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Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation

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Abstract

Background

Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential.

Methods

The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development.

Results

The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain.

Conclusions

PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

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References

  1. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144

    Article  PubMed  Google Scholar 

  2. Brown BC, Mckenna SP, Siddhi K, Mcgrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J Plast Reconstr Aesthet Surg 61:1049–1058

    Article  CAS  PubMed  Google Scholar 

  3. Kinahan KE, Sharp LK, Seidel K, Leisenring W, Didwania A, Lacouture ME, Stovall M, Haryani A, Robison LL, Krull KR (2012) Scarring, disfigurement, and quality of life in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol 30:2466–2474

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sullivan T, Smith J, Kermode J, Mciver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabil 11:256–260

    Article  CAS  PubMed  Google Scholar 

  5. Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MW (1998) A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 102:1954–1961

    Article  CAS  PubMed  Google Scholar 

  6. Fda (2014) Clinical Outcome Assessment Qualification Program. Journal 2015

  7. US Food and Drug Administration (2009) Guidance for industry patient-reported outcome measures: use in medical product development to support labeling claims. http://www.fda.gov/downloads/Drugs/…/Guidances/Ucm193282.Pdf. Accessed 11 Aug 2014

  8. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, De Vet HC (2010) 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 19:539–549

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, De Vet, HC (2012) Cosmin checklist manual. http://www.Cosmin.Nl/Images/Upload/Files/Cosminchecklistmanualv9.Pdf. Jan 2012

  10. Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, Stein RE (2002) Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11:193–205

    Article  PubMed  Google Scholar 

  11. Klassen AF, Stotland MA, Skarsgard ED, Pusic AL (2008) Clinical research in pediatric plastic surgery and systematic review of quality-of-life questionnaires. Clin Plast Surg 35:251–267

    Article  PubMed  Google Scholar 

  12. Singh SJ, Sodergren SC, Hyland ME, Williams J, Morgan MD (2001) A comparison of three disease-specific and two generic health-status measures to evaluate the outcome of pulmonary rehabilitation in COPD. Respir Med 95:71–77

    Article  CAS  PubMed  Google Scholar 

  13. Draaijers LJ, Tempelman FR, Botman YA, Tuinebreijer WE, Middelkoop E, Kreis RW, Van Zuijlen PP (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–1965 discussion 1966–1967

    Article  PubMed  Google Scholar 

  14. Bock O, Schmid-Ott G, Malewski P, Mrowietz U (2006) Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res 297:433–438

    Article  PubMed  Google Scholar 

  15. Durani P, Mcgrouther DA, Ferguson MW (2009) The patient scar assessment questionnaire: a reliable and valid patient-reported outcomes measure for linear scars. Plast Reconstr Surg 123:1481–1489

    Article  CAS  PubMed  Google Scholar 

  16. Brown BC, Mckenna SP, Solomon M, Wilburn J, Mcgrouther DA, Bayat A (2010) The patient-reported impact of scars measure: development and validation. Plast Reconstr Surg 125:1439–1449

    Article  CAS  PubMed  Google Scholar 

  17. Van De Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, Van Der Horst CM, Van Zuijlen PP (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116:514–522

    Article  PubMed  Google Scholar 

  18. Nicholas RS, Falvey H, Lemonas P, Damodaran G, Ghanem AM, Selim F, Navsaria H, Myers S (2012) Patient-related keloid scar assessment and outcome measures. Plast Reconstr Surg 129:648–656

    Article  CAS  PubMed  Google Scholar 

  19. Van Der Wal MBA, Tuinebreijer WE, Bloemen MCT, Verhaegen P, Middelkoop E, Van Zuijlen PPM (2012) Rasch analysis of the Patient and Observer Scar Assessment Scale (POSAS) in burn scars. Qual Life Res 21:13–23

    Article  PubMed  Google Scholar 

  20. Van Der Wal MB, Tuinebreijer WE, Lundgren-Nilsson A, Middelkoop E, Van Zuijlen PP (2014) Differential item functioning in the observer scale of the POSAS for different scar types. Qual Life Res 23:2037–2045

    Article  PubMed  Google Scholar 

  21. Durani P, Mcgrouther DA, Ferguson MW (2009) Current scales for assessing human scarring: a review. J Plast Reconstr Aesthet Surg 62:713–720

    Article  PubMed  Google Scholar 

  22. Tyack Z, Simons M, Spinks A, Wasiak J (2012) A systematic review of the quality of burn scar rating scales for clinical and research use. Burns 38:6–18

    Article  PubMed  Google Scholar 

  23. Schmid-Ott G, Burchard R, Niederauer HH, Lamprecht F, Kunsebeck HW (2003) Stigmatization and quality of life of patients with psoriasis and atopic dermatitis. Hautarzt 54:852–857

    Article  CAS  PubMed  Google Scholar 

  24. Ginsburg IH, Link BG (1989) Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol 20:53–63

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY, USA

    Lily R. Mundy

  2. School of Medicine, University of Washington, 4333 Brooklyn Avenue Northeast, Seattle, WA, USA

    H. Catherine Miller

  3. Departments of Pediatrics and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada

    Anne F. Klassen

  4. Clinical Neurology Research Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Drake Circus, Plymouth, Devon, UK

    Stefan J. Cano

  5. Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Andrea L. Pusic

Authors
  1. Lily R. Mundy
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  2. H. Catherine Miller
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  3. Anne F. Klassen
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  4. Stefan J. Cano
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  5. Andrea L. Pusic
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Corresponding author

Correspondence to Andrea L. Pusic.

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Mundy, L.R., Miller, H.C., Klassen, A.F. et al. Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation. Aesth Plast Surg 40, 792–800 (2016). https://doi.org/10.1007/s00266-016-0642-9

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  • DOI: https://doi.org/10.1007/s00266-016-0642-9

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