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Differences in Psychometric Properties of Clinician- and Patient-Reported Outcome Measures for Atopic Dermatitis by Race and Skin Tone: A Systematic Review

Published:August 02, 2021DOI:https://doi.org/10.1016/j.jid.2021.06.033
      The psychometric validity and reliability of widely used atopic dermatitis (AD) outcome measures across different races and ethnicities are unclear. We describe the rates of reporting race, ethnicity, and skin tone in studies testing the psychometric properties of AD outcome measures and compare the psychometric analyses across race, ethnicity, and skin tone. We systematically reviewed MEDLINE and EMBASE for studies reporting psychometric properties of clinician-reported or patient-reported outcome measures in AD (International Prospective Register of Systematic Reviews: CRD42021239614). Overall, 16,100 nonduplicate articles were screened; 165 met inclusion criteria. Race and/or ethnicity were reported in 55 (33.3%) studies; of those, race was assessed by self-report in 10 studies (6.1%) or was unspecified in 45 (27.3%). A total of 16 studies (9.7%) evaluated psychometric property differences by race, and only five (4.4%) of those did not recognize it as a limitation. Properties assessed across race, ethnicity, or skin tone were differential item functioning, convergent validity feasibility, inter-rater reliability, intrarater reliability, test‒retest reliability, and known-groups validity. Multiple instruments demonstrated performance differences across ethnoracial groups. This review highlights the paucity of race/ethnicity consideration for psychometric property testing in AD outcome measurement instruments. More AD outcomes instruments should be validated in diverse populations.

      Abbreviations:

      AD (atopic dermatitis), ClinROM (clinician-reported outcome measure), DIF (differential item functioning), DLQI (Dermatology Life Quality Index), EASI (Eczema Area and Severity Index), HOME (Harmonizing Outcome Measures for Eczema), ICC (intraclass correlation coefficient), IGA (Investigator Global Assessment), NRS (Numerical Rating Scale), oSCORAD (objective SCORing Atopic Dermatitis), POEM (Patient-Oriented Eczema Measure), PO-SCORAD (Patient-Oriented SCORing Atopic Dermatitis), PROM (patient-reported outcome measure), PROMIS-SD (Patient-reported Outcome Measures Information System Sleep Disorder), PROMIS-SRI (Patient-reported Outcome Measures Information System Sleep-Related Impairment), PIQ-MS (Patient-reported Outcome Measures Information System Itch Questionnaire Mood and Sleep), SASSAD (Six-Area, Six Sign Atopic Dermatitis), SOC (skin of color), TIS (Three Item Severity)
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