Validation of the Alopecia Areata Patient Priority Outcomes (AAPPO) Questionnaire in Adults and Adolescents with Alopecia Areata

Abstract

Introduction: Individuals with alopecia areata (AA) may experience significant impacts on their health-related quality of life. The novel Alopecia Areata Patient Priority Outcomes (AAPPO) questionnaire has been developed to assess hair loss signs, emotional symptoms, and activity limitations associated with AA. The objective of this study was to evaluate psychometric properties and establish scoring of the AAPPO in adults and adolescents with AA. Methods: Scoring and measurement properties of the AAPPO were examined using baseline and 2-week follow-up data from a prospective, noninterventional, web-based study of 121 patients with AA (85 adults aged C 18 years, 36 adolescents aged 12-17 years) with Severity of Alopecia Tool (SALT) C 25% scalp hair loss. Results: Exploratory and confirmatory factor analysis supported four single Hair Loss (HL) items, an Emotional Symptoms domain (ES; 4 items), and an Activity Limitations domain (AL; 3 items). Among all patients, the multi-item ES and AL domains had strong internal consistency (a C 0.87); all HL items and domain scores had strong test-retest reliability (weighted kappa or intraclass correlation coefficients C 0.78). All HL item scores demonstrated strong construct validity (r C 0.52) compared with the patient-reported Alopecia Areata Symptom and Impact Scale (AASIS) hair loss subscale score; ES and AL domain scores exhibited strong construct validity (r C 0.66) compared with the SF-36 Mental Component Summary (MCS) score. Using SALT scores, HL mean item scores were better (lower) in the 25-49% SALT subgroup versus those with highest SALT scores (76-100%); however, ES mean domain scores were better in the SALT 76-100% subgroup in the same comparison (p \ 0.0001). Using AASIS and MCS score-created subgroups, ES and AL mean domain scores demonstrated hypothesized differences across subgroups (all p values \ 0.0001). Conclusion:The AAPPO questionnaire is a reliable, valid disease-specific measure of hair loss severity and impact in individuals with AA.

The Association of Alopecia Areata-Related Emotional Symptoms with Work Productivity and Daily Activity Among Patients with Alopecia Areata

“…The AAPPO is a psychometrically validated AA-specific assessment of HL severity, symptoms, and impact on patients with AA [ 17 , 18 ]. This study only reports on the AAPPO ES subscale that measures AA-related emotional symptoms because detailed data on HL were collected in the PRF and the PSC questionnaires, while activity impairment was covered in the WPAI.…”

“…However, this online patient-reported study neither used any validated instruments for work productivity loss (WPL) or activity impairment nor fully characterized the patients’ AA history [ 14 ], which may undermine the true impact of AA extent, especially AA-related ES, on work productivity. Hence, in this real-world data study, we sought to examine the extent of AA-related ES burden on work productivity and activity impairment among patients with AA using two validated instruments—the Work Productivity and Activity Impairment (WPAI) and the AA Patient Priority Outcomes emotional symptoms (AAPPO ES) subscale [ 15 – 18 ].…”

Quality of life in children and adolescents with alopecia areata—A systematic review

“…The case study comprised two male patients 26 . Only three studies reported mean age, 12.1, 14 and 15 years 21,27,28 . The case study described the patient's extent of AA clinically; one study rated AA severity as mild, moderate or severe 22,26 .…”

“…The case study described the patient's extent of AA clinically; one study rated AA severity as mild, moderate or severe 22,26 . The Alopecia Areata Patient Priority Outcomes (AAPPO) development and validation studies reported severity as ordinal Severity of Alopecia Tool (SALT) score categories 27,28 . Two studies measured the SALT Scores 29 but did not report them separately for the paediatric subgroup 24,25 (Table 2).…”

Using artificial intelligence to analyze publicly available social media posts to understand patient perspectives toward specific treatments of alopecia areata

“…The Brandwatch artificial intelligence-powered database identified posts related to AA treatments. Natural language processing provided a Patient Global Impression of Change (PGIC) score 4 following treatment for each post. Emolex identified underlying positive or negative emotion behind posts.…”