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Development and validation of a vitiligo-specific quality-of-life instrument (VitiQoL)

Portions of this research have been presented at the American Academy of Dermatology 2011 Annual Meeting, New Orleans, LA, February 4-8, 2011, and published in J Am Acad Dermatol 2011;64:2(Suppl 1):AB142.
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Background

Vitiligo significantly affects a person’s health-related quality of life (HRQL). Although a small number of generic, and disease-specific, dermatologic HRQL measures exist, currently no vitiligo-specific instrument is available to capture disease-targeted concerns and issues.

Objective

We sought to develop and validate a vitiligo-specific self-report instrument for HRQL.

Methods

A pool of vitiligo-specific items was created based on in-depth interviews with patients with vitiligo (n = 16) and their responses to items in several previously validated HRQL measures. These items comprising our new instrument, VitiQoL, along with Skindex-16 and Dermatology Life Quality Index were administered to patients with vitiligo (n = 90) at two academic centers. This new instrument was validated using psychometric analysis.

Results

The VitiQoL items showed high internal consistency (Cronbach alpha = 0.935). Exploratory factor analysis demonstrated 3 factors: participation limitation, stigma, and behavior. Concurrent validity was evidenced by large correlations between self-reported severity and VitiQoL scores (r = 0.51). Known groups validity was demonstrated for the VitiQoL behavior subscale between individuals with exposed and unexposed patches (P = .01). Convergent validity was shown by strong correlations between VitiQoL and outside dermatology scales measuring similar constructs (Skindex-16, r = 0.82; Dermatology Life Quality Index, r = 0.83).

Limitations

Potential selection bias was a limitation as most patients were recruited from academic centers. Reliability of the instrument was tested only with internal consistency and not reproducibility. Responsiveness of the instrument was not tested because of the prolonged time course necessary to observe clinically significant change in vitiligo.

Conclusion

VitiQoL is a reliable and valid HRQL instrument.

Section snippets

Methods

Adult patients (n = 90) were recruited at two university dermatology clinics and from the general public. All protocols were approved and patient consent obtained in accordance with the institutional review board at both institutions.

Results

We recruited 90 patients (29 from New York, NY, and 61 from Chicago, IL) using advertisements, from a generated list of clinic patients who were given the diagnosis of vitiligo, and via direct recruitment in outpatient university-based dermatology clinic. At New York University, 7 participants were recruited through public advertisements while the rest were through outpatient clinics. At Northwestern University, the enterprise data warehouse search identified a total of 210 patients with

Discussion

This study represents the development and preliminary validation of a HRQL instrument specifically for patients with vitiligo. We ensured face and content validity by developing vitiligo-specific items from in-depth open-ended interviews with 16 patients, clinical input, and literature review. Exploratory factor analysis with oblique rotation revealed 3 factors: participation limitation, stigma, and behavior. We demonstrated reliability by high internal consistency. Concurrent validity was

Conclusion

As a significant step, a HRQL instrument (VitiQoL–an objective measure of disease status, burden of disease, and treatment outcome), specifically for patients with vitiligo, has been validated using vitiligo-specific items from in-depth open-ended patient interviews, clinical input, and literature review. There was strong correlation between self-reported severity and VitiQoL score (significant psychosocial impairment). Despite some limitations, a validated vitiligo-specific HRQL instrument is

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    Supported by the Ambi Skin of Color Society Research Award.

    The first two authors contributed equally to this article.

    Conflicts of interest: None declared.

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