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- Title
Measuring Atopic Eczema Control and Itch Intensity in Clinical Practice: A Consensus Statement From the Harmonising Outcome Measures for Eczema in Clinical Practice (HOME-CP) Initiative.
- Authors
Leshem, Yael A.; Chalmers, Joanne R.; Apfelbacher, Christian; Katoh, Norito; Gerbens, Louise A. A.; Schmitt, Jochen; Spuls, Phyllis I.; Thomas, Kim S.; Howells, Laura; Williams, Hywel C.; Simpson, Eric L.
- Abstract
This Consensus Statement recommends instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice. Key Points: Question: What instruments are recommended to measure eczema control and itch intensity in patients with atopic eczema in clinical practice? Findings: Based on a consensus process informed by systematic reviews, the Recap of Atopic Eczema (RECAP) and Atopic Dermatitis Control Tool (ADCT) were recommended to measure long-term control in eczema in clinical practice. Recommended itch-intensity instruments were a peak 24-hour numeric rating scale (NRS)-itch and peak and average 1-week NRS-itch instruments from the Patient-Reported Outcomes Measurement Information System (PROMIS) Itch Questionnaire. Meaning: Clinicians should consider using these simple, validated instruments when treating patients with atopic eczema, to support clinical care, real-world studies, and quality-of-care assessments. Importance: Measuring 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. Objective: To recommend instruments to measure eczema control and itch intensity in patients with atopic eczema in clinical practice. Evidence Review: Available 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. Findings: Of 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 Relevance: Clinicians 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.
- Publication
JAMA Dermatology, 2022, Vol 158, Issue 12, p1429
- ISSN
2168-6068
- Publication type
Article
- DOI
10.1001/jamadermatol.2022.4211