Advertisement

A pilot quality-of-life instrument for pruritus

      Objective

      We sought to develop a validated, reliable pruritus-specific quality-of-life (QOL) instrument, ItchyQoL.

      Methods

      From 21 in-depth interviews with patients with pruritus, we developed 22 pruritus-specific items, and hypothesized 3 major constructs that explain the way pruritus affects patients' QOL: symptoms, functional limitations, and emotions. We developed two versions of the pruritus QOL instrument, which assess for level of bother or frequency using items from the interviews and from generic skin QOL instruments, Skindex-16 (bother) and Skindex-29 (frequency). The instrument was tested for validity, reliability, and responsiveness. The frequency version was subsequently applied clinically to further evaluate its face validity.

      Results

      A total of 89 patients with dermatologic conditions participated in the validation phase and 101 patients participated in the clinical application phase of the study. Construct validity was demonstrated by principal axes factor analyses and by demonstrating that differences in symptoms, functioning, and emotion differed among the varying levels of self-reported pruritus severity more than would be expected by chance (P < .05 by analysis of variance). The instrument demonstrated reliability with internal consistency (Cronbach α: frequency 0.72-0.93 and bother 0.78-0.81) and reproducibility (intraclass correlation coefficient: frequency 0.91 and bother 0.84-0.87). The instrument suggested preliminary responsiveness for patients with improved disease for both frequency and bother items with both overall scores and the majority of the subscales scored demonstrating significant changes. Discriminant validity was shown by comparing differences in and the number of insensitive items between the pruritus-specific QOL instrument and the generic Skindex instruments.

      Limitations

      Lack of generalizability and potential selection bias are limitations.

      Conclusions

      This study represents, to our knowledge, the first attempt at a pruritus-specific QOL instrument that is reliable, valid, and responsive.

      Abbreviations used:

      ANOVA (analysis of variance), ICC (intraclass correlation coefficient), QOL (quality of life)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yosopovitch G.
        • Goon A.
        • Wee J.
        • Chan Y.H.
        • Goh C.L.
        The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis.
        Br J Dermatol. 2000; 143: 969-973
        • Koblenzer C.S.
        Itching and the atopic skin.
        J Allergy Clin Immunol. 1999; 104: S109-S113
        • Yosipovitch G.
        • Ansari N.
        • Goon A.
        • Chan Y.H.
        • Goh C.L.
        Clinical characteristics of pruritus in chronic idiopathic urticaria.
        Br J Dermatol. 2002; 147: 32-36
        • Bernhard J.
        Pruritus in skin diseases.
        in: Bernhard J.D. Itch: mechanisms and management of pruritus. McGraw-Hill, New York1994: 37-68
        • Etter L.
        • Myers S.A.
        Pruritus in systemic disease: mechanisms and management.
        Dermatol Clin. 2002; 20: 459-472
        • Zucker I.
        • Yosipovitch G.
        • David M.
        • Gafter U.
        • Boner G.
        Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease.
        J Am Acad Dermatol. 2003; 49: 842-846
        • Leuschner U.
        Primary biliary cirrhosis: presentation and diagnosis.
        Clin Liver Dis. 2003; 7: 741-758
        • Shapiro R.
        • Samorodin C.
        • Hood A.
        Pruritus as a presenting sign of acquired immunodeficiency syndrome.
        J Am Acad Dermatol. 1987; 16: 1115-1117
        • Zirwas M.J.
        • Seraly M.P.
        Pruritus of unknown origin: a retrospective study.
        J Am Acad Dermatol. 2001; 45: 892-896
        • Braverman I.M.
        Skin manifestations of internal malignancy.
        Clin Geriatr Med. 2002; 18: 1-19
        • Ogunbiyi A.O.
        • Daramola O.O.
        • Alese O.O.
        Prevalence of skin diseases in Ibadan, Nigeria.
        Int J Dermatol. 2004; 43: 31-36
        • Wolkenstein P.
        • Grob J.J.
        • Bastuji-Garin S.
        • Ruszczynski S.
        • Roujeau J.C.
        • Revuz J.
        French people and skin disease: results of a survey using a representative sample.
        Arch Dermatol. 2003; 139: 1614-1619
        • Norman R.A.
        Xerosis and pruritus in the elderly: recognition and management.
        Dermatol Ther. 2003; 16: 254-259
        • Chren M.M.
        • Lasek R.J.
        • Flocke S.A.
        • Zyzanski S.J.
        Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases.
        Arch Dermatol. 1997; 133: 1433-1440
        • Chren M.M.
        • Lasek R.J.
        • Sahay A.P.
        • Sands L.P.
        Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases.
        J Cutan Med Surg. 2001; 5: 105-110
        • Chen S.C.
        • Yeung J.
        • Chren M.M.
        Scalpdex: a quality of life instrument for scalp dermatitis.
        Arch Dermatol. 2002; 138: 803-807
        • Nicholson K.
        • Abramova L.
        • Chren M.M.
        • Yeung J.
        • Chon S.Y.
        • Chen S.C.
        A pilot quality-of-life instrument for acne rosacea.
        J Am Acad Dermatol. 2007; 57: 213-221
        • Dillon W.
        • Goldstein M.
        Multivariate analysis: methods and applications.
        John Wiley and Sons, New York1984
      1. Spilker B. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Lippincott-Raven, New York1996: 43
      2. US Food and Drug Administration. Patient-reported outcome measures: use in medical product development to support labeling claims. February 2006. Available from: URL: http://www.fda.gov/CDER/GUIDANCE/5460dft.pdf. Accessed December 4, 2006.