Questionnaire Modifications and Alternative Scoring Methods of the Dermatology Life Quality Index: A Systematic Review

Rencz, Fanni; Szabó, Ákos; Brodszky, Valentin

doi:10.1016/j.jval.2021.02.006

Cited by 13 publications

(22 citation statements)

References 123 publications

(127 reference statements)

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“…This might call into question the equivalence of ‘not at all’ and NRRs according to the original DLQI scoring. Although the DLQI‐R scoring modification may improve certain measurement properties of the DLQI, 20,25–29,39,45,46 it cannot address the problems surrounding its content validity. The high number of NRRs reported in different diagnoses is a sign of issues with item relevance 20,26–28,46–50 .…”

Section: Discussionmentioning

confidence: 99%

“…The plethora of DLQI questionnaire modifications, including 21 different bolt‐ons [i.e. additional questionnaire item(s) appended to the original questionnaire], may be considered as evidence for problems with comprehensiveness 25 . However, Skindex‐16 (and the other Skindex measures) may also have content validity problems.…”

Section: Discussionmentioning

confidence: 99%

“…additional questionnaire item(s) appended to the original questionnaire], may be considered as evidence for problems with comprehensiveness. 25 However, Skindex-16 (and the other Skindex measures) may also have content validity problems. In a recent qualitative study, for example, patients with acne reported redundant items, uncertainties regarding the meaning of the 'never bothered' endpoint and unlabelled response options which may lead to arbitrary response choices.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with hand‐foot syndrome, vitiligo, hidradenitis suppurativa and melasma, Skindex‐16 exhibited slightly better convergent validity with condition‐specific HRQoL questionnaires and slightly worse convergent validity with generic HRQoL questionnaires than the DLQI 19–24 . Furthermore, many recent studies have confirmed that the scoring modification DLQI‐Relevant (DLQI‐R) improves the validity of the DLQI 20,25–29 . DLQI‐R is calculated by multiplying the DLQI total score by an adjustment factor that increases with the number of ‘not relevant’ responses (NRRs) 27 .…”

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A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI‐Relevant and Skindex‐16*

2021

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Background Dermatology Life Quality Index (DLQI) and Skindex-16 are among the most commonly used dermatology-specific health-related quality-of-life (HRQoL) instruments. DLQI has two common scoring methods, the original and the DLQI-Relevant (DLQI-R) modification. Head-to-head comparisons of the measurement properties of the DLQI, DLQI-R and Skindex-16 are currently lacking. Objectives We aim to compare the measurement properties of the DLQI, DLQI-R and Skindex-16. Methods We analysed data from 618 patients with self-reported physiciandiagnosed dermatological conditions from a cross-sectional survey carried out in Hungary in early 2020. DLQI, DLQI-R and Skindex-16 were compared in terms of ceiling and floor effects, informativity, convergent validity and known-group validity.Results Mean DLQI, DLQI-R and Skindex-16 total scores were 3Á76 AE 5Á03, 4Á11 AE 5Á34 and 29Á36 AE 26Á62, respectively. Among patients with a DLQI/ DLQI-R total score of zero, 64% reported problems on Skindex-16. Overall, 23-38% of patients with 'not relevant' responses on DLQI items 3 (shopping/ home/gardening), 7 (working/studying), 8 (interpersonal problems) and 9 (sexual difficulties) reported problems on their corresponding Skindex-16 items. Average relative informativity (Shannon's evenness index) was the highest for Skindex-16 (0Á85), followed by DLQI-R (0Á66) and DLQI (0Á54). DLQI, DLQI-R and Skindex-16 demonstrated similar convergent validity. DLQI was able to better discriminate between known groups of patients based on overall skin-related HRQoL impairment, whereas DLQI-R and Skindex-16 performed better with respect to self-perceived health status. Conclusions Skindex-16 seems to be more sensitive than DLQI/DLQI-R in capturing mild impairment in HRQoL. Our findings help to provide a fuller understanding of the difference between DLQI, DLQI-R and Skindex-16 and support the informed choice of instrument for clinical and research purposes.What is already known about this topic?• Dermatology Life Quality Index (DLQI) and Skindex-16 are among the most commonly used dermatology-specific instruments to measure health-related quality of life (HRQoL). DLQI has an alternative scoring, DLQI-Relevant (DLQI-R), developed in 2018. • So far, no studies have provided a comprehensive head-to-head comparison of the measurement properties of the DLQI, DLQI-R and Skindex-16.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI‐Relevant and Skindex‐16*

2021

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“…Specialty- or condition-specific measures take better account of the types and degrees of impairment caused by skin diseases [ 5 ]. Among them, the Dermatology Life Quality Index (DLQI) is the most frequently used skin-specific HRQoL measure [ 6 , 7 ], the validity, reliability, and responsiveness of which has been confirmed by numerous studies across a variety of skin conditions [ 8 ]. A shortcoming of the DLQI, however, is that its outcome combinations have hitherto not been valued on a utility scale, and previous studies have reported discrepancies between DLQI scores and utilities assessed by skin disease patients as well as by the general population [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of health state utilities in dermatology: an experimental time trade-off value set for the dermatology life quality index

Ruzsa

Rencz

Brodszky

2022

Health Qual Life Outcomes

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Background Dermatology Life Quality Index (DLQI) scores are used in many countries as access and reimbursement criteria for costly dermatological treatments. In this study we examined how time trade-off (TTO) utility valuations made by individuals from the general population are related to combinations of DLQI severity levels characterizing dermatologically relevant health states, with the ultimate purpose of developing a value set for the DLQI. Methods We used data from an online cross-sectional survey conducted in Hungary in 2020 (n = 842 after sample exclusions). Respondents were assigned to one of 18 random blocks and were asked to provide 10-year TTO valuations for the corresponding five hypothetical health states. To analyze the relationship between DLQI severity levels and utility valuations, we estimated linear, censored, ordinal, and beta regression models, complemented by two-part scalable models accommodating heterogeneity effects in respondents’ valuation scale usage. Successive severity levels (0–3) of each DLQI item were represented by dummy variables. We used cross-validation methods to reduce the initial set of 30 dummy variables and improve model robustness. Results Our final, censored linear regression model with 13 dummy variables had R2 = 0.136, thus accounting for 36.9% of the incremental explanatory power of a maximal (full-information) benchmark model (R2 = 0.148) over the uni-dimensional model (R2 = 0.129). Each DLQI item was found to have a negative effect on the valuation of health states, yet this effect was largely heterogeneous across DLQI items, and the relative contribution of distinctive severity levels also varied substantially. Overall, we found that the social/interpersonal consequences of skin conditions (in the areas of social and leisure activities, work and school, close personal relationships, and sexuality) had roughly twice as large disutility impact as the physical/practical aspects. Conclusions We have developed an experimental value set for the DLQI, which could prospectively be used for quantifying the quality-adjusted life years impact of dermatological treatments and serve as a basis for cost-effectiveness analyses. We suggest that, after validation of our main results through confirmatory studies, population-specific DLQI value sets could be developed and used for conducting cost-effectiveness analyses and developing financing guidelines in dermatological care.

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Dermatology Life Quality Index in Thai Patients with Facial Port-Wine Stains

Jantarakolica,

Wanitphakdeedecha,

Yan

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Port-wine stains (PWS) are congenital capillary abnormalities caused by immature, venule-like vasculature that progressively dilates due to poor endothelial cell differentiation. PWS affects between 0.3% and 0.9% of newborns, with 90% of cases occurring on the face. Individuals with facial PWS and their parents had a significant negative impairment on their quality of life (QoL) and also suffered from psychological disabilities. Methods This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaires included demographic data, subjective evaluation (SE), and the Dermatology Life Quality Index (DLQI). The questionnaire was performed with a full scale and adjusted scale of validity and reliability test of DLQI using factor analysis and Cronbach’s alpha. The study outcome was a subjective evaluation and DLQI in patients who received pulsed dye laser (PDL) treatment. Results Of the 54 patients, 35.2% (19) are male, and 64.8% (35) are female. Regarding age groups, 64.8% (35) are below 5 years old, and 35.2% (19) are older than 5 years. SE results showed that males evaluated an improvement of the facial PWS lesion significantly better than females ( P < 0.05). The older age group graded the percentage of improvement better than the younger age group ( P < 0.01). The result of the DLQI showed no difference in DLQI between gender. Older age result resulted in a significantly different DLQI compared with younger age ( P < 0.01). Parent-reported DLQI improvement was less than self-reported DLQI improvement in patients with PWS treated with PDL ( P < 0.05). Concerning the instrument of the study, the validity and reliability analysis of the DLQI questionnaire using factor analysis and Cronbach’s alpha have been performed. The adjusted scale with the 5-item DLQI questionnaire is more appropriate in terms validity and reliability. Conclusion This study demonstrates that facial PWS reduces the QoL as measured by DLQI. We discovered that the QoL of patients and parents with PWS was significantly impaired. The main influencing factors were older age, the improved perception between gender, and PDL treatments. In addition, we found only five questions that are reliable for PWS. The adjusted five-item DLQI questionnaires are more appropriate regarding validity and reliability. Trial Registration Number TCTR20230210001, COA no. si 1059/2020.

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Questionnaire Modifications and Alternative Scoring Methods of the Dermatology Life Quality Index: A Systematic Review

Cited by 13 publications

References 123 publications

A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI‐Relevant and Skindex‐16*

A comparative study on the measurement properties of Dermatology Life Quality Index (DLQI), DLQI‐Relevant and Skindex‐16*

Assessment of health state utilities in dermatology: an experimental time trade-off value set for the dermatology life quality index

Dermatology Life Quality Index in Thai Patients with Facial Port-Wine Stains

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