Little is known about the measurement properties of numeric rating scales (NRS) for pain in AD. We evaluated a novel NRS for skin-pain and existing NRS for average overall-pain in adults with AD. Self-administered questionnaires and skin-examination were performed in 463 AD patients (age 18–97 years) in a dermatology practice setting. Numeric rating scales skin-pain and average overall-pain had moderate correlations with each other, and multiple clinician-reported and patient-reported AD severity outcomes (Spearman correlations, P < 0.0001). There were significant and stepwise increases of NRS skin-pain and average overall-pain scores with patient-reported global severity (Wilcoxon rank-sum test, P < 0.0001). Floor-effects were observed for NRS skin-pain and average overall-pain. Changes from baseline in NRS skin-pain and average overall-pain showed weak–moderate correlations with changes of POEM, vIGA-AD*BSA, SCORAD, and DLQI. Using an anchoring approach, the optimal interpretability band for NRS skin-pain was clear = 0, mild = 1–3, moderate = 5–6, severe = 7–9, and very severe = 10 (weighted kappa = 0.4923). The thresholds for minimally clinically important difference for NRS skin-pain ranged from 2.2 to 2.9. NRS skin-pain and average overall-pain showed moderate–good reliability. Numeric rating scales skin-pain and average overall-pain had sufficient validity, reliability, responsiveness, and interpretability in adults with AD, and were inherently feasible as single-items for use in clinical trials and practice.
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Body surface area
Clinician-reported outcome measures
Patient-Oriented Eczema Measure
Numeric Rating Scale
Dermatology Life Quality Index
SCORing Atopic Dermatitis
Eczema Area and Severity Index
Patient-reported outcome measures
Quality of life
Validated Investigator’s Global Assessment
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This publication was made possible with support from the Agency for Healthcare Research and Quality (AHRQ), Grant Number K12 HS023011, the Dermatology Foundation.
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Silverberg, J.I. Validity and reliability of a novel numeric rating scale to measure skin-pain in adults with atopic dermatitis. Arch Dermatol Res 313, 855–861 (2021). https://doi.org/10.1007/s00403-021-02185-3