Perceptual Matching for Assessment of Itch; Reliability and Responsiveness Analyzed by a Rank-Invariant Statistical Method

Abstract

The aim of this study was to evaluate the reliability and responsiveness of a new device-perceptual matching by Matcher (Cefar Medical AB, Lund, Sweden)-in the assessment of the progress of experimentally induced itch as well as determine the reliability of the method in patients with skin disease and itch. The perceptual matching unit electrically stimulates the skin of the fingers in the left hand. When the amplitude of the sensation corresponded to that of the experienced itch, the subject was instructed to halt the stimulation and a value was automatically saved in the electronic device. A total of 36 healthy subjects and nine patients participated in the study. The healthy subjects were asked to rate the level of itch every 30 s during the first 5 min and thereafter every minute. The reliability was determined in a test-retest procedure of the time points 5, 10, and 15 min after induction of itching. To test the stability of the method, the first sensation of pain in healthy subjects without itch was determined every 10th minute during 60 min. In patients, the test-retest procedure was repeated within 5 min. Perceptual matching was found to be a reliable method of itch assessment, with no evidence for random individual disagreement between the assessments. The augmented rank order coefficient ra was excellent: 1.00 at 5 min; 0.99 at 10 min; and 1.00 at 15 min. There was a clear indication of responsiveness for detecting changes in itch over time, p<or=0.05. The perceptual matcher device can detect immediate changes in perceived itch and is also sensitive to gradual decreases after the induction of itch. The first sensation of pain in healthy subjects without itch was unaffected when assessed every 10th minute during 60 min. In patients, no evidence for random disagreement or systematic disagreement by group between repeated assessments was detected. The augmented rank order coefficient was high (0.98). In conclusion, Matcher measures itch intensity via perceptual matching with a high reliability and excellent responsiveness. The method is stable and can be recommended as an assessment tool for itch intensity both in experimental conditions as well as in patients with skin disease and itch.