOL) in dermatological research protocols. The DLQI’s classical psychometric properties have been considered adequate in validation studies from several countries. However, the structure of the DLQI is a matter of discussion, especially concerning the dimensionality and informative properties of its questions according to the item response theory (IRT). Methods Pooled data from studies in Brazil that utilized the DLQI to assess HRQOL in 14 dermatoses were reanalyzed. Classical psychometrical analysis, dimensionality assessment through parallel analysis and IRT (Samejima’s ordinal model) analysis were performed. Results The sample consisted of 1286 patients with a mean age of 47 years (SD = 16), and the proportion of women was 59% (765). The DLQI scores ranged from 0 to 29, with a median (p25–p75) of 5 (2–11). All items indicated significant correlations with the total DLQI score (rho > 0.54). The Cronbach’s alpha result was 0.90 (CI 95% 0.89–0.91). Parallel analysis indicated a unidimensional factor structure. According to IRT analysis, items q6 (sports) and q7 (work/study) exhibited insufficient fit to the model (p < 0.01), while the items that indicated the best discrimination and information functions were q2 (embarrassment), q3 (shopping/gardening), q4 (clothing) and q5 (social/leisure). The ordination of the scores was confirmed for all items. Most items revealed non-uniform behavior according to sex, age and type of disease. Conclusions The DLQI exhibits adequate psychometric reliability and a unidimensional structure for assessing HRQOL in Brazilian dermatological patients. The DLQI’s performance varies in the assessment of HRQOL in heterogeneous samples.
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Affiliation(s)
- Marilia F S Jorge
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil.
| | - Ticiane D Sousa
- Departamento de Enfermagem, Unesp Medical School, Botucatu, SP, Brazil, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Camila F Pollo
- Departamento de Enfermagem, Unesp Medical School, Botucatu, SP, Brazil, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Bianca S R Paiva
- Health-Related Quality of Life Research Group (GPQual), Learning and Research Institute - Barretos Cancer Hospital, Barretos, SP, 14784-40, Brazil
| | - Mayra Ianhez
- Departamento de Dermatologia, Universidade Federal de Goiás (UFGO), Av. Esperança, s/n - Chácaras de Recreio Samambaia, Goiânia, GO, 74690-900, Brazil
| | - Juliana C Boza
- Departamento de Dermatologia, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Paulo Gama, 110 - Farroupilha, Porto Alegre, RS, 90040-060, Brazil
| | - Silmara Meneguin
- Departamento de Enfermagem, Unesp Medical School, Botucatu, SP, Brazil, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Juliano V Schmitt
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Daniel Holthausen Nunes
- Disciplina de Dermatologia, Universidade Federal de Santa Catarina (UFSC), R. Eng. Agronômico Andrei Cristian Ferreira, s/n - Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Joel C Lastoria
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
| | - Hélio A Miot
- Departamento de Dermatologia da Faculdade de Medicina da Unesp, Unesp Medical School, Campus Universitário de Rubião Jr, Botucatu, SP, 18618-000, Brazil
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Cadamuro SDA, Franco JO, Paiva CE, de Oliveira CZ, Paiva BSR. Symptom screening in paediatrics tool for screening multiple symptoms in Brazilian patients with cancer: a cross-sectional validation study. BMJ Open 2019; 9:e028149. [PMID: 31377698 PMCID: PMC6687019 DOI: 10.1136/bmjopen-2018-028149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The objective of this study was to translate, culturally adapt and validate the Symptom Screening in Paediatrics Tool (SSPedi) into the Brazilian Portuguese language to be used by paediatric oncology patients in Brazil. DESIGN A descriptive, cross-sectional study that follows an established methodology for translation and cultural adaptation, developed in two phases: phase I, linguistic translation and cultural adaptation of the SSPedi scale and phase II, psychometric properties evaluation. SETTING Children's Hospital for Cancer Treatment in Latin America. PARTICIPANTS Paediatric patients between 7 and 18 years of age and proxies of patients between 2 and 6 years of age, diagnosed with cancer and undergoing chemotherapy treatment. Patients and proxies with significant neuropsychiatric disorders and/or visual impairment that prevented the ability to read were excluded. PRIMARY OUTCOME MEASURES Construct validation of SSPedi using convergent validity and contrasted groups. Reliability was evaluated using Cronbach's alpha test and assessing the retest using the intraclass correlation coefficient (ICC). RESULTS The psychometric properties of the symptom screening tool were evaluated using 157 participants, of which 116 were patients and 41 were proxies. Convergent validity and hypothesised correlations (Spearman's r>0.4) were confirmed for both self- and proxy-reported versions of the assessment tool. No significant differences found between the two contrasting groups. Assessment of SSPedi resulted in an internal consistency of reliability of α=0.77 (95% CI 0.70 to 0.82) for the self and α=0.81 (95% CI 0.71 to 0.88) for the proxy and overall reproducibility ICC values of (95% CI), 0.54 (0.15 to 0.77) and 0.77 (0.64 to 0.86). CONCLUSION SSPedi was found to be culturally and linguistically adaptable and considered valid and reliable for use by paediatric oncology patients in Brazil. The new translated and adapted version was named SSPedi-BR.
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Affiliation(s)
- Sandra de Andrade Cadamuro
- Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Julia Onishi Franco
- Dr. Paulo Prata School of Health Sciences of Barretos and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Cleyton Zanardo de Oliveira
- Education and Research BP - A, Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Oncology Graduate Program and Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, BARRETOS, Brazil
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