Validation of ‘ItchApp©’ in Poland and in the USA: multicentre validation study of an electronical diary for the assessment of pruritus

Usability evaluation and reporting for mobile health apps targeting patients with skin diseases: a systematic review

BACKGROUND

Usability is an important method for evaluating mobile health apps from a user perspective. Yet many publicly available apps lack adequate attention to their design, development and evaluation.

OBJECTIVES

To assess usability evaluation and reporting for mobile health apps targeting patients with skin diseases.

METHODS

The protocol was registered with PROSPERO (CRD42022347184). A search strategy combined terms for usability evaluation, user experience, skin disease and mobile health apps (search date 2012-2023). Six databases (Embase, MEDLINE, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus) were searched, identifying 18 052 results. Nine studies (comprising nine apps) were included in the final analysis.

RESULTS

Skin conditions and issues targeted included skin cancer (n = 3); sun protection (n = 3); chronic pruritus (n = 2); cutaneous leishmaniasis (n = 1); spina bifida (n = 1); and a study of acne, psoriasis, rosacea, laser treatments, actinic damage, monitoring benign moles, alopecia and inflammatory rash. All studies assessed app usability and feasibility, with the majority concluding that the apps were deemed useful and easy to use. Qualitative methods, such as usability questionnaires and semistructured interviews, were predominantly employed. Common emerging themes included ease of use and navigation, comprehensibility, security and privacy concerns, data sharing issues, customizability, costs, and the ability to track progress or self-monitor.

CONCLUSIONS

While smartphone apps for skin disorders show promising usability across diverse diseases, the limited literature compared with the rapid development of apps highlights the need for meticulous user-centred design and rigorous evaluation. The study emphasizes the importance of evaluating and reporting usability findings to optimize the long-term adoption of mobile health apps, particularly those targeting skin diseases.

Psychometric evaluation of the Worst Pruritus Numerical Rating Scale (NRS), Atopic Dermatitis Symptom Scale (ADerm-SS), and Atopic Dermatitis Impact Scale (ADerm-IS)

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus, skin pain, and sleep impacts, which are only reportable by patients themselves. The goal of this research is to evaluate the reliability, validity, and interpretability of the scores from three patient-reported outcome measures within the context of a clinical trial for adolescents and adults with moderate to severe AD.

METHODS

Data from a Phase 3 randomized, double-blind, placebo-controlled, multinational clinical trial for individuals 12-75 years of age with moderate to severe AD (AD Up [ClinicalTrials.gov NCT03568318]) were used to assess the reliability, validity, and interpretability of scores on the Worst Pruritus Numerical Rating Scale (NRS) and the Atopic Dermatitis Symptom and Impact Scales (ADerm-SS and ADerm-IS). Analyses were conducted separately for the adult and adolescent subgroups.

RESULTS

Of the 882 participants included in the psychometric analyses, the majority were adults (n = 769, 87.2%), male (n = 536, 60.8%), and white (n = 630, 71.4%). Multi-item scores from the ADerm-SS and ADerm-IS had good internal consistency reliability, and most scores demonstrated acceptable test-retest reliability. Scores from the three questionnaires demonstrated adequate validity, exhibiting correlations with other conceptually related outcome assessments and score differences between clinically distinct subgroups. Finally, the score interpretation analyses provide estimates for meaningful within-person change and between-groups difference thresholds that may be useful for future research in adults and adolescents with moderate to severe AD.

CONCLUSIONS

These results provide evidence that the scores produced by the Worst Pruritus NRS, ADerm-SS, and ADerm-IS are reliable and construct-valid when completed by adults and adolescents with moderate to severe AD in a clinical trial setting. The results presented here expand upon the previous qualitative evidence of these tools and provide further support for their use in future clinical studies. While results are specific to clinical trials, next steps would be to evaluate the use of these questionnaires in clinical practice. This can provide clinicians and dermatologists a window into the patient's disease experience outside of the clinic, aid in shared decision making, and support a patient-centric approach to management of moderate to severe AD.

Measurement properties of patient-reported outcome measures for pruritus: An updated systematic review

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 by Schoch et al. in 2017 and to identify new validation studies published between October 2015 and July 2019. The methodological quality of validation studies was assessed based on 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. Nineteen new studies were included and added to the 22 studies identified in the previously published review. Evidence from all 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 quality of life. COSMIN rating revealed mixed results with deficiencies in methodological quality of many studies across all constructs. The most appropriate pruritus severity measure was the "Itch Severity Scale". "Itchy Quality of Life" and the disease-specific "Uremic Pruritus in Dialysis Scale" achieved most promising results considering the construct pruritus-specific health-related quality of life. For pruritus intensity, nine measures performed similarly well.

Use of Mobile Applications in Dermatology

Smartphones and applications related to the same are ubiquitous now. As dermatologists, we have a wide array of smartphone apps at our disposal which we can use to improve our practice in all aspects—clinical, academic, research, and administrative. This article provides an overview of available apps, tips on using apps—both general and specific for dermatology, as well as discusses the scientific validity of some of these apps and the future of smartphone apps in the context of dermatology.