Validity and reliability of a novel numeric rating scale to measure skin-pain in adults with atopic dermatitis

Abstract

Little is known about the measurement properties of numeric rating scales (NRS) for pain in AD. We evaluated a novel NRS for skin-pain and existing NRS for average overall-pain in adults with AD. Self-administered questionnaires and skin-examination were performed in 463 AD patients (age 18–97 years) in a dermatology practice setting. Numeric rating scales skin-pain and average overall-pain had moderate correlations with each other, and multiple clinician-reported and patient-reported AD severity outcomes (Spearman correlations, P < 0.0001). There were significant and stepwise increases of NRS skin-pain and average overall-pain scores with patient-reported global severity (Wilcoxon rank-sum test, P < 0.0001). Floor-effects were observed for NRS skin-pain and average overall-pain. Changes from baseline in NRS skin-pain and average overall-pain showed weak–moderate correlations with changes of POEM, vIGA-AD*BSA, SCORAD, and DLQI. Using an anchoring approach, the optimal interpretability band for NRS skin-pain was clear = 0, mild = 1–3, moderate = 5–6, severe = 7–9, and very severe = 10 (weighted kappa = 0.4923). The thresholds for minimally clinically important difference for NRS skin-pain ranged from 2.2 to 2.9. NRS skin-pain and average overall-pain showed moderate–good reliability. Numeric rating scales skin-pain and average overall-pain had sufficient validity, reliability, responsiveness, and interpretability in adults with AD, and were inherently feasible as single-items for use in clinical trials and practice.

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Abbreviations

AD:

Atopic dermatitis

BSA:

Body surface area

ClinROM:

Clinician-reported outcome measures

POEM:

Patient-Oriented Eczema Measure

NRS:

Numeric Rating Scale

DLQI:

Dermatology Life Quality Index

SCORAD:

SCORing Atopic Dermatitis

EASI:

Eczema Area and Severity Index

PROM:

Patient-reported outcome measures

QOL:

Quality of life

vIGA-AD:

Validated Investigator’s Global Assessment

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Funding

This publication was made possible with support from the Agency for Healthcare Research and Quality (AHRQ), Grant Number K12 HS023011, the Dermatology Foundation.

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JIS had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis, study concept and design, data curation, investigation, formal analysis, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis.

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Correspondence to Jonathan I. Silverberg.

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Silverberg, J.I. Validity and reliability of a novel numeric rating scale to measure skin-pain in adults with atopic dermatitis. Arch Dermatol Res (2021). https://doi.org/10.1007/s00403-021-02185-3

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Keywords

  • Atopic dermatitis
  • Eczema
  • Pain
  • Itch
  • Pruritus
  • Patient-reported outcomes
  • Burden