Background
Objectives
Materials and methods
Protocol and registration
Literature search
Eligible studies
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | Patients with hyperhidrosis | All other |
Study design | PROM development study, validation study | All other study designs |
Outcome | All patient-reported outcomes | Non-patient-reported outcomes, such as biomarkers or physiology of the skin |
Type of measurement instrument | Patient-reported outcome measures | All others |
Publication type | Articles with available full-text | Abstracts |
Study selection
Data extraction
Assessment of measurement properties and adequacy of the PROMs
Box 1 | PROM development | Content validity |
Box 2 | Content validity | |
Box 3 | Structural validity | Internal structure |
Box 4 | Internal consistency | |
Box 5 | Cross-cultural validity\measurement invariance | |
Box 6 | Reliability | Remaining measurement properties |
Box 7 | Measurement error | |
Box 8 | Criterion validity | |
Box 9 | Hypotheses testing for construct validity | |
Box 10 | Responsiveness |
Quality of evidence | Lower if |
---|---|
High (We are very confident that the true measurement property lies close to that of the estimate of the measurement property) | Risk of bias: 1. Serious 2. Very serious 3. Extremely serious |
Moderate (We are moderately confident that the true measurement property is likely to be close to the estimate of the measurement property, but there is a possibility that it is substantially different) | Inconsistency: 1. Serious 2. Very serious |
Low (Our confidence in the measurement property estimate is limited: the true measurement property may be substantially different form the estimate of the measurement property) | Imprecision: 1. total n = 50–100 2. total n < 50 |
Very Low (We have very little confidence in the measurement property estimate: the true measurement property is likely to be substantially different from the estimate of the measurement property | Indirectness: 1. Serious 2. Very serious |
Generating recommendations for the use of PROMs in patients with hyperhidrosis
Results
Data extraction
Evaluation of content validity
ASDD/ASDD-C | HDSM-Ax | HidroQoL | HQ | HQLQ | SCI | |
---|---|---|---|---|---|---|
Box 1. PROM development | Doubtful | Doubtful | Doubtful | Inadequate | Inadequate | Inadequate |
Box 2. Content validity | – | Doubtful | Doubtful | Doubtful | – | – |
Relevance | Comprehensiveness | Comprehensibility | Content validity rating | ||
---|---|---|---|---|---|
ASDD/ASDD-C | Overall rating | + | − | + | Inconsistent ( ±) |
Quality of evidence | No grading if overall rating is inconsistent | ||||
DLQI | Overall rating | ± | – | ± | Insufficient ( −) |
Quality of evidence | Very low (due to risk of bias) | ||||
HDSM-Ax | Overall rating | ± | + | + | Sufficient ( +) |
Quality of evidence | Low (due to risk of bias and inconsistency) | ||||
HDSS | Overall rating | ± | – | – | Insufficient ( −) |
Quality of evidence | Very low (due to risk of bias and inconsistency) | ||||
HHIQ | Overall rating | + | + | ± | Sufficient ( +) |
Quality of evidence | Very low (due to risk of bias and inconsistency) | ||||
HidroQoL | Overall rating | + | + | + | Sufficient ( +) |
Quality of evidence | Moderate (due to risk of bias) | ||||
HQ | Overall rating | ± | + | + | Sufficient ( +) |
Quality of evidence | Very low (due to risk of bias and inconsistency) | ||||
HQLQ | Overall rating | + | + | + | Sufficient ( +) |
Quality of evidence | Very low (due to risk of bias) | ||||
HS | Overall rating | ± | – | + | Inconsistent ( ±) |
Quality of evidence | No grading if overall rating is inconsistent | ||||
IIRS | Overall rating | ± | ± | ± | Inconsistent ( ±) |
Quality of evidence | No grading if overall rating is indeterminate | ||||
SCI | Overall rating | + | + | + | Sufficient ( +) |
Quality of evidence | Very low (due to risk of bias) | ||||
SES | Overall rating | ? | + | ? | Indeterminate (?) |
Quality of evidence | No grading if overall rating is indeterminate | ||||
SF-36 | Overall rating | ± | − | + | Inconsistent ( ±) |
Quality of evidence | No grading if overall rating is inconsistent |
Evaluation of the remaining measurement properties (structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity and responsiveness)
PROMs | ASDD/ ASDD-C a | DLQI b,c,d,e,f | HDSM-Axg,h | HDSSd,i,j | HHIQk | HidroQoLl,m,n,o | HQp | HQLQq,r,s | HSr,t | IIRSu | SCIv | SESw | SF-36d,n |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Structural validity | Inadequate | Very good | Inadequate | Adequate | |||||||||
Inadequate | Adequate | Very good | |||||||||||
Very good | Very good | ||||||||||||
Internal consistency | Very good | Very good | Very good | Doubtful | Very good | Very good | |||||||
Very good | Very good | ||||||||||||
Very good | |||||||||||||
Reliability | Doubtful | Doubtful | Doubtful | Adequate | Doubtful | ||||||||
Doubtful | Doubtful | Adequate | |||||||||||
Doubtful | Adequate | ||||||||||||
Criterion validity | Very good | Very good | Very good | ||||||||||
Very good | |||||||||||||
Hypotheses testing for construct validity | Very good | Very good | Adequate | Doubtful | Very good | Adequate | Adequate | Inadequate | Very good | Adequate | Doubtful | ||
Adequate | Doubtful | Very good | Doubtful | Very good | Very good | Inadequate | Doubtful | Adequate | Adequate | Very good | |||
Very good | Inadequate | Inadequate | Doubtful | Adequate | Adequate | very good | |||||||
Adequate | Adequate | Adequate | Inadequate | Adequate | Inadequate | ||||||||
Inadequate | Inadequate | Adequate | |||||||||||
Inadequate | Inadequate | ||||||||||||
Inadequate | Very good | ||||||||||||
Inadequate | Inadequate | ||||||||||||
Doubtful | Adequate | ||||||||||||
Doubtful | |||||||||||||
Doubtful | |||||||||||||
Responsiveness | Very good | Very good | Very good | Very good | Very good | Very good | Very good | Very good | Doubtful | Doubtful | |||
Adequate | Very good | Adequate | Very good | Doubtful | Very good | ||||||||
Very good | Very good | Adequate | Adequate | ||||||||||
Adequate | Very good | Very good | |||||||||||
Inadequate | Very good | Very good | |||||||||||
Inadequate | Inadequate | ||||||||||||
Inadequate | |||||||||||||
Inadequate | |||||||||||||
Doubtful |
Characteristics of the included PROMs and study populations
Information on interpretability and feasibility
Summary of findings (SoF) tables and recommendation
PROMs | Summary or pooled result | Overall rating | Quality of evidence |
---|---|---|---|
Structural validity | |||
HDSM-Ax | No monotonicity, local dependence, degrees of model misfit | Insufficient | High |
HidroQoL | Draft 21-item HidroQoL: CFI = 0.98, TLI = 0.977, RMSEA = 0.077 Final 18-item HidroQoL: CFI = 0.815, RMSEA = 0.084, SRMR = 0.074 | Sufficient | High |
HQ | Model fit not reported | Indeterminate | – |
SCI | CFI = 0.97, TLI = 0.96, SRMR = 0.03, RMSEA = 0.077 | Sufficient | Moderate (due to indirectness) |
Internal consistency | |||
HDSM-Ax | Criteria for “at least low evidence for sufficient structural validity” not met | Indeterminate | – |
HidroQoL | Total scale: 0.89–0.90, domain 1: 0.76–0.81, domain 2: 0.86–0.87, n = 764 | Sufficient | High |
HQ | 0.71–0.95, n = 85 | Sufficient | Moderate (due to imprecision) |
HQLQ | 0.84, n = 34–48 | Sufficient | Very low (due to risk of bias and imprecision) |
IIRS | 0.80, n = 80 | Sufficient | Moderate (due to imprecision) |
SCI | 0.91–0.92, n = 708 | Sufficient | Moderate (due to indirectness) |
Reliability | |||
ASDD | Item 2: 0.91–0.94, item 3: 0.89–0.90, item 4: 0.88–0.89, n = 770 | Sufficient | Moderate (due to risk of bias) |
ASDD-C | Item 2: 0.92, n = 32 | Sufficient | Very low (due to risk of bias and imprecision) |
HDSM-Ax | 0.543, n = 227 | Insufficient | Low (due to risk of bias) |
HDSS | 0.65–0.84, n = 92 | Inconsistent | – |
HidroQoL | Without intervention (subgroup) total scale: 0.93, domain 1: 0.88–0.89, domain 2: 0.91–0.92 | Sufficient | High |
with intervention (subgroup) total scale: 0.61, domain 1: 0.53, domain 2: 0.66 | Insufficient | Moderate (due to risk of bias) | |
IIRS | 0.89, n = 68 | Sufficient | Very low (due to imprecision) |
Criterion validity | |||
HS (#1, #2) | AUC not reported | Indeterminate | – |
SCI | 0.80, n = 708 | Sufficient | High |
SES | 0.93, n = 34 | Sufficient | Low (due to imprecision) |
Hypotheses testing for construct validity | |||
ASDD | Item 2: 7 out of 8 hypotheses confirmed, n = 770 Item 3: 6 out of 8 hypotheses confirmed, n = 802 Item 4: 6 out of 8 hypotheses confirmed, n = 802 | Sufficient (inadequate studies ignored) | High |
ASDD-C | Item 2: 2 out of 4 hypotheses confirmed, n = 32 | Inconsistent (inadequate studies ignored) | – |
DLQI | 3 out of 4 hypotheses confirmed, n = 171 | Sufficient (inadequate study ignored) | High |
HDSM-Ax | 4 out of 5 hypotheses confirmed, n = 261 | Sufficient (inconsistency could be explained) | High |
HDSS | 1 out of 1 hypothesis confirmed, n = 369 | Sufficient (inadequate study ignored) | Moderate (due to risk of bias) |
HidroQoL | 12 out of 14 hypotheses confirmed, n = 329–333 | Sufficient (inconsistency could be explained) | High |
HQLQ | 1 out of 3 hypotheses confirmed, n = 144–160 | Insufficient (based on majority of the results) | Moderate (due to inconsistency) |
HS | 1 out of 1 hypothesis confirmed, n = 132–146 | Sufficient (inadequate study ignored) | high |
IIRS | 1 out of 1 hypothesis confirmed, n = 80 | Sufficient (inadequate study ignored) | Very low (due to risk of bias and imprecision) |
SCI | 3 out of 8 hypotheses confirmed, n = 708 | Inconsistent | – |
SES | 2 out of 2 hypotheses confirmed, n = 34 | Sufficient | Low (due to imprecision) |
SF-36 | 1 out of 3 hypotheses confirmed, n = 184 | Insufficient (based on the high-quality study) | Moderate (due to inconsistency) |
Responsiveness | |||
ASDD | Item 2: 3 out of 4 hypotheses confirmed, n = 802 | Sufficient (inadequate studies ignored) | High |
Item 3: 1 out of 3 hypotheses confirmed, n = 802 Item 4: 1 out of 3 hypotheses confirmed, n = 802 | Inconsistent (inadequate studies ignored) | – | |
ASDD-C | Item 2: 3 out of 3 hypotheses confirmed, n = 32 | Sufficient (inadequate studies ignored) | Very low (due to risk of bias and imprecision) |
DLQI | 5 out of 5 hypotheses confirmed, n = 167 | Sufficient | High |
HDSM-Ax | 1 out of 1 hypothesis confirmed, n = 201 | Sufficient | High |
HDSS | 3 out of 3 hypotheses confirmed, n = 307 | Sufficient | High |
HHIQ | 1 out of 1 hypothesis confirmed, n = 106 | Sufficient | High |
HidroQoL | 6 out of 7 hypotheses confirmed, n = 433–444 | Sufficient (inconsistency could be explained) | High |
HQLQ | 1 out of 1 hypothesis confirmed, n = 509 | Sufficient | High |
HS | 1 out of 1 hypothesis confirmed, n = 106 | Sufficient | High |
IIRS | 1 out of 1 hypothesis confirmed, n = 4 | Sufficient | Very low (due to risk of bias and imprecision) |
SF-36 | 0 out of 2 hypotheses confirmed, n = 120 | Insufficient | High |
PROM | Category A | Category C | ||
---|---|---|---|---|
Sufficient content validity (any level) | At least low-quality evidence for sufficient internal consistency | High quality evidence for an insufficient measurement property | Recommen-dation | |
ASDD/ASDD-C | ✗ | ✗ | ✗ | B |
DLQI | ✗ | ✗ | ✗ | B |
HDSM-Ax | ✓ | ✗ | ✓ | C |
HDSS | ✗ | ✗ | ✗ | B |
HHIQ | ✓ | ✗ | ✗ | B |
HidroQoL | ✓ | ✓ | ✗ | A |
HQ | ✓ | ✓ | ✗ | A |
HQLQ | ✓ | ✗ | ✗ | B |
HS | ✗ | ✗ | ✗ | B |
IIRS | ✗ | ✓ | ✗ | B |
SCI | ✓ | ✓ | ✗ | A |
SES | ✗ | ✗ | ✗ | B |
SF-36 | ✗ | ✗ | ✓ | C |