PROMIS Outcome Measures Effective for Evaluating Chronic Skin Disease

A generalized set of patient-reported outcomes measures known as the Patient-Reported Outcomes Measurement Information System (PROMIS) has been validated for evaluating the impacts of chronic skin diseases, new data suggest.1

PROMIS was evaluated in a recent analysis for which the corresponding author was John S. Barbieri, MD, MBA, from the Department of Dermatology at Brigham and Women’s Hospital. Barbieri et al noted the potential integration of this set of patient-reported outcome measures (PROMs) into the dermatologic clinic setting. Nonetheless, prior to this study, the measurement properties of these PROMs among individuals with various chronic skin diseases had not yet been established.

“...[There] have been limited studies on the validity of these measures among patients with chronic skin diseases,” the investigative team wrote.1,2,3 “...[We] aimed to investigate the measurement properties of PROMIS measures among a cohort of US adults with a range of chronic skin diseases.”

Study Design and Outcome Measures

Barbieri and colleagues set out to evaluate multiple psychometric properties of the PROMIS short-form instruments, including the measures' construct validity, structural validity, internal consistency, and responsiveness, for domains of anxiety, social satisfaction, depression, and social isolation. Additionally, the investigative team assessed the construct validity and responsiveness of single-item measures evaluating both pain and pruritus intensity among patients with various skin diseases.

Those taking part were recruited through Prolific, an online research recruitment platform, for this cohort analysis. Those deemed eligible were adults in the age range of 18 years or older, residents of the US, and those who reported having at least a single chronic dermatologic condition. Such skin diseases included:

• Acne
• Rosacea
• Atopic dermatitis
• Seborrheic dermatitis
• Psoriasis
• Hidradenitis suppurativa
• Alopecia areata

Additionally, patients involved in Barbieri and coauthors' analysis might have a condition such as the following autoimmune connective tissue disorders:

• Dermatomyositis
• Cutaneous lupus
• Scarring alopecia
• Morphea
• Scleroderma

They could also have reported a blistering diseases including the following:

• Pemphigus vulgaris and bullous pemphigoid
• Lichen planus
• Ichthyosis

Those involved as participants in Barbieri et al's study self-identified their ancestral, racial, or ethnic background via a questionnaire. The survey included a separate item used to determine whether subjects of the study identified as Hispanic or Latino/a/x. Those involved would then fill out a baseline survey that included PROMIS instruments and additional relevant outcome measures between February 5 and February 7, 2025. The investigative team also carried out a follow-up evaluation approximately 3 months later. The team's survey was available from April 30 - May 29. Data collection encompassed PROMIS measures, Skindex-29, the Dermatology Life Quality Index, a patient global assessment at baseline, and a follow-up anchor inquiry looking at any perceived shifts in participants' skin condition status.

The investigators highlighted structural validity, internal consistency, construct validity, and responsiveness for the PROMIS short-form measures. Both construct validity and responsiveness were specifically evaluated for the single-item pain and itch intensity measures. In their final analytic sample, the team included 549 adults with chronic skin diseases, with 52.3% being listed as women and 47.7% as men. There was a median age of 36 years among the subjects. Acne was noted by 44.8% of participants, atopic dermatitis by 45.1%, and psoriasis by 20.6%.

Findings on PROMIS in Dermatology

In Barbieri and colleagues' psychometric assessment, their findings suggested anxiety, social satisfaction, depression, and social isolation PROMIS short forms met the study's criteria for adequate structural validity.1 They noted comparative fit index and/or Tucker-Lewis index values exceeding .95 and standardized root mean residual values below .08. The PROMIS instruments also demonstrated strong internal consistency, which the investigators noted was reflected by Cronbach α values greater than .90.

The construct validity was shown by the investigators to have been supported across all measures through known-groups comparisons as well as convergent validity analyses.1 These included Pearson correlation coefficients of .30 or higher between measures which evaluated related constructs. In looking at responsiveness, Barbieri and coauthors' standardized response mean analyses suggested the single-item pain measure (SRM, .41) as well as intensity of pruritus measures (SRM range, .32–.44) showed responsiveness comparable to the Skindex-29 symptoms domain (SRM, .47).

In a similar conclusion, the investigative team highlighted social isolation (SRM, .27) and social satisfaction (SRM, −.20) PROMIS measures were shown to be similarly responsive to those observed for the Skindex-29 functioning domain (SRM, .25).1 Conversely, Barbieri et al found responsiveness for the measures of anxiety (SRM, .11) and depression (SRM, .16) was below that of the Skindex-29 emotions domain, which had an SRM of .43.

“Our study demonstrates the good measurement properties of a novel profile of PROMIS instruments for capturing the physical, emotional, and social effects of chronic skin diseases,” they concluded.1 “Further research is needed to confirm the generalizability of our findings.”

References

1. Nock MR, Ershadi S, Sánchez-Feliciano A, et al. Measurement Properties of PROMIS Measures Relevant to Chronic Skin Diseases. JAMA Dermatol. Published online December 23, 2025. doi:10.1001/jamadermatol.2025.5163.

2. Terwee CB. The Value of Item Banks, CAT, and PROMIS for Dermatology. J Invest Dermatol. 2020 May;140(5):1089-1091. doi: 10.1016/j.jid.2019.12.017. Epub 2020 Jan 13. PMID: 31945350.

3. Esaa F, Prezzano J, Ryan Wolf J, et al. The utility of PROMIS domain measures in dermatologic care. Arch Dermatol Res. 2021 Jan;313(1):17-24. doi: 10.1007/s00403-020-02074-1. Epub 2020 Apr 8. PMID: 32270322.