Validation and Clinical Results of the FLQA-d, a Quality of Life Questionnaire for Patients with Chronic Skin Disease

Abstract

Background: Quality of Life (QoL) has become an important outcome parameter in dermatology. Although various dermatology- specific questionnaires have been developed in the last years, many methodological questions on how to evaluate QoL in skin diseases are still unanswered. We previously published the concept of a modular QoL instrument called Freiburg Life Quality Assessment (FLQA) with variants for the use in chronic venous insufficiency, leg ulcer and allergies. Objective: To develop, validate and test a new FLQA variant for the use in chronic skin diseases that includes disease-specific as well as generic components. Methods: An open survey was performed, asking 46 patients with atopic dermatitis, psoriasis and urticaria about the most important psychosocial and physical implications of their disease. The resulting list of answers was further reduced by an expert panel and combined with generic QoL items derived from previously validated variants of the FLQA. The resulting questionnaire (FLQA-d) includes 53 items referring to 6 dimensions of QoL. This questionnaire was validated on 747 patients with chronic skin diseases at admission to hospital. Results: Clinically, patients with atopic dermatitis showed significantly greater reductions of QoL than patients with psoriasis, urticaria and other dermatoses. Regarding the FLQA-d validation, satisfactory results were found with respect to internal consistency, distribution characteristics, test-retest reliability, responsiveness, convergent (construct) validity and discriminant validity. The number of missing data was low. Conclusion: The FLQA-d is a valid and easy-to-use instrument for the evaluation of QoL in chronic dermatoses.

German Adaptation of the Skindex-29 Questionnaire on Quality of Life in Dermatology: Validation and Clinical Results

“…The questionnaire package included sociodemographic items, the German version of the Skindex-29 and 2 validated German skin disease-specific questionnaires: the Freiburger Life Quality Assessment for Dermatoses (FLQA-d) [21]and the Marburger Skin Questionnaire (MHF) [22]. In addition, sample II completed the internationally established Dermatology Life Quality Index (DLQI) [23].…”

“…In dermatology, studies have shown that HRQOL can be severely reduced in patients with a great variety of different skin diseases such as atopic dermatitis and psoriasis [3], acne vulgaris [4, 5], urticaria [6], skin tumours [7], port wine stains [8], onychomycosis [9]or chronic venous insufficiency and leg ulcers [10, 11, 12, 13]. Domains of everyday life that may be affected by skin diseases include aspects of physical and emotional well-being, the patients’ social life as well as their level of functioning at work or school.…”

Cost of Moderate to Severe Plaque Psoriasis in Germany: A Multicenter Cost-of-Illness Study

“…Psoriasis is a skin disease which has substantial socioeconomic bearing for several reasons: (1) it is a highly prevalent disease, affecting about 2–3% of adults in Western populations [1,2,3,4,5,6]; (2) it is a chronic disease which is associated with permanent or frequently recurring, highly visible and symptomatic skin lesions [7, 8]; (3) it leads to significant burden of disease and a reduction in quality of life (QoL) in patients from all countries [9,10,11,12]; (4) many patients with psoriasis are of working age, this results in work day loss, and therefore increased indirect costs (productivity losses). …”

How do regional factors influence psoriasis patient care in Germany?

“…The same is true for Bavaria where 18 % of patients had PASI > 20 and 41.8 % had DLQI > 10. These figures suggest a severely limited quality of life [23], as found in international studies in patients with severe forms of disease [10,16,[24][25][26][27]. The sometimes low concordance between the clinical severity of disease (PASI) and quality of life (DLQI) could be due to regional variation in patient numbers and a certain selection bias.…”