Development and validation of a quality of life instrument for cutaneous diseases☆,☆☆,★

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Abstract

Background: The Dermatology-Specific Quality of Life (DSQL) instrument is a new tool to quantify the effects of skin disease on physical discomfort and symptoms, psychologic well-being, social functioning, self-care activities, performance at work or school, and self-perceptions. Objective: Our purpose was to describe the reliability and validity of the DSQL in two disease cohorts comprising patients with contact dermatitis and acne vulgaris. Methods: Reliability was assessed from the internal consistency of the items, and correlations were made between DSQL scores from a 3- to 7-day retest. Validity was assessed from correlations of DSQL scales with global ratings of bothersome symptoms and perceived severity and by discrimination of clinically defined severity groups. Results: The DSQL scales had high internal consistency (0.70 to > 0.90) and test-retest reliability ( r = 0.81 to 0.89), and were moderately to highly correlated with patient global ratings of symptom distress ( r = 0.25 to 0.67) and overall disease severity ( r = 0.19 to 0.54). Patients rated with severe contact dermatitis or acne scarring had higher DSQL scores than those with less severe skin disease. Factor analyses found separate dimensions of physical, emotional, and social functioning involvement from skin disease. Conclusion: The DSQL provides valid and reliable assessments of quality of life impacts associated with acne and contact dermatitis. (J Am Acad Dermatol 1997; 37:41–50).

Section snippets

Overview

The DSQL is intended as a self-administered QOL profile, which can be completed in 15 minutes or less. It contains five scales and eight global rating items (see Appendix). Two subscales that assess general emotional distress in the MOS SF-36 were added to the DSQL. The DSQL Contact Dermatitis form has 43 dermatology-specific items; to this were added nine items from two SF-36 scales assessing general emotional well-being. Thus the entire battery contained 52 items. For the acne version, an

RESULTS

Respondent accuracy in completing the DSQL was appraised by percentage of missing item responses among forms. For the CD study, the percentages of forms with 0, 1, and 2 or more missing items were 86.5%, 5.8%, and 7.7%, respectively. For the acne study, 93.0%, 5.4%, and 1.6% had 0, 1, and 2 or more missing responses, respectively. The DSQL does not contain skip patterns among the scale items.

The DSQL scale means, standard deviations, and floor and ceiling effects are shown in Table II . In both

DISCUSSION

Consumers and purchasers of primary care place emphasis on QOL as an outcome of treatment and as a guide to selecting therapy. Evaluations of the efficacy of current and emerging treatments of skin disease will increasingly include QOL end points. 36 In this regard, in dermatology, efforts to develop comprehensive QOL instruments for clinical research and descriptive studies are fairly recent. Reports on QOL outcomes associated with major prevalent cutaneous conditions and treatment are

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    Data reported in this study originate from research studies previously supported by Glaxo Wellcome, Inc.

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    Reprint requests: Roger T. Anderson, PhD, Department of Public Health Sciences, The Bowman Gray School of Medicine, Winston-Salem, NC 27101.

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    Copyright © 1997 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.