Journal of Investigative Dermatology Home

Measurement Properties of Patient-Reported Outcome Measures for Pruritus: An Updated Systematic Review

Published:August 02, 2021DOI:
      This systematic review aims to provide an update on measurement properties of patient-reported outcome measures for pruritus. A Medline literature search was conducted to update the systematic review published in this journal in 2017 and to identify new validation studies published between October 2015 and July 2019. The methodological quality of validation studies was assessed on the basis of the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, and the measurement properties of patient-reported outcome measures were evaluated. A total of 19 new studies were included and added to the 22 studies identified in the previously published review. Evidence from all the 41 studies evaluating 38 different measures was summarized. Outcome measures were mapped to one of three constructs where possible: pruritus intensity, pruritus severity, pruritus-specific health-related QOL. COSMIN rating revealed mixed results, with deficiencies in the methodological quality of many studies across all constructs. The most appropriate pruritus severity measure was the Itch Severity Scale. ItchyQoL and the disease-specific Uremic Pruritus in Dialysis Scale achieved the most promising results considering the construct pruritus-specific health-related QOL. For pruritus intensity, nine measures performed similarly well.


      COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments), EL (evidence level), HRQOL (health-related QOL), ISS (Itch Severity Scale), MP (measurement property), NRS (Numerical Rating Scale), VAS (visual analog scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      PDF Download and 24 Hours Online Access
      Society Members (SID/ESDR), remember to log in for access.


      Subscribe to Journal of Investigative Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Amtmann D.
        • McMullen K.
        • Kim J.
        • Bocell F.D.
        • Chung H.
        • Bamer A.
        • et al.
        Psychometric properties of the modified 5-D itch scale in a burn model system sample of people with burn injury.
        J Burn Care Res. 2017; 38: e402-e408
        • Blome C.
        • Augustin M.
        • Siepmann D.
        • Phan N.Q.
        • Rustenbach S.J.
        • Ständer S.
        Measuring patient-relevant benefits in pruritus treatment: development and validation of a specific outcomes tool.
        Br J Dermatol. 2009; 161: 1143-1148
        • Bruscky D.M.V.
        • Melo A.C.C.D.B.
        • Sarinho E.S.C.
        Cross-cultural adaptation and validation of the itching severity scale in children and adolescents with atopic dermatitis.
        Rev Paul Pediatr. 2017; 35: 244-251
        • Bushmakin A.G.
        • Mamolo C.
        • Cappelleri J.C.
        • Stewart M.
        The relationship between pruritus and the clinical signs of psoriasis in patients receiving tofacitinib.
        J Dermatolog Treat. 2015; 26: 19-22
        • Daudén E.
        • Sánchez-Perez J.
        • Prieto M.
        • Roset M.
        Validación de la versión española de la escala de intensidad del picor (Cuestionario Itch Severity Scale, ISS). Estudio PSEDA [Validation of the Spanish Version of the Itch Severity Scale: the PSEDA study].
        Actas Dermosifiliogr. 2011; 102: 527-536
        • Desai N.S.
        • Poindexter G.B.
        • Monthrope Y.M.
        • Bendeck S.E.
        • Swerlick R.A.
        • Chen S.C.
        A pilot quality-of-life instrument for pruritus.
        J Am Acad Dermatol. 2008; 59: 234-244
        • Elbers R.G.
        • Rietberg M.B.
        • van Wegen E.E.H.
        • Verhoef J.
        • Kramer S.F.
        • Terwee C.B.
        • et al.
        Self-report fatigue questionnaires in multiple sclerosis, Parkinson’s disease and stroke: a systematic review of measurement properties.
        Qual Life Res. 2012; 21: 925-944
        • Elman S.
        • Hynan L.S.
        • Gabriel V.
        • Mayo M.J.
        The 5-D itch scale: a new measure of pruritus.
        Br J Dermatol. 2010; 162: 587-593
        • Everett T.
        • Parker K.
        • Fish J.
        • Pehora C.
        • Budd D.
        • Kelly C.
        • et al.
        The construction and implementation of a novel postburn pruritus scale for infants and children aged five years or less: introducing the Toronto Pediatric Itch Scale.
        J Burn Care Res. 2015; 36: 44-49
        • Evers A.W.
        • Duller P.
        • van de Kerkhof P.C.
        • van der Valk P.G.
        • de Jong E.M.
        • Gerritsen M.J.
        • et al.
        The Impact of Chronic Skin Disease on Daily Life (ISDL): a generic and dermatology-specific health instrument.
        Br J Dermatol. 2008; 158: 101-108
        • Gernart M.
        • Tsianakas A.
        • Zeidler C.
        • Riepe C.
        • Osada N.
        • Pihan D.
        • et al.
        ItchApp©: an app-based eDiary for assessment of chronic pruritus in clinical trials.
        Acta Derm Venereol. 2017; 97: 601-606
        • Gottlieb A.
        • Feng J.
        • Harrison D.J.
        • Globe D.
        Validation and response to treatment of a pruritus self-assessment tool in patients with moderate to severe psoriasis.
        J Am Acad Dermatol. 2010; 63: 580-586
        • Haydek C.G.
        • Love E.
        • Mollanazar N.K.
        • Valdes Rodriguez R.
        • Lee H.
        • et al.
        Validation and Banding of the ItchyQuant: A Self-Report Itch Severity Scale.
        J Invest Dermatol. 2017; 137: 57-61
        • Hjermstad M.J.
        • Fayers P.M.
        • Haugen D.F.
        • Caraceni A.
        • Hanks G.W.
        • Loge J.H.
        • et al.
        Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review.
        J Pain Symptom Manage. 2011; 41: 1073-1093
        • Hsu M.C.
        • Chen H.W.
        • Hwu Y.J.
        • Chanc C.M.
        • Liu C.F.
        Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis.
        J Adv Nurs. 2009; 65: 2397-2408
        • Jang Y.H.
        • Kim S.M.
        • Eun D.H.
        • Park K.D.
        • Park G.-.H.
        • Kim B.-.S.
        • et al.
        Validity and reliability of itch assessment scales for chronic pruritus in adults: a prospective multicenter study.
        J Am Acad Dermatol. 2020; 82: 80-86
        • Jones O.
        • Schindler I.C.
        • Holle H.
        Assessing acute itch intensity: general labelled magnitude scale is more reliable than classic visual analogue scale.
        Acta Derm Venereol. 2017; 97: 375-376
        • Khan T.M.
        • Al-Haider I.
        • Syed Sulaiman S.A.
        • Hassali M.A.
        Linguistic validation of the 5D itching scale to Arabic in patients with end-stage kidney disease.
        J Ren Care. 2013; 39: 222-227
        • Kimball A.B.
        • Naegeli A.N.
        • Edson-Heredia E.
        • Lin C.Y.
        • Gaich C.
        • Nikaï E.
        • et al.
        Psychometric properties of the Itch Numeric Rating Scale in patients with moderate-to-severe plaque psoriasis.
        Br J Dermatol. 2016; 175: 157-162
        • Koch J.
        • Manworren R.
        • Clark L.
        • Quinn C.T.
        • Buchanan G.R.
        • Rogers Z.R.
        Pilot study of continuous co-infusion of morphine and naloxone in children with sickle cell pain crisis.
        Am J Hematol. 2008; 83: 728-731
        • Kopyciok M.E.R.
        • Ständer H.F.
        • Osada N.
        • Steinke S.
        • Ständer S.
        Prevalence and characteristics of pruritus: a one-week cross-sectional study in a German dermatology practice.
        Acta Derm Venereol. 2016; 96: 50-55
        • Krause K.
        • Kessler B.
        • Weller K.
        • Veidt J.
        • Chen S.C.
        • Martus P.
        • et al.
        German version of ItchyQoL: validation and initial clinical findings.
        Acta Derm Venereol. 2013; 93: 562-568
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gøtzsche P.C.
        • Ioannidis J.P.A.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Majeski C.J.
        • Johnson J.A.
        • Davison S.N.
        • Lauzon C.J.
        Itch Severity Scale: a self-report instrument for the measurement of pruritus severity.
        Br J Dermatol. 2007; 156: 667-673
        • Mathur V.S.
        • Lindberg J.
        • Germain M.
        • Block G.
        • Tumlin J.
        • Smith M.
        • et al.
        A longitudinal study of uremic pruritus in hemodialysis patients.
        Clin J Am Soc Nephrol. 2010; 5: 1410-1419
        • Mokkink L.B.
        • de Vet H.C.W.
        • Prinsen C.A.C.
        • Patrick D.L.
        • Alonso J.
        • Bouter L.M.
        • et al.
        COSMIN risk of bias checklist for systematic reviews of patient-reported outcome measures.
        Qual Life Res. 2018; 27: 1171-1179
        • Mokkink L.B.
        • Terwee C.B.
        • Patrick D.L.
        • Alonso J.
        • Stratford P.W.
        • Knol D.L.
        • et al.
        The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study.
        Qual Life Res. 2010; 19: 539-549
        • Morris V.
        • Murphy L.M.
        • Rosenberg M.
        • Rosenberg L.
        • Holzer 3rd, C.E.
        • Meyer 3rd, W.J.
        Itch assessment scale for the pediatric burn survivor.
        J Burn Care Res. 2012; 33: 419-424
        • Nochaiwong S.
        • Ruengorn C.
        • Awiphan R.
        • Panyathong S.
        • Noppakun K.
        • Chongruksut W.
        • et al.
        Development of a multidimensional assessment tool for uraemic pruritus: uraemic pruritus in dialysis patients (UP-Dial).
        Br J Dermatol. 2017; 176: 1516-1524
        • Pedersen C.B.
        • McHorney C.A.
        • Larsen L.S.
        • Lophaven K.W.
        • Moeller A.H.
        • Reaney M.
        Reliability and validity of the Psoriasis Itch Visual Analog Scale in psoriasis vulgaris.
        J Dermatolog Treat. 2017; 28: 213-220
        • Pereira M.P.
        • Ständer S.
        Assessment of severity and burden of pruritus.
        Allergol Int. 2017; 66: 3-7
        • Phan N.Q.
        • Blome C.
        • Fritz F.
        • Gerss J.
        • Reich A.
        • Ebata T.
        • et al.
        Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus.
        Acta Derm Venereol. 2012; 92: 502-507
        • Rehman I.U.
        • Khan T.M.
        Validity and reliability of the Urdu version of the 5D itching scale to assess pruritus among patients with chronic kidney disease in Pakistan.
        BMC Nephrol. 2017; 18: 302
        • Reich A.
        • Bożek A.
        • Janiszewska K.
        • Szepietowski J.C.
        12-Item pruritus severity scale: development and validation of new itch severity questionnaire.
        BioMed Res Int. 2017; 2017: 3896423
        • Reich A.
        • Heisig M.
        • Phan N.Q.
        • Taneda K.
        • Takamori K.
        • Takeuchi S.
        • et al.
        Visual analogue scale: evaluation of the instrument for the assessment of pruritus.
        Acta Derm Venereol. 2012; 92: 497-501
        • Schnitzler C.
        • Rosen J.
        • Szepietowski J.C.
        • Reich A.
        • Yosipovitch G.
        • Reszke R.
        • et al.
        Validation of ‘ItchApp©’ in Poland and in the USA: multicentre validation study of an electronical diary for the assessment of pruritus.
        J Eur Acad Dermatol Venereol. 2019; 33: 398-404
        • Schoch D.
        • Sommer R.
        • Augustin M.
        • Ständer S.
        • Blome C.
        Patient-reported outcome measures in pruritus: a systematic review of measurement properties.
        J Invest Dermatol. 2017; 137: 2069-2077
        • Simone D.A.
        • Ngeow J.Y.
        • Whitehouse J.
        • Becerra-Cabal L.
        • Putterman G.J.
        • LaMotte R.H.
        The magnitude and duration of itch produced by intracutaneous injections of histamine.
        Somatosens Res. 1987; 5: 81-92
        • Ständer S.
        • Augustin M.
        • Reich A.
        • Blome C.
        • Ebata T.
        • Phan N.Q.
        • et al.
        Pruritus assessment in clinical trials: consensus recommendations from the International Forum for the Study of Itch (IFSI) Special Interest Group Scoring Itch in Clinical Trials.
        Acta Derm Venereol. 2013; 93: 509-514
        • Ständer S.
        • Blome C.
        • Anastasiadou Z.
        • Zeidler C.
        • Jung K.A.
        • Tsianakas A.
        • et al.
        Dynamic pruritus score: evaluation of the validity and reliability of a new instrument to assess the course of pruritus.
        Acta Derm Venereol. 2017; 97: 230-234
        • Ständer S.
        • Luger T.
        • Cappelleri J.C.
        • Bushmakin A.G.
        • Mamolo C.
        • Zielinski M.A.
        • et al.
        Validation of the itch severity item as a measurement tool for pruritus in patients with psoriasis: results from a phase 3 tofacitinib program.
        Acta Derm Venereol. 2018; 98: 340-345
        • Stener-Victorin E.
        • Lundeberg T.
        • Kowalski J.
        • Opdal L.
        • Sjöström J.
        • Lundeberg L.
        Perceptual matching for assessment of itch; reliability and responsiveness analyzed by a rank-invariant statistical method.
        J Invest Dermatol. 2003; 121: 1301-1315
        • Storck M.
        • Zeidler C.
        • Rehr M.
        • Riepe C.
        • Dugas M.
        • Ständer S.
        • et al.
        Validation of pruritus measures gathered with the electronic patient-reported outcome system MoPat.
        Acta Derm Venereol. 2018; 98: 38-43
        • Szepietowski J.C.
        • Reich A.
        Pruritus in psoriasis: an update.
        Eur J Pain. 2016; 20: 41-46
        • Terwee C.B.
        • Bot S.D.M.
        • de Boer M.R.
        • van der Windt D.A.W.M.
        • Knol D.L.
        • Dekker J.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Van Loey N.E.
        • Hofland H.W.
        • Hendrickx H.
        • Van de Steenoven J.
        • Boekelaar A.
        • Nieuwenhuis M.K.
        Validation of the burns itch questionnaire.
        Burns. 2016; 42: 526-534
        • van Tulder M.
        • Furlan A.
        • Bombardier C.
        • Bouter L.
        • Editorial Board of the Cochrane Collaboration Back Review Group
        Updated method guidelines for systematic reviews in the cochrane collaboration back review group.
        Spine (Phila Pa 1976). 2003; 28: 1290-1299
        • Verweyen E.
        • Ständer S.
        • Kreitz K.
        • Höben I.
        • Osada N.
        • Gernart M.
        • et al.
        Validation of a comprehensive set of Pruritus Assessment Instruments: the chronic pruritus tools questionnaire PRURITOOLS.
        Acta Derm Venereol. 2019; 99: 657-663
        • Wahlgren C.F.
        Children's rating of itch: an experimental study.
        Pediatr Dermatol. 2005; 22: 97-101
        • Wahlgren C.F.
        • Hägermark O.
        • Bergström R.
        • Hedin B.
        Evaluation of a new method of assessing pruritus and antipruritic drugs.
        Skin Pharmacol. 1988; 1: 3-13
        • Welz-Kubiak K.
        • Reszke R.
        • Szepietowski J.C.
        Pruritus as a sign of systemic disease.
        Clin Dermatol. 2019; 37: 644-656
        • Yosipovitch G.
        • Reaney M.
        • Mastey V.
        • Eckert L.
        • Abbé A.
        • Nelson L.
        • et al.
        Peak pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis.
        Br J Dermatol. 2019; 181: 761-769
        • Yosipovitch G.
        • Zucker I.
        • Boner G.
        • Gafter U.
        • Shapira Y.
        • David M.
        A questionnaire for the assessment of pruritus: validation in uremic patients.
        Acta Derm Venereol. 2001; 81: 108-111
        • Zachariae R.
        • Lei U.
        • Haedersdal M.
        • Zachariae C.
        Itch severity and quality of life in patients with pruritus: preliminary validity of a Danish adaptation of the itch severity scale.
        Acta Derm Venereol. 2012; 92: 508-514
        • Zeidler C.
        • Steinke S.
        • Riepe C.
        • Bruland P.
        • Soto-Rey I.
        • Storck M.
        • et al.
        Cross-European validation of the ItchyQoL in pruritic dermatoses.
        J Eur Acad Dermatol Venereol. 2019; 33: 391-397

      Linked Article

      • Patient-Reported Outcome Measures in Pruritus: A Systematic Review of Measurement Properties
        Journal of Investigative DermatologyVol. 137Issue 10
        • Preview
          This review aims to systematically evaluate studies on the measurement properties of patient-reported outcome measures in pruritus, especially for use in clinical trials. Validation studies on instruments were identified based on a PubMed literature search. The consensus-based standards for the selection of health status measurement instruments checklist was used to evaluate the studies’ methodological quality, and the consensus-based standards for the selection of health status measurement instruments criteria were used to synthesize the instruments’ measurement properties.
        • Full-Text
        • PDF
        Open Archive