DLQI scores: less reliable during the pandemic?

During the COVID-19 pandemic lockdowns, results of the Dermatology Life Quality Index may have been altered by an increased number of “not-relevant” responses. DLQI-scores could be underestimated.

Several items on the DLQI questionnaire (numbers 3–10) include an NRR option. These questions include the influence of shopping, social/leisure activities, sex, sports, and work/studying. “Most European countries, Ireland included, went through a series of lockdowns and we hypothesised that, because people were not able to access shops, gyms, restaurants, more ‘non-relevant’ responses would be ticked on DLQI questionnaires,” Dr Ali Alsharqi (St. Vincent’s University Hospital, Republic of Ireland) explained the study’s aim¹.

Previous research had found that 38.8% of psoriasis patients generally choose an NRR at least once in their questionnaires. Thus, it suggested that more than 1 NNR would decrease the DLQI score, and a formula was created that led to a score-adjusted for NRR: the DLQI-R. A second interest of the single centre, retrospective study was to evaluate for potential differences in DLQI and DLQI-R during the lockdown phases of the pandemic. The 52 study participants all had stable disease, reflected by a Psoriasis Area Severity Index (PASI) score of ≤4.

The most current DLQI scores before lockdown restrictions and during lockdown were assessed. The mean age of the study subjects was 55.3, and 53.8% were women. Unsurprisingly in the setting of a specialist clinic, the vast majority was treated with biologics or other systemic drugs. The results showed similar mean disease activity before (PASI 2.16) and during lockdown (PASI 2.09). Looking at the DLQI in general, the mean scores even slightly dropped with 3.13 pre-pandemic and 3.0 during the restrictions.

However, mean values for NRRs increased during the restraints (0.62 vs 1.27), and the picture changed when adjusted for these NRRs with the DLQI-R. “There was a statistically significant increase in the number of non-relevant responses and that corresponded to a statistically significant increase in the DLQI-R,” Dr Alsharqi highlighted, pointing out that the numerical scores for interpersonal relationships, social/ leisure, shopping/garden, and home were higher during lockdowns than in pre-pandemic research.

“We think it is important for clinicians to be aware of this, as they make decisions with respect to continuation or altering patient’s treatments and also when it comes to data collection in registries,” Dr Alsharqi summarised the findings.