Background: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. Objective: To provide a ratio...Background: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. Objective: To provide a rationale for simplifying and standardizing objective atopic eczema scoring by investigating which visual variables provide the best measure of disease severity from the patient’ s perspective. Setting: The dermatology outpatient department at the Queen’ s Medical Centre, University Hospital in Nottingham, and 5 local general practices. Patients: One hundred eighty individuals with atopic eczema. Interventions: Clinical examination with scoring of 7 clinical signs and disease extent, followed by regression analyses of visual variable scores against a patient- rated measure of current disease severity. Results: Objective measurements account for only a quarter of the variation in patient- rated disease severity. Three clinical signs were independent predictors of patient- rated disease severity: excoriations, erythema, and edema/papulation. Disease extent measurements do not reflect patient- rated disease severity in a linear manner, with mean severity scores increasing little above 30% body surface area involvement. Conclusions: From the patient’ s perspective, the measurement of 3 clinical signs- excoriations, erythema, and edema/papulation- provides as much information about current atopic eczema severity as more complex scoring systems that measure multiple clinical signs and disease extent. The simplicity of the Three Item Severity score, a previously published atopic eczema score based on measurement of these 3 clinical signs, makes it a suitable tool for research studies or clinical practice.展开更多
Objective:To develop a simple, valid, repeatable, and readily understandable patient-oriented assessment measure for monitoring disease activity in children and adults with atopic eczema. Design:Qualitative semistruct...Objective:To develop a simple, valid, repeatable, and readily understandable patient-oriented assessment measure for monitoring disease activity in children and adults with atopic eczema. Design:Qualitative semistructured patient inter views identified a list of symptoms of atopic eczema. These symptoms were quanti tatively analyzed in a larger patient population to identify which symptoms were important to patients and amenable to monitoring as part of a scoring system. S etting:The outpatient Department of Dermatology at the Queen’s Medical Centre, University Hospital, Nottingham, England, and 5 local general practices. Patien ts:Four hundred thirty-five patients with atopic eczema. Results:Seven sympto ms were incorporated into the final patient-oriented eczema measure using a sim ple 5-point scale of frequency of occurrence during the previous week, with a m aximum total score of 28. Validity testing against the Dermatology Life Quality Index, Children’s Dermatology Life Quality Index, and patients’global severity assessments showed good correlation (r=0.78, r=0.73, and r=0.81, respectively; P < .001). Internal consistency was high (Cronbach α=0.88), and test-retest reliability was good, with 95%of scores falling within 2.6 point s on repeat testing (mean score difference, 0.04; SD, 1.32). Individual variable s in the measure demonstrated sensitivity to change during a 4-week in-clinic period and an 18-week randomized controlled clinical trial. Conclusion:The pat ient-oriented eczema measure is a practical self-assessed measurement tool for monitoring aspects of atopic eczema that are important to patients in routine c linical practice or in the clinical trial setting.展开更多
文摘Background: There is wide variation in the objective visual variables used to measure atopic eczema severity in clinical trials, making comparison and interpretation of results difficult. Objective: To provide a rationale for simplifying and standardizing objective atopic eczema scoring by investigating which visual variables provide the best measure of disease severity from the patient’ s perspective. Setting: The dermatology outpatient department at the Queen’ s Medical Centre, University Hospital in Nottingham, and 5 local general practices. Patients: One hundred eighty individuals with atopic eczema. Interventions: Clinical examination with scoring of 7 clinical signs and disease extent, followed by regression analyses of visual variable scores against a patient- rated measure of current disease severity. Results: Objective measurements account for only a quarter of the variation in patient- rated disease severity. Three clinical signs were independent predictors of patient- rated disease severity: excoriations, erythema, and edema/papulation. Disease extent measurements do not reflect patient- rated disease severity in a linear manner, with mean severity scores increasing little above 30% body surface area involvement. Conclusions: From the patient’ s perspective, the measurement of 3 clinical signs- excoriations, erythema, and edema/papulation- provides as much information about current atopic eczema severity as more complex scoring systems that measure multiple clinical signs and disease extent. The simplicity of the Three Item Severity score, a previously published atopic eczema score based on measurement of these 3 clinical signs, makes it a suitable tool for research studies or clinical practice.
文摘Objective:To develop a simple, valid, repeatable, and readily understandable patient-oriented assessment measure for monitoring disease activity in children and adults with atopic eczema. Design:Qualitative semistructured patient inter views identified a list of symptoms of atopic eczema. These symptoms were quanti tatively analyzed in a larger patient population to identify which symptoms were important to patients and amenable to monitoring as part of a scoring system. S etting:The outpatient Department of Dermatology at the Queen’s Medical Centre, University Hospital, Nottingham, England, and 5 local general practices. Patien ts:Four hundred thirty-five patients with atopic eczema. Results:Seven sympto ms were incorporated into the final patient-oriented eczema measure using a sim ple 5-point scale of frequency of occurrence during the previous week, with a m aximum total score of 28. Validity testing against the Dermatology Life Quality Index, Children’s Dermatology Life Quality Index, and patients’global severity assessments showed good correlation (r=0.78, r=0.73, and r=0.81, respectively; P < .001). Internal consistency was high (Cronbach α=0.88), and test-retest reliability was good, with 95%of scores falling within 2.6 point s on repeat testing (mean score difference, 0.04; SD, 1.32). Individual variable s in the measure demonstrated sensitivity to change during a 4-week in-clinic period and an 18-week randomized controlled clinical trial. Conclusion:The pat ient-oriented eczema measure is a practical self-assessed measurement tool for monitoring aspects of atopic eczema that are important to patients in routine c linical practice or in the clinical trial setting.
