Advanced

Assessment of clinical signs of atopic dermatitis: A systematic review and recommendation

Schmitt, Jochen; Langan, Sinead; Deckert, Stefanie; Svensson, Åke LU ; von Kobyletzki, Laura; Thomas, Kim and Spuls, Phyllis (2013) In Journal of Allergy and Clinical Immunology 132(6). p.1337-1347
Abstract
Background: Clinical signs are a core outcome domain for atopic dermatitis (AD) trials. The current lack of standardization of outcome measures in AD trials hampers evidence-based communication. Objective: We sought to provide evidence-based recommendations for the measurement of clinical signs in AD trials and to inform the Harmonising Outcome Measures for Atopic Dermatitis Initiative. Methods: We conducted a systematic review on measurement properties of outcome measurements for clinical signs of AD. We systematically searched MEDLINE and Embase (until October 1, 2012) for validation studies on instruments measuring the clinical signs of AD. Grading of the truth, discrimination, and feasibility of scales; methodological study quality;... (More)
Background: Clinical signs are a core outcome domain for atopic dermatitis (AD) trials. The current lack of standardization of outcome measures in AD trials hampers evidence-based communication. Objective: We sought to provide evidence-based recommendations for the measurement of clinical signs in AD trials and to inform the Harmonising Outcome Measures for Atopic Dermatitis Initiative. Methods: We conducted a systematic review on measurement properties of outcome measurements for clinical signs of AD. We systematically searched MEDLINE and Embase (until October 1, 2012) for validation studies on instruments measuring the clinical signs of AD. Grading of the truth, discrimination, and feasibility of scales; methodological study quality; and recommendations were based on predefined criteria. Results: Sixteen eligible instruments were identified, of which 2 were best validated. The Eczema Area and Severity Index has adequate validity, responsiveness, internal consistency, intraobserver reliability, and intermediate interobserver reliability but unclear interpretability and feasibility. The Severity Scoring of Atopic Dermatitis Index (SCORAD) has adequate validity, responsiveness, interobserver reliability, and interpretability and unclear intraobserver reliability. Only the objective SCORAD (ie, the clinical signs domain of the SCORAD) is internally consistent. The Six Area, Six Sign Atopic Dermatitis Index severity score and Three Item Severity Score fulfill some quality criteria, but the performance in other required measurement properties is unclear. The Patient-oriented Eczema Measure is reliable and responsive but has inadequate content validity to assess clinical signs of AD. The remaining 11 scales have either (almost) not been validated or performed inadequately. Conclusions: The Eczema Area and Severity Index and SCORAD are the best instruments to assess the clinical signs of AD. The other 14 instruments identified are (currently) not recommended because of unclear or inadequate measurement properties. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atopic dermatitis, evidence-based medicine, systematic review, severity, of illness index, reliability, validity, responsiveness
in
Journal of Allergy and Clinical Immunology
volume
132
issue
6
pages
1337 - 1347
publisher
Elsevier
external identifiers
  • wos:000327538200013
  • scopus:85027949797
ISSN
1097-6825
DOI
10.1016/j.jaci.2013.07.008
language
English
LU publication?
yes
id
a35aec90-a4b6-4917-9b55-1006bc7998cd (old id 4273087)
date added to LUP
2014-02-10 12:24:12
date last changed
2019-10-01 01:43:44
@article{a35aec90-a4b6-4917-9b55-1006bc7998cd,
  abstract     = {Background: Clinical signs are a core outcome domain for atopic dermatitis (AD) trials. The current lack of standardization of outcome measures in AD trials hampers evidence-based communication. Objective: We sought to provide evidence-based recommendations for the measurement of clinical signs in AD trials and to inform the Harmonising Outcome Measures for Atopic Dermatitis Initiative. Methods: We conducted a systematic review on measurement properties of outcome measurements for clinical signs of AD. We systematically searched MEDLINE and Embase (until October 1, 2012) for validation studies on instruments measuring the clinical signs of AD. Grading of the truth, discrimination, and feasibility of scales; methodological study quality; and recommendations were based on predefined criteria. Results: Sixteen eligible instruments were identified, of which 2 were best validated. The Eczema Area and Severity Index has adequate validity, responsiveness, internal consistency, intraobserver reliability, and intermediate interobserver reliability but unclear interpretability and feasibility. The Severity Scoring of Atopic Dermatitis Index (SCORAD) has adequate validity, responsiveness, interobserver reliability, and interpretability and unclear intraobserver reliability. Only the objective SCORAD (ie, the clinical signs domain of the SCORAD) is internally consistent. The Six Area, Six Sign Atopic Dermatitis Index severity score and Three Item Severity Score fulfill some quality criteria, but the performance in other required measurement properties is unclear. The Patient-oriented Eczema Measure is reliable and responsive but has inadequate content validity to assess clinical signs of AD. The remaining 11 scales have either (almost) not been validated or performed inadequately. Conclusions: The Eczema Area and Severity Index and SCORAD are the best instruments to assess the clinical signs of AD. The other 14 instruments identified are (currently) not recommended because of unclear or inadequate measurement properties.},
  author       = {Schmitt, Jochen and Langan, Sinead and Deckert, Stefanie and Svensson, Åke and von Kobyletzki, Laura and Thomas, Kim and Spuls, Phyllis},
  issn         = {1097-6825},
  keyword      = {Atopic dermatitis,evidence-based medicine,systematic review,severity,of illness index,reliability,validity,responsiveness},
  language     = {eng},
  number       = {6},
  pages        = {1337--1347},
  publisher    = {Elsevier},
  series       = {Journal of Allergy and Clinical Immunology},
  title        = {Assessment of clinical signs of atopic dermatitis: A systematic review and recommendation},
  url          = {http://dx.doi.org/10.1016/j.jaci.2013.07.008},
  volume       = {132},
  year         = {2013},
}