Responsiveness and interpretability of the Hand Eczema Severity Index (HECSI).
Br J Dermatol. 2019 Jul 01;:
Authors: Oosterhaven JAF, Schuttelaar MLA
BACKGROUND: The Hand Eczema Severity Index (HECSI) is used to measure severity of hand eczema. It is unclear what HECSI scores mean and what is the minimally important change (MIC). Furthermore, responsiveness has not been studied.
OBJECTIVES: To study responsiveness and interpretability of the HECSI.
METHODS: Prospective study covering two time points; baseline and after 4-12 weeks. Responsiveness was assessed using a criterion approach with a ? 1 step improvement on the ‘Photographic guide for severity of hand eczema’ as anchor for important improvement. Interpretability of single scores was determined by defining severity bands based on agreement with the anchor. For change scores, smallest detectable change (SDC) was calculated in unchanged patients and MIC was obtained in changed patients using three methods: mean cut-off, receiver operating curve (ROC) and 95%-limit.
RESULTS: N=294 patients participated (N=160 males, mean age 44·9). HECSI scores improved/deteriorated in parallel with the anchor. The area under the ROC curve was 0·86 (95% confidence interval: 0·81-0·91). The final severity band for single scores had a ?-coefficient of agreement of 0·694: clear, 0; almost clear, 1-16; moderate, 17-37; severe, 38-116; very severe, ?117. The SDC in N=93 unchanged patients was 40·3 points. The obtained MIC values were all smaller than the SDC.
CONCLUSIONS: The HECSI has good responsiveness. This study gives meaning to HECSI scores, which can be applied to clinical decision making and the design of clinical trials. We recommend that an improvement of 41 points on the HECSI is regarded as minimally measurable true change. This article is protected by copyright. All rights reserved.
PMID: 31260086 [PubMed – as supplied by publisher]