Quality-of-Life Instruments: Evaluation of the Impact of Psoriasis on Patients
Section snippets
Definition of QoL
QoL is a broad term used to evaluate the general well-being of an individual. It is meant to encompass all variables that may impact an individual’s life, including physical, social, and psychologic factors. Some authors define QoL as an individual’s perception of his or her position in life, in relation to his or her life goals and belief system.9 Health-related QoL is a more limited concept used to describe the effects that a disease or its symptoms have on an individual’s life. In terms of
Importance of QoL evaluation
There are many reasons why it is especially important to measure the impact of psoriasis on a patient’s QoL. Perhaps the most significant reason is in determining appropriate therapy for psoriasis. Presently, there are several highly effective, systemic therapies for psoriasis, such as cyclosporine, methotrexate. and the biologics including etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and ustekinumab (Stelera). There are also many new systemic and biologic therapies
Health-related QoL instruments
Health-related QoL instruments are questionnaires designed to assess the impact of a disease on a patient’s QoL. These QoL instruments can be generic, specialty-specific (ie, dermatology-specific), or disease-specific (ie, psoriasis-specific). Most have been developed for adult patients, but a few have been designed for children. To be a useful QoL instrument, it should demonstrate the following criteria: (1) validity (ie, the instrument evaluates well what it intends to measure); (2)
QoL instruments for psoriasis
Several useful generic, dermatology-specific, and disease-specific QoL instruments exist to evaluate the impact of psoriasis on patient’s QoL.9, 10, 11, 12 Specifically, generic QoL instruments given to patients with psoriasis include the Short Form 36 (SF-36),13, 14 the Sickness Impact Profile (SIP),15 the General Health Questionnaire (GHQ),16 and the Psychological General Well-Being Index (PGWB).17 The dermatology-specific QoL instruments commonly administered to patients with psoriasis
Short Form 36
The SF-36 is a 36-question survey that measures eight broad health dimensions: (1) physical functioning, (2) social functioning, (3) role limitations caused by physical problems, (4) role limitations caused by emotional problems, (5) general mental health, (6) energy and fatigue, (7) bodily pain, and (8) general health perception.13, 14 In addition, there is a question regarding the change in general health in the past year. The SF-36 is scored from 0 (worst health state) to 100 (best health
Dermatology-specific QoL instruments
The dermatology-specific instruments allow for psoriasis to be compared with other skin conditions.
Children’s Dermatology Life Quality Index
The CDLQI, published in 1995, is the children’s version of the DLQI. It was standardized on 169 children (ages 3–16 years), who presented to a pediatric dermatologic clinic. The CDLQI was developed based on what these children, with the assistance of their parents, described to be all the ways in which their skin disease affected their lives. The CDLQI has a similar structure to the adult DQLI and has the same scoring system. Specifically, it is a 10-item text-only questionnaire (maximum score
Psoriasis-specific QoL instruments
The psoriasis-specific instruments are the most sensitive and comprehensive to psoriasis. As such, they are best in two scenarios. The first is to detect small changes in psoriasis-specific QoL, which is relevant in both the clinical setting and in interventional trials. The second scenario is the need to elaborate what aspects of psoriasis is most important to the patient. The following instruments fit in these scenarios in differing ways.
Summary
Psoriasis results in a significantly negative QoL impact for a large portion of the affected population. Although psoriasis may not be life-threatening, it is a potentially life-ruining disease with multiple comorbidities in addition to the psychosocial implications. Fortunately, there are many new systemic treatment options available, such as biologic agents, which more effectively treat psoriasis not just for the short-term, but also for the long-term maintenance of control. However, when
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Out-of-pocket costs for patients with psoriasis in an outpatient dermatology referral service
2021, Anais Brasileiros de DermatologiaCitation Excerpt :The medical products were calculated according to pharmacy prices and the money was measured in Colombian Pesos (COP) and converted to US Dollars (USD) according to the representative exchange rate of the market (Source: Banco de la República de Colombia exchange value: 3177.94 COP April 24, 2019). Other economic and clinical variables like employment status (employee, unemployed or pensioner), cause of unemployment if applied (due to illness or other causes), work absenteeism measured in number of days that the patient did not go to work due to the disease in the last 6-months with or without sick leave; Area and Severity Index of Psoriasis (PASI), Dermatological Quality of Life Index (DLQI) which evaluates 10 questions in relation to the impact of cutaneous disease on the social, family, sexual and labor spheres, responding: very much (3 points), a lot (2 points), a little (1 point) and not at all (0 points), giving a final score between 0–30 with 0 being the least affected in life quality and 30 the maximum; the course time of the disease in years, comorbidities (diabetes, hypertension, dyslipidemia, metabolic syndrome, cardiovascular disease, obesity, cancer, others), type of treatment (topical, systemic, phototherapy, biological, others or none), and cause of treatment abandonment if applied (costs, transportation, poor attention, lack of availability of appointments, disaffiliation of health service provider, other causes) were also considered in the survey.9,10 All patients with psoriasis were invited to participate and underwent a complete physical examination and a survey, which were performed by a trained third-year dermatology resident.
The latency period between type 2 diabetes and development of Coronary Artery Disease based on psychological factors
2020, Clinical Epidemiology and Global HealthCitation Excerpt :Besides the direct impact of DM in increasing the probability of cardiovascular complications, cardiovascular diseases (CVDs) risk factors are also highly common among patients with Type 2 diabetes.1 Cardiovascular professionals have considered certain physical factors, such as age, hypertension, high cholesterol and hyperlipidemia, overweight and family history of CVDs among the cardiovascular risk factors.3 Besides the above-mentioned medical and demographic variables, psychological and mental factors can also play an important role in the development of coronary artery disorders (CAD).4
Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis
2018, Anais Brasileiros de DermatologiaCitation Excerpt :Analysis of the psoriasis group showed that patients reporting sexual dysfunction also presented more extensive skin lesions. This same relationship had been observed by Sampogna et al. in 200732, later confirmed by Guenther et al. in 2011,33 although it is not a consensus.8, 13, 25, 30, 34-37 Various factors can impact the quality of sexual life in psoriasis patients, including side effects of medications, increased prevalence of comorbidities,38 lesion site, and symptoms of the skin condition itself, such as pruritis, psychological alterations, and the partner ‘s concerns33
Generating EQ-5D-3L Utility Scores from the Dermatology Life Quality Index: A Mapping Study in Patients with Psoriasis
2018, Value in HealthCitation Excerpt :Psoriasis is a commonly occurring immune-mediated condition affecting about 2% of the UK population [1]. In addition to affecting the skin, psoriasis is associated with significant mental and physical comorbidity [2]. Treatments for psoriasis, such as biologic therapies, have been shown to improve health-related quality of life (HRQOL) as measured by the dermatology-specific Dermatology Life Quality Index (DLQI) and the generic EuroQol five-dimensional questionnaire (EQ-5D) [3].
Conflicts of Interest Disclosure: JWW, TVN, MMH, ESL, and TB have no financial conflicts of interest to disclose. JYMK has the following conflicts of interest: Abbott, Amgen, Leo, Galderma, Glaxo-Smith-Klein, PhotoMedex, Pfizer, and Teikoku. AM has the following conflicts of interest: Abbott, Amgen, Astellas, Celgene, Centocor, Eli Lilly, Galderma, Genentech, Novartis, Novo Nordisk, Pfizer, Promius, Stiefel, Syntrix Biosystems, Warner Chilcott, and Wyeth. There were no funding sources for this manuscript.