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Global adoption of the Dermatology Life Quality Index into clinical practice

Patient suffering with Dermatitis

Development of this established clinical assessment tool leads to increased global reach and applications, and increases overall patient quality of life.

On a global level, dermatological conditions can cause suffering to the patient and poor quality of life. In the UK alone, skin conditions such as eczema, psoriasis and atopic dermatitis affect around 60% of the adult population at some point in their lifetime. These conditions can severely impact quality-of-life, as well as overall patient wellbeing.

The Dermatology Life Quality Index (DLQI) is a clinical assessment tool, developed by researchers at Cardiff University via research published in 1994. The simple-to-use questionnaire asks patients to describe the impact of their skin disease on different aspects of their health-related quality-of-life over the previous week. Before this research, no standard method was used to assess the impact of skin diseases on patient wellbeing.

Doctor filling in forms as they're sitting with a patient

Between 2002 and 2005, the DLQI was further developed. Research on almost 2,000 patients led to the publication of score bandings designed to enhance its use - a score above 10 reflects a major impact of the disease on quality-of-life. This breakthrough meant that the DLQI could be used to increase the appropriateness of clinical decisions and services, to assess new drugs and to inform treatments.

New research enhancing global reach and clinical applicability

Since 2014 a Cardiff University team lead by Professor Andrew Finlay undertook additional extensive research, in order to enhance the use of the DLQI in clinical settings, broaden its global reach and increase the variety of clinical applications, including into clinical trials and drug development studies.

The university team refined the interpretation of the DLQI’s Minimal Clinically Important Difference (MCID) score, which can determine what kind of response a patient has to therapy or signal a need to alter patient management. This refinement altered the MCID from 5 to 4, which improved the DLQI’s validity, reliability and interpretation of change.

It had also been noted that clinicians had been using non-validated electronic versions of the DLQI, as patient-reported measures are increasingly being made in electronic format.

In a study of patients from a hospital dermatology outpatient clinic the university team validated the digital delivery and completion of the DLQI on iPads, providing opportunities for real-time monitoring of quality-of-life and an easier transfer of data to patient records.

Skin condition

Linking the DLQI to health utility estimates

Health utility estimates provide a measure of a patient’s preference for a given health-related outcome. Previously it wasn’t possible to calculate health utility values from the DLQI. Instead, a different instrument, such as the European Quality of Life-5 Dimension (EQ-5D) score, was required.

The university team developed a new method to calculate EQ-5D data and utility values from DLQI scores, simplifying the process for clinicians and patients.

The new validated method means that DLQI data can be mapped onto health utility measures, which can then be used in economic analyses, increasing the value of DLQI data and improving the identification of meaningful changes in quality of life for patients.

Psoriasis of the skin

The World Health Organisation has noted that the DLQI questionnaire “is currently the most frequently used method of evaluating quality of life for patients with different skin conditions”. Further systematic review validated the DLQI as the most commonly used instrument for quality-of-life assessment in psoriasis.

Key results

The Dermatology Life Quality Index (DLQI) is now a vital clinical assessment tool. Inclusion of the DLQI in critical national and international guidelines, as well as the successful move towards a digital format further extended the reach of the tool across multiple countries.

Since 2014, the DLQI has become a widely used international assessment tool, benefiting a wide range of people including patients, clinicians, and pharmaceutical companies. This is reflected in its inclusion in many guidelines worldwide.

Since 2014:

  • The DLQI has formed part of national guidelines for a wide range of dermatological conditions in 31 new countries, bringing the total number of countries using it to 45. Countries with national guidelines that recommend use of DLQI include the USA, New Zealand, China, Germany, France, Brazil, Chile, and Venezuela.
  • There have been a further 34 validated translations of the DLQI, and it is now available in 125 languages. It has been used in research studies and clinical trials in 62 countries, covering over 70 diseases.
  • There have been 1601 licences for the DLQI issued, of which 826 were for commercial use, generating revenue of over £3.5 million. Since Cardiff University’s validation of the e-format DLQI in 2017, 314 requests were granted for use of an e-format DLQI between 2018 and 2020. Licenses purchased by pharmaceutical companies are typically used for clinical trials, contributing to the successful development of treatments for dermatological conditions. This use complements extensive use (free of charge) by the NHS and other non-profit organisations. Any patient, nurse or doctor worldwide can also use the DLQI for clinical purposes free of charge.
  • There have been 44 published new measures validated against the DLQI, covering conditions such as alopecia, atopic dermatitis, albinism, and non-melanoma skin cancer.
  • The DLQI score was included in 15 further NICE Technology Appraisals and Evidence Summaries, for dermatological conditions such as atopic dermatitis, hidradenitis suppurativa, psoriatic arthritis, hyperhidrosis and rosacea.

"Professor Andrew Finlay and his team have given a voice to all our patients in everyday consultation. This contributes to a new way of practicing medicine and dermatology, putting the patient in the centre, making a person-centred consultation."
Journal of the European Academy of Dermatology and Venereology 2017; 31: 1247

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