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The Localized Scleroderma Cutaneous Assessment Tool: Responsiveness to change in a pediatric clinical population - 17/07/13

Doi : 10.1016/j.jaad.2013.02.007 
Christina E. Kelsey, MSEd , Kathryn S. Torok, MD
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 

Reprint requests: Christina E. Kelsey, MSEd, Pediatric Rheumatology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, 4401 Penn Ave, Third Floor Faculty Pavilion, Pittsburgh, PA 15224.

Abstract

Background

Lack of agreement on how to accurately capture disease outcomes in localized scleroderma (LS) has hindered the development of efficacious treatment protocols. The LS Cutaneous Assessment Tool (LoSCAT), consisting of the modified LS Skin Severity Index (mLoSSI) and the LS Damage Index, has potential for use in clinical trials.

Objective

The goal of this article is to further evaluate the clinical responsiveness of the LoSCAT. Based on the modifiable nature of disease activity versus damage, we expected the mLoSSI to be responsive to change.

Methods

At 2 study visits, a physician completed the LoSCAT and Physician Global Assessment (PGA) of Disease Activity and of Disease Damage for 29 patients with LS. Spearman correlations were used to examine the relationships between the change in the LoSCAT and the PGA scores. To evaluate contrasted group validity, patients were grouped according to disease activity classification and change scores of groups were compared. Minimal clinically important differences were calculated and compared with the standard error of measurement.

Results

Change in the mLoSSI score correlated strongly with change in the PGA of Disease Activity score, whereas change in the LS Damage Index score correlated weakly with change in the PGA of Disease Damage score. The mLoSSI and PGA of Disease Activity exhibited contrasted group validity. Minimal clinically important differences for the activity measures were greater than the respective standard errors of measurement.

Limitations

Only 2 study visits were included in analysis.

Conclusion

This study gives further evidence that the LoSCAT, specifically the mLoSSI, is a responsive, valid measure of activity in LS and should be used in future treatment studies.

Le texte complet de cet article est disponible en PDF.

Key words : localized scleroderma, measurement, minimal clinically important difference, outcomes, responsiveness to change, validity

Abbreviations used : CARRA, CDLQI, ECM, LoSCAT, LoSDI, LS, MCID, mLoSSI, PGA, PGA-A, PGA-D


Plan


 Supported by the Nancy Taylor Foundation for Chronic Diseases and the National Institute of Arthritis and Musculoskeletal and Skin Diseases Mentored Patient Oriented Research Award (No. K23 AR059722).
 Conflicts of interest: None declared.


© 2013  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 69 - N° 2

P. 214-220 - août 2013 Retour au numéro
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