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

Leshem, Yael A; Chalmers, Joanne R; Apfelbacher, Christian; Katoh, Norito; Gerbens, Louise AA; Schmitt, Jochen; Spuls, Phyllis I; Thomas, Kim S.; Howells, Laura; Williams, Hywel C.; Simpson, Eric L

Abstract

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..

• Journal Article Type: Article
• Acceptance Date: Aug 9, 2022
• Online Publication Date: Oct 12, 2022
• Publication Date: 2022-12
• Deposit Date: Aug 18, 2022
• Journal: JAMA Dermatology
• Print ISSN: 2168-6068
• Electronic ISSN: 2168-6084
• Peer Reviewed: Peer Reviewed
• Volume: 158
• Issue: 12
• Pages: 1429-1435
• DOI: https://doi.org/10.1001/jamadermatol.2022.4211
• Keywords: Dermatology
• Public URL: https://nottingham-repository.worktribe.com/output/10080828
• Publisher URL: https://jamanetwork.com/journals/jamadermatology/article-abstract/2797297