What are the best outcome measurements for atopic eczema? A systematic review

BACKGROUND: Valid and reliable outcome measurements are a prerequisite for evidence-based practice. The comparative validity and reliability of outcome measurements for assessing atopic eczema (AE) severity is unclear. OBJECTIVE: We sought to assess the validity, reliability, sensitivity to change, and ease of use of outcome measurements for AE. We also sought to give recommendations on which outcomes to use in clinical research and for clinical monitoring. METHODS: We performed a systematic review and survey of clinical experts and patients. RESULTS: Twenty published outcome measurements were identified. There is evidence of adequate construct validity for 3 measurements (Severity Scoring of Atopic Dermatitis index [SCORAD], Eczema Area and Severity Index [EASI], and Three Item Severity Score), adequate internal consistency of 1 scale (Patient-oriented Eczema Measure [POEM]), adequate interobserver reliability of 5 measurements (Basic Clinical Scoring System; Nottingham Eczema Severity Score; Objective Severity Assessment of Atopic Dermatitis; Six Area, Six Sign Atopic Dermatitis severity score; and SCORAD), adequate test-retest reliability of 1 scale (POEM), and adequate sensitivity to change of 3 measurements (EASI, SCORAD, and Investigators' Global Atopic Dermatitis Assessment). Most outcome measurements have adequate content validity, as assessed by patients and experts. Data on the time to perform the assessment was identified for 8 outcome measurements. Only SCORAD, EASI, and POEM have been tested sufficiently and performed adequately. CONCLUSION: There are too many published outcome measures for AE. Most have not been tested properly or perform adequately when tested, and their continued use hampers scientific communication. CLINICAL IMPLICATIONS: Only SCORAD, EASI, and POEM currently perform adequately. These scales should be used in future studies.


The objectives of this systematic review are to (1) update the previous review on named measurements of objective disease severity of AE and (2) extend the previous review by summarizing which of these measurements have acceptable validity, reliability, sensitivity to change, and ease of use to recommend them for clinical studies and for clinical monitoring.


Schmitt, J. Langan, S. Williams, H. C.


Journal: J Allergy Clin Immunol
Volume: 120
Issue: 6
Pages: 1389 - 98
Year: 2007
DOI: 10.1016/j.jaci.2007.08.011

Further Study Information

Current Stage: Not Applicable
Funding source(s): None stated

Health Area

Disease Category: Skin

Disease Name: Eczema

Target Population

Age Range: Unknown

Sex: Either

Nature of Intervention: Not specified

Stakeholders Involved

- Consumers (patients)
- Clinical experts

Study Type

- Systematic review of outcomes measured in trials
- Prioritising
- COS for clinical trials or clinical research
- COS for practice


- Systematic review
- Survey

Systematic review of named outcome measurements specifically designed for atopic eczema to measure disease severity.

Survey of clinical experts - dermatology experts (n=6) and patients (n=12): rated content validity of all domains and items included in the named outcome measurements on a 5 point Likert scale ranging from very important to unimportant.
A median rating of ‘‘important’’ or ‘‘very important’’ was required to rate a domain or item as adequate. More than 50% of the items used a particular outcome measurement to describe a domain needed to be rated as ‘‘important’’ or ‘‘very important’’ to conclude that the domain was measured adequately.

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