Measuring Atopic Eczema Control and Itch Intensity in Clinical Practice

Author:

Leshem Yael A.12,Chalmers Joanne R.3,Apfelbacher Christian45,Katoh Norito6,Gerbens Louise A. A.7,Schmitt Jochen8,Spuls Phyllis I.7,Thomas Kim S.3,Howells Laura3,Williams Hywel C.3,Simpson Eric L.9,Abuabara Katrina10,Ahn Jiyoung10,Aoki Valeria10,Apfelbacher Christian10,Arai Takahiro10,Arents Bernd10,Awici-Rasmussen Maren10,Baker Arabella10,Bang Bo10,Baughman Lauren10,Beck Lisa10,Bosma Angela10,Burton Tim10,Byrnes Vanessa10,Calimlim Brian10,Capozza Korey10,Chalmers Jo10,Chavda Rajeev10,DeLozier Amy10,Drucker Aaron10,Ebata Toshiya10,Eichenfield Laurence10,Flohr Carsten10,Frey Surina10,Futamura Masaki10,Gabes Michaela10,George Susannah10,Gerbens Louise10,Grinich Erin10,Grossouw Kristin10,Howells Laura10,Irvine Alan10,Kataoka Yoko10,Katoh Norito10,Kerkmann Urs10,Lawton Sandra10,Lee Dong Hun10,Leshem Yael10,Lossius Astrid H.10,Maeda-Chubachi Tomoko10,Margolis David10,Matsui Takeshi10,Merhand Stephanie10,Murakami Mami10,Murota Hiroyuki10,Nakahara Takeshi10,Nunes Fabio10,Ohya Yukihiro10,Ong Peck10,Orfali Raquel Leão10,Paller Amy10,Redding Magali10,Rincón Pérez Catalina10,Roberts Amanda10,Rogers Natasha10,Schmitt Jochen10,Shear Neil10,Silverberg Jonathan10,Simpson Eric10,Singh Jasvidner10,Smith Begolka Wendy10,Spuls Phyllis10,Stalder Jean-Francois10,Sugerman Philip10,Svensson Ake10,Thomas Kim10,Thyssen Jacob10,Todd Gail10,van der Most Floor10,van Halewijn Karlijn10,Vestby Helle10,Vestergaard Christian10,Volke Annika10,von Kobyletzki Laura10,Wahlgren Carl-Fredrik10,Weisshaar Elke10,Williams Hywel10,Wollenberg Andreas10,Zhao Yang10,

Affiliation:

1. Division of Dermatology, Rabin Medical Center, Petach-Tikva, Israel

2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

3. Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom

4. Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany

5. Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore

6. Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan

7. Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, the Netherlands

8. Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Germany

9. Department of Dermatology, Oregon Health and Science University, Portland, Oregon

10. for the Harmonising Outcome Measures for Eczema (HOME) initiative

Abstract

ImportanceMeasuring outcomes in clinical practice can aid patient care, quality improvement, and real-world evidence generation. The Harmonising Outcome Measures for Eczema (HOME) Clinical Practice initiative is developing a list of validated, feasible instruments to measure atopic eczema in clinical care. Prior work identified symptoms and long-term control as the most important domains to measure in clinical practice. The Patient-Oriented Eczema Measure (POEM) and the Patient-Oriented Scoring Atopic Dermatitis Index (PO-SCORAD) were recommended by consensus to measure symptoms in clinical practice, but a need for instruments to measure itch intensity specifically was recognized. The HOME group also previously decided that long-term control should be captured by repeated measurements of eczema control. Recommended instruments to measure eczema control in clinical practice have not been defined.ObjectiveTo recommend instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice.Evidence ReviewAvailable instruments to measure eczema control and itch intensity were identified through systematic reviews, informing a consensus process held at the HOME VIII virtual online meeting (October 6 and October 9, 2020). Feasibility aspects were highlighted to optimize instrument selection for the clinical practice. Consensus on an instrument was reached if fewer than 30% of the voters disagreed.FindingsOf 7 identified instruments, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were the recommended instruments to measure eczema control (3 of 63 [5%] and 7 of 69 [10%] of voters disagreed, respectively). A single-question patient global assessment garnered support, but the current available instrument did not reach consensus. Six available itch-intensity instruments were identified. Of them, 3 instruments were recommended by consensus: a peak 24-hour numeric rating scale (NRS)-itch, and 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire, measuring average and peak itch (11 of 63 [17%], 14 of 63 [22%], and 16 of 59 [27%] voters disagreed, respectively).Conclusions and RelevanceClinicians and patients are encouraged to incorporate these well-validated, quick-to-perform, and easy-to-use instruments into their clinic, selecting the instruments that best fit their need. These assessments are meant to enhance, not replace, the patient–clinician encounter, and to support real-world research and health care improvement.

Publisher

American Medical Association (AMA)

Subject

Dermatology

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