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Development and Validation of Nail Psoriasis Quality of Life Scale (NPQ10)
Development and Validation of Nail Psoriasis Quality of Life Scale (NPQ10)
DOI: 10.1111/j.1468-3083.2009.03344.x
ORIGINAL ARTICLE
APLCP, France
Abstract
Background The chronic and treatment-resistant nature of nail psoriasis affects patients lives not only physically but
also psychologically. Although there are scoring systems available for disease severity, there is as yet no scale to evaluate
the impact of this condition upon the patients quality of life.
Objectives This study aims to develop and validate a quality of life scale specifically for nail psoriasis.
Methods A questionnaire was developed during a study conducted in France between 2004 and 2005. With the
cooperation of lAssociation Pour la Lutte Contre le Psoriasis, the questionnaire was sent to a random sample of 4000
of its 17 000 members.
Results The response rate was 33%. Of the 1309 questionnaires returned, 795 showed the presence of nail psoriasis
and these were eligible. The scale score is obtained by adding together the responses to the 10 questionnaire items and
the result is expressed as a percentage. The value of the score obtained is proportional to the functional difficulty
experienced. The determination of Cronbachs a coefficient and a Principal Component Factor Analysis show,
respectively, very good internal consistency and the unidimensional nature of the scale. Testretest results on 15 patients
showed good reproducibility. Results were validated with reference to the Dermatology Life Quality Index.
In this study, the NPQ10 score is significantly influenced by gender (women have a higher score) and by the duration
of psoriasis (recent onset implies greater functional difficulty). Finally, the score is much higher when the nail psoriasis
affects both the hands and the feet.
Conclusion This study confirms a change in the quality of life of patients who have nail psoriasis. The NPQ10 scale,
specific to this condition, is simple to use and has the attributes needed in a quality of life scale. The scale must now be
tested in longitudinal studies (such as clinical trials) to confirm its ability to measure a change in status.
Received: 16 April 2009; Accepted 6 May 2009
Keywords
nails, psoriasis, quality of life, questionnaires, severity of illness
Conflicts of interest
None declared.
Introduction
Psoriasis is a common dermatosis (affecting 1.5% to 3.0% of the
population in Europe) which features nail involvement in 10%
to 78% of cases.14 This percentage increases to 80% to 90% in patients
with psoriatic arthropathy. Nail involvement is much less frequent
in children (7% to 13%).57 Eighty to ninety per cent of psoriatics
have nail changes during their lives.8 Nail psoriasis rarely occurs in
isolation but can precede skin eruptions by several years.
23
Objectives
Results
Study population
Demographic and clinical characteristics From the random
sample of 4000 members of the APLCP, 1309 questionnaires were
returned. The mean age of those who responded was 51.8 years; 57%
were men and 43% were women; the duration of their psoriasis was
more than 5 years in 88%, 1 to 5 years in 11% (see Table 1).
Gender, N (%)
Age (years)
Duration of psoriasis
Women
547 (43%)
Men
733 (57%)
Mean (range)
51.8 (495)
39
306 (25%)
4053
311 (25%)
5464
322 (26%)
65
297 (24%)
5 (0.4%)
6 months to 1 years
9 (0.7%)
1 to 5 years
138 (10.8%)
1125 (88.1%)
Ortonne et al.
24
25
2. Toenails
3. Both
3. Not painful
2. Sometimes
3. Never
3. Because of my psoriasis of the nails, I dont do any of the jobs I usually do around the house:
1. Always
2. Sometimes
3. Never
4. Because of my psoriasis of the nails, I get dressed more slowly than usual:
1. Always
2. Sometimes
3. Never
5. Because of my psoriasis of the nails, I have trouble putting on my socks (or stockings or tights):
1. Always
2. Sometimes
3. Never
2. Sometimes
3. Never
2. Sometimes
3. Never
2. Sometimes
3. Never
9. Because of my psoriasis of the nails, I avoid doing big jobs around the house:
1. Always
2. Sometimes
3. Never
10. Because of my psoriasis of the nails, I am more irritable than usual, and bad-tempered with people:
1. Always
2. Sometimes
3. Never
The questionnaire comprises 10 items, with three possible responses for each question. The first question considers pain (Very painful, Not very painful and
Not painful), the other 9 address functional impairment in daily life (Yes without hesitation, Yes, sometimes and No without hesitation). A preliminary
question clarifies the location of the nail psoriasis.
p3 Les deux
p2 Peu douloureux
p3 Pas douloureux
2-A cause de mon psoriasis des ongles, jai des difficultes a` me chausser:
p1 Oui sans hesiter
3-A cause de mon psoriasis des ongles, je neffectue aucune des taches que jai lhabitude de faire a` la maison:
p1 Oui sans hesiter
4-A cause de mon psoriasis des ongles, je mhabille plus lentement que dhabitude:
p1 Oui sans hesiter
5-A cause de mon psoriasis des ongles, jai du mal a` mettre mes chaussettes (ou bas/collants):
p1 Oui sans hesiter
6-A cause de mon psoriasis des ongles, jai du mal a` tourner la clef de ma porte:
p1 Oui sans hesiter
7-A cause de mon psoriasis des ongles, jai du mal a` conduire ma voiture:
p1 Oui sans hesiter
8-A cause de mon psoriasis des ongles, quelquun maide pour mhabiller:
p1 Oui sans hesiter
9-A cause de mon psoriasis des ongles, jevite de faire de gros travaux a` la maison:
p1 Oui sans hesiter
10-A cause de mon psoriasis des ongles, je suis plus irritable que dhabitude et de mauvaise humeur avec les gens:
p1 Oui sans hesiter
Ortonne et al.
26
0.38
Daily activities
0.46
Leisure
0.37
Work
0.44
Personal relationships
0.34
Treatment
0.24
DLQI total
0.48
The NPQ10 score was compared with the dimensions of the DLQI score to
assess the degree of agreement. The strongest correlation with the NPQ10
score was obtained with the total score of the DLQI (coefficient of correlation,
0.48) and the dimension daily activities (0.46).
total score of the DLQI and for the dimension daily activities
(Table 3).
Functional impairment (NPQ10 score) according to gender,
age and duration of psoriasis The NPQ10 score is significantly
Discussion
Figure 3 Total DLQI score by NPQ10 score. The NPQ10 score was
compared with the existing DLQI score to assess the degree of
agreement. The two scores were well correlated and changed in the
same direction. The coefficient of correlation was 0.48.
27
score of 8.3, compared with a score of 8.9 for severe psoriasis, 12.5
for atopic dermatitis and 4.5 for acne.14
Comparison of NPQ10 scores with DLQI scores shows good
agreement between the two scales, but without the appearance of
redundancy. This broad correlation is due to the high specificity
of the NPQ10 scale. It addresses only patients affected by nail
psoriasis, whereas the DLQI covers all dermatological pathologies.
Also, the NPQ10 is a unidimensional scale oriented more towards
functional impairment than the DLQI.
Scales exist for measuring quality of life for dermatoses in
general, and for psoriasis in particular.15 To date, no quality-of-life
scale exists for specifically evaluating the impact of the nail effects
of psoriasis. This is why our questionnaire specifically targets nail
symptoms.
Conclusion
The NPQ10 scale, specific to nail psoriasis, is very simple to use
and allows self-evaluation by the patient. This study demonstrates the
aptness of the instrument: understandability, reliability (testretest,
internal consistency), validity (unidimensional nature, comparison
with DLQI), discriminative ability (the score is higher in proportion
to the severity of the nail psoriasis). This validated instrument
must now be used during longitudinal studies (for example, in
clinical trials) in order to confirm that it can measure a change in
status over time in the same patient (before and after treatment).
The complaints expressed by patients in response to this
enquiry about the impact of nail psoriasis on the quality of daily
life demonstrate the need for the development of this type of
instrument for better understanding and thus, better overall management of these patients.
Acknowledgements
We acknowledge Dr Mike Matthews and Dr Catriona Urquhart
for their help in drafting the manuscript in the roles of translator
and medical writer on behalf of Laboratoires Pierre Fabre.
This study was funded by the Public Health and Quality of Life
Department, PFSA, Boulogne Billancourt, France.
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