Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus.

The most commonly used tool for self-report of pruritus intensity is the visual analogue scale (VAS). Similar tools are the numerical rating scale (NRS) and verbal rating scale (VRS). In the present study, initiated by the International Forum for the Study of Itch assessing reliability of these tools, 471 randomly selected patients with chronic itch (200 males, 271 females, mean age 58.44 years) recorded their pruritus intensity on VAS (100-mm line), NRS (0-10) and VRS (four-point) scales. Re-test reliability was analysed in a subgroup of 250 patients after one hour. Statistical analysis showed a high reliability and concurrent validity (r>0.8; p<0.01) for all tools. Mean values of all scales showed a high correlation. In conclusion, high reliability and concurrent validity was found for VAS, NRS and VRS. On re-test, higher correlation and less missing values were observed. A training session before starting a clinical trial is recommended.

[1]  S. Ständer.  Chronischer Pruritus , 2007, Der Hautarzt.

[2]  D G Ferris,et al.  Measurement of subjective phenomena in primary care research: the Visual Analogue Scale. , 1993, Family practice research journal.

[3]  Flaherty Sa,et al.  Pain measurement tools for clinical practice and research. , 1996, AANA journal.

[4]  P. Bijur,et al.  Reliability of the visual analog scale for measurement of acute pain. , 2001, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[5]  E. C. Huskisson,et al.  Graphic representation of pain , 1976, Pain.

[6]  C. Wahlgren.  Children's Rating of Itch: An Experimental Study , 2005, Pediatric dermatology.

[7]  J. Oosting,et al.  Improved device for measuring scratching activity in patients with pruritus , 1998, Medical and Biological Engineering and Computing.

[8]  A. Finlay,et al.  Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use , 1994, Clinical and experimental dermatology.

[9]  I Oswald,et al.  Scratching during sleep. , 1973, Lancet.

[10]  C. Wahlgren,et al.  Measurement of itch. , 1995, Seminars in dermatology.

[11]  Ebata,et al.  The characteristics of nocturnal scratching in adults with atopic dermatitis , 1999, The British journal of dermatology.

[12]  J. Ring,et al.  New Aspects of Itch Pathophysiology: Component Analysis of Atopic Itch Using the ‘Eppendorf Itch Questionnaire’ , 2001, International Archives of Allergy and Immunology.

[13]  R. Schwartz,et al.  Uremic pruritus , 1998, International journal of dermatology.

[14]  M. Niimura,et al.  Use of a wrist activity monitor for the measurement of nocturnal scratching in patients with atopic dermatitis , 2001, The British journal of dermatology.

[15]  G. Lauzon,et al.  Itch Severity Scale: a self‐report instrument for the measurement of pruritus severity , 2007, The British journal of dermatology.

[16]  B. Feldman,et al.  Minimal difference in pain associated with change in quality of life in children with rheumatic disease. , 2002, Arthritis and rheumatism.

[17]  R. Ettl.  6 Diagnostik und Therapie (I) Diagnostik Therapie , 2013 .

[18]  Mustakallio Kk.  Scratch radar for the measurement of pruritus. , 1991 .

[19]  S. K. Lo,et al.  Reliability and Validity , 2020, International Encyclopedia of Human Geography.

[20]  E A Jones,et al.  Application of piezo film technology for the quantitative assessment of pruritus. , 1991, Biomedical instrumentation & technology.

[21]  S. Shuster,et al.  A new method for the measurement of itch and the response to treatment , 1975, The British journal of dermatology.

[22]  J. Pellegrini,et al.  Correlating an 11-point verbal numeric rating scale to a 4-point verbal rating scale in the measurement of pruritus. , 2009, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[23]  F. Dalgard,et al.  Epidemiology of itch: adding to the burden of skin morbidity. , 2009, Acta dermato-venereologica.

[24]  S. Ständer,et al.  Prevalence of Chronic Pruritus in Germany: Results of a Cross-Sectional Study in a Sample Working Population of 11,730 , 2010, Dermatology.

[25]  Y. Hishikawa,et al.  Nocturnal scratching and its relationship to the disturbed sleep of itchy subjects , 1991, Clinical and experimental dermatology.

[26]  Ö. Hägermark,et al.  Some methods for evaluating clinical itch and their application for studying pathophysiological mechanisms. , 1992, Journal of dermatological science.

[27]  K. Hon,et al.  Measurement of pruritus in a Chinese woman with pemphigoid gestationis using a wrist movement detector , 2007, International journal of dermatology.

[28]  E. Stener-Victorin,et al.  Perceptual matching for assessment of itch; reliability and responsiveness analyzed by a rank-invariant statistical method. , 2003, The Journal of investigative dermatology.

[29]  L. Hynan,et al.  The 5‐D itch scale: a new measure of pruritus , 2010, The British journal of dermatology.

[30]  C. Wahlgren,et al.  Some aspects of the experimental induction and measurement of itch. , 1989, Acta dermato-venereologica.

[31]  L. Misery,et al.  Clinical classification of itch: a position paper of the International Forum for the Study of Itch. , 2007, Acta dermato-venereologica.

[32]  S. Ständer,et al.  Measuring patient‐relevant benefits in pruritus treatment: development and validation of a specific outcomes tool , 2009, The British journal of dermatology.

[33]  H. Gollnick,et al.  Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients , 2006, The British journal of dermatology.

[34]  Suephy C. Chen,et al.  A pilot quality-of-life instrument for pruritus. , 2008, Journal of the American Academy of Dermatology.

[35]  T Aoki,et al.  Evaluation of scratch movements by a new scratch-monitor to analyze nocturnal itching in atopic dermatitis. , 1997, Acta dermato-venereologica.

[36]  A. Taïeb,et al.  Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. , 1993, Dermatology.

[37]  R. Aitken.  Measurement of feelings using visual analogue scales. , 1969, Proceedings of the Royal Society of Medicine.

[38]  S. Ständer,et al.  Chronic pruritus – pathogenesis, clinical aspects and treatment , 2010, Journal of the European Academy of Dermatology and Venereology : JEADV.

[39]  G Kishi,et al.  Reliability and Validity , 1999 .

[40]  J. Rees,et al.  Measurement of itch using actigraphy in pediatric and adult populations. , 2004, Journal of the American Academy of Dermatology.

[41]  Mark S. Litwin,et al.  How to Measure Survey Reliability and Validity , 1995 .

[42]  R. Snaith,et al.  The hospital anxiety and depression scale. , 2013, Acta psychiatrica Scandinavica.

[43]  J. Summerfield,et al.  The measurement of itch with sensitive limb movement meters , 1980, The British journal of dermatology.

[44]  G. Yosipovitch,et al.  A questionnaire for the assessment of pruritus: validation in uremic patients. , 2001, Acta dermato-venereologica.

[45]  B. Diffey,et al.  The development of an objective method for measuring scratch in children with atopic dermatitis suitable for clinical use. , 2004, Journal of the American Academy of Dermatology.

[46]  Julia Brasch,et al.  Severity Scoring of Atopic Dermatitis: The SCORAD Index , 1993 .

[47]  R. Snaith,et al.  The Hospital Anxiety and Depression Scale , 1983 .

[48]  M Bijak,et al.  Pruritometer 2: Portable Recording System for the Quantification of Scratching as Objective Criterion for the Pruritus - Pruritometer 2: Ambulantes Meßsystem zur Quantifizierung des Kratzens als objektives Maß für den Pruritus , 2001, Biomedizinische Technik. Biomedical engineering.

[49]  B. Hoggart,et al.  Pain: a review of three commonly used pain rating scales. , 2005, Journal of clinical nursing.

[50]  D. Streiner,et al.  Introduction to health measurement scales. , 2010, Journal of psychosomatic research.

[51]  S. Ständer.  [Chronic pruritus: principals of diagnostics and therapy]. , 2007, Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete.