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Comparing the measurement properties, informativity and responsiveness of the DLQI, DLQI-Relevant (DLQI-R), and Skindex-29 in patients with chronic skin disease: a prospective cohort study
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DOI：10.1007/s11136-026-04286-w.png)
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Abstract
En 中文
Patient-reported outcome measures (PROMs) are important tools for assessing the impact of skin diseases on health-related quality of life (HRQoL). However, comparative data on the measurement properties of commonly used instruments are limited. The objective of this study was to compare the measurement properties of the Dermatology Life Quality Index (DLQI), DLQI-Relevant (DLQI-R), and Skindex-29 in a cohort of patients with chronic skin disease. Participants completed the DLQI, Skindex-29, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures at baseline and 3 months. Structural validity was assessed with confirmatory factor analysis; internal consistency with Cronbach’s alpha; construct validity via known-groups comparisons and PROMIS correlations; informativity with Shannon’s index; and responsiveness with standardized response means, Cohen’s d, and change score correlations. Of 549 participants (mean age 37.8 years; 52.3% female), 406 (74.0%) completed follow-up. All instruments demonstrated high internal consistency (α ≥ 0.85) and no floor or ceiling effects. Skindex-29 domains demonstrated stronger structural validity and informativity compared to DLQI and DLQI-R. Construct validity was supported by expected associations with patient global assessment (PtGA) and PROMIS correlations. The DLQI, DLQI-R, and Skindex Symptoms and Emotions showed moderate responsiveness. The DLQI, DLRI-R and Skindex-29 demonstrated strong measurement properties in a heterogeneous cohort of individuals with chronic skin disease. Skindex-29 showed stronger structural validity and informativity, while the DLQI and DLQI-R demonstrated slightly greater responsiveness. Selection of PROM should depend on the intended clinical or research purpose. Chronic skin conditions, such as acne, eczema, psoriasis, and hidradenitis suppurativa, can affect many areas of daily life, including symptoms, emotional wellbeing, and social interactions. Physicians and researchers often use questionnaires, called patient-reported outcome measures, to better understand this impact from the patient’s perspective. Two of the most widely used in dermatology are the Dermatology Life Quality Index (DLQI), and the Skindex-29. A newer scoring approach to the DLQI, known as the DLQI-Relevant (DLQI-R), was developed to improve accuracy by adjusting how responses are scored when patients indicate that certain questions do not apply to them. In this study, we wanted to understand which of these questionnaires works best in people living with chronic skin conditions. We surveyed over 500 adults in the United States who reported having one or more skin condition. The participants completed the DLQI and the Skindex-29 at the start of the study, and again 3 months later. We found that the Skindex-29 provided a broader and more detailed picture of how skin conditions affect health-related quality of life. The DLQI and DLQI-R, on the other hand, were slightly better at detecting changes in health-related quality of life over time, although the differences between the questionnaires were small. These results show that no single instrument is best for all situations. The choice of questionnaire should depend on the purpose—whether the goal is to capture the full burden of disease, or to measure how much a patient improves with treatment.
Keywords:
Patient reported outcomes
Measurement properties
Dermatology life quality index
DLQI
DLQI-R
Skindex-29
Structural validity
Responsiveness
Informativity
Psychometric properties