Not relevant responses on the DLQI from psoriasis patients

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This study suggests a reconsideration of the use of the DLQI for medical and financial decision-making in psoriasis patients is needed.

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Background:
Dermatology Life Quality Index (DLQI) is the most common health-related quality of life measure in dermatology that is widely used in treatment guidelines for psoriasis. Eight out of the 10 questions of the DLQI offer a ‘not relevant’ response (NRR) option that is scored as the item had no impact on patients’ life at all.

Objective:
To explore the occurrence of NRRs on the DLQI in psoriasis patients, and to examine the effect of several socio-demographic and clinical factors on giving NRRs.

Methods:
Data were obtained from two cross-sectional surveys among psoriasis patients at two academic dermatology clinics in Hungary. Health-related quality of life was measured by employing DLQI and EQ-5D-3L, while disease severity was graded by Psoriasis Area and Severity Index (PASI). Multivariate logistic regression was applied to determine the predictors of providing NRRs.

Results:
Mean age of the 428 patients was 49 years, and 65% were males. Mean PASI, DLQI and EQ-5D-3L index scores were 8.4±9.5, 6.8±7.4 and 0.74±0.28, respectively. Overall, 38.8% of the patients had at least one NRR: 19.6% (one), 11.5% (two), 5.1% (three) and 2.6% (more than three). Most NRRs occurred in sport, sexual difficulties and working/studying items of the DLQI (28.4%, 16.4% and 14.0%, respectively). Female gender (OR 1.65; 95% CI 1.04-2.61), older age (OR 1.05; 95% CI 1.03-1.07) and higher PASI score (OR 1.03; 95% CI 1.01-1.06) were associated with providing more NRRs, whereas highly educated patients (OR 0.34; 95% CI 0.16-0.72) and those with a full-time job (OR 0.47; 95% CI 0.29-0.77) less frequently tended to tick NRRs.

Conclusion:
The high rate of psoriasis patients with NRRs, especially among women, less educated and elderly patients, indicates a content validity problem of the measure. A reconsideration of the use of the DLQI for medical and financial decision-making in psoriasis patients is suggested.

Source: onlinelibrary.wiley.com

*Early view funding unknown.

Dermatology Life Quality Index (DLQI)