Only 2 acne-specific PROMs receive an “A” grade for measuring quality of life


Of the 10 patient-reported outcome measures studied, only 2 received an “A” grade for sufficient content validity and internal structure.

According to a recent study published in JAMA Dermatology.

Both instruments have been shown to be suitable for facial and truncal acne in adults and adolescents.

A systematic review of previous studies was conducted to examine health-related quality of life (HRQOL) PROMs for use in adolescents and adults by identifying development and validation studies and assessing methodological quality and quality. proofs.

Methodological quality was assessed based on the criteria of the Consensus Standards for the Selection of Health Measurement Instruments (COSMIN).

After performing a literature search, 47 met the inclusion criteria and 7 additional reports on PROM development were included. The study identified and evaluated 10 acne-specific PROMS. In addition, 6 dermatology-specific PROMS have been evaluated in acne and 5 generic PROMS have been studied in acne.

The results showed that Acne-Q and CompAQ had sufficient evidence of content and internal structure validity to receive an A use recommendation. However, responsiveness was not assessed in Acne -Q, and the evidence for reliability and construct validity was found to be weak. Likewise, the CompAQ has not been rated for responsiveness or reliability.

The study found no abbreviated HRQoL instruments for acne that met the recommendation criteria. The authors suggested this as a shortcoming, noting that abbreviated instruments can be rapidly deployed in a clinical setting with a lower likelihood of survey fatigue.

The other acne-specific measures studied were given a B grade “for not having high-quality evidence for insufficient measurement properties or sufficient evidence to recommend”. No acne-specific instructions received a C grade.

The Skindex-29 was the only dermatology-specific instrument with sufficient overall content validity; however, the lack of acne-specific internal structure data available for evaluation precluded an A recommendation.

Among the acne-specific measures studied:

  • The Acne Quality of Life Index (A-Qol) and Acne Severity and Impact Scale (ASIS) had inconsistent ratings for content validity, ruling out an A rating
  • Cardiff Acne Disability Index (ADI) and Acne Disability Index (CADI) were found to have inadequate PROM development and insufficient scores for content validity
  • The Psychological and Social Effects of Acne Assessment (APSEA) was found to have inadequate PROM development.
  • The Acne Quality of Life Scale (AQOL) received a score reflecting poor developmental design and insufficient content validity.

The authors suggest that the evidence for ADI, CADI, AQOL and APSEA is more limited and should not be used without further investigation. However, the authors suggest that Acne-QoL and ASIS could be considered if additional content validity was performed.

In addition, important measurement properties have not been sufficiently investigated for all instruments. The authors suggest that further research aims to better define the content validity, responsiveness, and interpretability of PROMs used to assess HRQoL in patients with acne.

The study encountered limitations. The authors noted that the COSMIN framework has been criticized for its relative lack of benchmarks from modern measurement theory, its subjectivity and dependence on the expertise of reviewers, the lack of evidence surrounding the risk of bias of the items of the checklist and scoring procedures, and low reliability between reviewers.


Zachary HH, Diane T, Haya AH, et al. Patient-reported outcome measures for health-related quality of life in patients with acne vulgaris: a systematic review of measure development and measurement properties. JAMA Dermatology. Published June 22, 2022. doi:10.1001/jamadermatol.2022.2260


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