52 SCAR-Q, A Patient-Reported Outcome Measure for Scars, Field-Test of Individuals with Burn Scars

Abstract

As mortality rates of burn survivors continues to decrease, burn surgeons are facing more complex reconstructive challenges and need a systematic way to elicit patient input about their scars. Burn scars are especially difficult to treat as the vast majority will develop hypertrophic scars, which are more symptomatic and lead to increased functional and cosmetic disabilities. A comprehensive scar-specific PROM for the burn, surgical, and traumatic scar populations was field-tested worldwide. Our aim is to describe the field-test findings specific for the burn population and the overall Rasch Measurement Theory (RMT) analysis. A preliminary PROM, the SCAR-Q, was developed from a secondary analysis of 244 qualitative interviews, 45 cognitive interviews, and feedback from 27 clinical experts worldwide to encompass three scales: Appearance, Symptoms, and Psychosocial Impact. SCAR-Q was field-tested in 4 burn-specific clinics worldwide. RMT was used to analyze its psychometric properties and to further refine it of the overall sample. Of the 731 participants who filled out the SCAR-Q booklet, a total of 184 burn survivors completed the SCAR-Q study booklet. The majority were adults(87,47%), individuals with flame burns(97,53%), immature scars(92,50%), normal scar type(96,52%), spanning multiple anatomic locations(average 3.1+/12.9). The RMT findings are on the overall sample. RMT analysis decreased the number of items from 48 to 29 due to poor item fit, disordered thresholds, and/or redundancy. No DIF was found based on scar etiology suggesting items worked the same across all scar etiologies. Person separation indexes were above 0.80 (with extremes) and 0.79 (without extremes). Cronbach’s alpha values were 0.91 and higher, and the intraclass correlation coefficients were 0.88 and above. Lower mean scores were associated with burn scars on all three SCAR-Q scales. With surgical evaluations becoming more person-centered, a PROM specific to scars is essential to adequately capture patient concerns and the impact of interventions on their lives. The SCAR-Q can be used in the burn scar population. We anticipate that SCAR-Q will be used to determine the crucial timing for scar modulation, evaluate outcomes in scar therapies, aid in clinical trials, and be part of quality improvement initiatives.