Abstract
BackgroundSeveral questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE).MethodsObservational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes.ResultsThe final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach’s alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = −0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting ‘much improved’ health status at study completion was 1.01 (large effect size).ConclusionsThe present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.
Highlights
Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed for the Spanish population
Other studies have shown that the disease has a negative effect on self-perception of body image leading to low selfesteem, stigma, and a feeling of shame in the patient because of the lesions produced by the psoriasis [2]
56.3% of patients were men compared to 51.8% in controls (p = 0.54), and the control group showed higher levels of education (46% who had completed university level education compared to 24% of patients; p < 0.01)
Summary
Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed for the Spanish population. A study by the National Psoriasis Foundation found that 75% of patients reported that the disease had a negative impact on the daily lives [2]. A review of 17 studies of HRQoL in psoriasis showed that patients with the disease reported physical discomfort, impaired emotional functioning, a negative body and self-image, and limitations in daily activities, social contacts and (skinexposing) activities, and work [3]. Other studies have shown that the disease has a negative effect on self-perception of body image leading to low selfesteem, stigma, and a feeling of shame in the patient because of the lesions produced by the psoriasis [2]. As well as other disease specific questionnaires like the Psoriasis Disability Index (PDI) [9], the Impact of Psoriasis questionnaire (IPSO) [10], the 12-Item Psoriasis Quality of Life Questionnaire (PQoL-12) [11], the Psoriasis Index of Quality of Life (PSORIQOL) [12], the Psoriasis Life Stress Inventory (PLSI) [13], and the Questionnaire on Experience with Skin Complaints (SF-QES) [14]
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