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A Comparative Study on the Measurement Properties (Criterion Validity, Informativity, and Floor and Ceiling Effects)
Aaqid Siraj Syed1, Sheenam Sethi2, Shakti Chauhan2
1From the Department of Internal Medicine, Mobile Infirmary Medical Centre, Mobile, Alabama, USA.
Background:
The measurement of health-related quality of life (HRQoL) is essential in dermatology, with the DLQI and Skindex-29 being popular tools for assessment. However, the literature comparing the measuring features of these two questionnaires is lacking.
Aims:
This study aims to provide a comparison of the measurement properties of DLQI and Skindex-29 in patients with common dermatology conditions such as psoriasis vulgaris (PV), vitiligo vulgaris (VV), leprosy, and acne vulgaris (AV).
Methods:
In this cross-sectional study, the HRQoL of 301 patients with the four dermatological conditions was measured using the DLQI and Skindex-29 questionnaires at a tertiary care centre located in Dehradun, Uttarakhand, India. Statistical analysis included determining ceiling and floor effects, informativity, and criterion validity.
Results:
The mean DLQI total scores were: PV (11.03 ± 0.89), VV (4.73 ± 0.78), leprosy (8.97 ± 1.09), and AV (7.79 ± 0.63), and the mean Skindex-29 scores were: PV (37.98 ± 2.82), VV (27.92 ± 2.93), leprosy (45.12 ± 3.63), and AV (27.6 ± 1.08), with a 95% confidence interval. Of the patients with a DLQI score of 0 (n = 66), 64 (96%) had a total score greater than 0 on the Skindex-29. The most troubled areas of HRQoL among patients with a DLQI score of 0 according to the Skindex-29 were item 17 (showing affection; 12.1%), item 9 (worry about scars; 9.1%), item 12, item 13, and item 14 (being ashamed, worrying about worsening, and tending to do things oneself; 7.6%). The ceiling effect was observed in 4.7% of patients for DLQI and 0% for Skindex-29. The floor effect was high for the DLQI total score (22%), whereas Skindex-29 observed only 0.7%. The absolute informativity value of Skindex-29 was 1.66, and that of the DLQI was 1.92. The typical relative informativity value for both was 0.83.
Conclusion:
Skindex-29 showed better sensitivity to clinical severity, less floor effect, higher absolute informativity, and better coverage of the 'emotion' domain. Skindex-29 was found to be more effective in detecting minor HRQoL impairment than DLQI.
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