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Es de agradecer el esfuerzo de los autores por determinar los instrumentos de valoraci&#243;n de PROs con validaci&#243;n transcultural disponibles en Espa&#241;a&#44; y revisar sus caracter&#237;sticas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Destaca la correlaci&#243;n d&#233;bil-moderada y variable encontrada entre las medidas de calidad de vida relacionada con la salud &#40;HRQoL&#41; y la gravedad cl&#237;nica medida por el PASI&#44; que se explica en parte por el impacto de algunas &#225;reas topogr&#225;ficas &#8212;manos&#44; brazos&#44; genitales&#44; cuero cabelludo y u&#241;as&#8212;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#44; los s&#237;ntomas y la visibilidad de las lesiones&#44; que no recoge el PASI<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aunque el DLQI tiene un efecto suelo superior al Skindex-29&#44; que tambi&#233;n es m&#225;s sensible a los cambios cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a>&#44; la introducci&#243;n de un DLQI modificado teniendo en cuenta el n&#250;mero de &#237;tems considerados no relevantes &#40;casilla &#171;Sin relaci&#243;n&#187;&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> puede contribuir a superar esta limitaci&#243;n &#40;efecto suelo&#41; del DLQI&#44; especialmente importante en mujeres&#44; pacientes de edad avanzada&#44; desempleados y con menor nivel educativo<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Asimismo&#44; hay que tener en cuenta la correlaci&#243;n no lineal &#40;mayor impacto relativo para valores de PASI bajos&#41; y el mayor efecto de la mejor&#237;a en el PASI sobre la HRQoL en las mujeres<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>&#46; El sexo femenino&#44; junto con el PASI&#44; es el principal factor determinante del PDI en nuestro medio&#44; y es bien conocido el mayor impacto en las mujeres que en los varones de un mismo nivel de enfermedad sobre el DLQI y otras medidas de HRQoL en la psoriasis &#8212;que no se recoge en esta revisi&#243;n&#8212; y otras enfermedades inflamatorias cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En la discusi&#243;n los autores comentan la escasa sensibilidad a los cambios cl&#237;nicos asociados a la psoriasis de los cuestionarios gen&#233;ricos de HRQoL validados en Espa&#241;a&#58; Short Form 36 &#40;SF-36&#41;&#44; EuroQol 5D &#40;EQ-5D&#41; y Nottingham Health Profile &#40;NHP&#41;&#46; De entre ellos&#44; posiblemente el m&#225;s &#250;til sea el EQ-5D<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a>&#44; empleado en sus diferentes versiones en pacientes con psoriasis<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10&#44;11</span></a>&#44; y que ha permitido desarrollar algoritmos que permitan establecer puntuaciones de utilidad <span class="elsevierStyleItalic">&#40;utility scores&#41;</span> a partir de los valores del DLQI en pacientes con psoriasis<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a>&#44; y eventualmente definir en estudios farmacoecon&#243;micos los a&#241;os de vida con ajuste de calidad &#40;QALY&#41; ganados por una determinada intervenci&#243;n terap&#233;utica&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finalmente&#44; cabr&#237;a destacar las cualidades &#40;consistencia interna&#44; fiabilidad&#44; validez del contenido y estructural&#41; del cuestionario de satisfacci&#243;n con el tratamiento desarrollado en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> comparado con otras medidas espec&#237;ficas de psoriasis&#44; dermatol&#243;gicas o gen&#233;ricas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>&#46;</p></span>"
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Patient reported outcomes en psoriasis validados en España: PROs y contras
Patient-Reported Outcomes in Psoriasis Validated in Spain: PROs and Cons
L. Puig
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lpuig@santpau.cat

Autor para correspondencia.
Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En el presente n&#250;mero de <span class="elsevierStyleSmallCaps">Actas Dermosifiliogr&#225;ficas</span> aparece publicada una revisi&#243;n sistem&#225;tica de la literatura sobre estudios que hayan validado o utilizado instrumentos espec&#237;ficos de valoraci&#243;n de resultados reportados por el paciente o <span class="elsevierStyleItalic">Patient Reported Outcomes</span> &#40;PROs&#41; en la poblaci&#243;n espa&#241;ola con psoriasis<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a>&#46; Esta revisi&#243;n incluye 5 elementos validados&#58; 2 cuestionarios de calidad de vida dermatol&#243;gicos &#40;Dermatology Life Quality Index &#91;DLQI&#93; y Skindex-29&#41;&#44; 2 espec&#237;ficos para psoriasis &#40;Psoriasis Disability Index &#91;PDI&#93; y PSO-LIFE&#44; este &#250;ltimo desarrollado en Espa&#241;a&#41; y un cuestionario de satisfacci&#243;n con el tratamiento tambi&#233;n desarrollado en Espa&#241;a &#40;CESTEP&#41;&#46; Es de agradecer el esfuerzo de los autores por determinar los instrumentos de valoraci&#243;n de PROs con validaci&#243;n transcultural disponibles en Espa&#241;a&#44; y revisar sus caracter&#237;sticas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Destaca la correlaci&#243;n d&#233;bil-moderada y variable encontrada entre las medidas de calidad de vida relacionada con la salud &#40;HRQoL&#41; y la gravedad cl&#237;nica medida por el PASI&#44; que se explica en parte por el impacto de algunas &#225;reas topogr&#225;ficas &#8212;manos&#44; brazos&#44; genitales&#44; cuero cabelludo y u&#241;as&#8212;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>&#44; los s&#237;ntomas y la visibilidad de las lesiones&#44; que no recoge el PASI<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Aunque el DLQI tiene un efecto suelo superior al Skindex-29&#44; que tambi&#233;n es m&#225;s sensible a los cambios cl&#237;nicos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a>&#44; la introducci&#243;n de un DLQI modificado teniendo en cuenta el n&#250;mero de &#237;tems considerados no relevantes &#40;casilla &#171;Sin relaci&#243;n&#187;&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> puede contribuir a superar esta limitaci&#243;n &#40;efecto suelo&#41; del DLQI&#44; especialmente importante en mujeres&#44; pacientes de edad avanzada&#44; desempleados y con menor nivel educativo<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Asimismo&#44; hay que tener en cuenta la correlaci&#243;n no lineal &#40;mayor impacto relativo para valores de PASI bajos&#41; y el mayor efecto de la mejor&#237;a en el PASI sobre la HRQoL en las mujeres<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>&#46; El sexo femenino&#44; junto con el PASI&#44; es el principal factor determinante del PDI en nuestro medio&#44; y es bien conocido el mayor impacto en las mujeres que en los varones de un mismo nivel de enfermedad sobre el DLQI y otras medidas de HRQoL en la psoriasis &#8212;que no se recoge en esta revisi&#243;n&#8212; y otras enfermedades inflamatorias cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En la discusi&#243;n los autores comentan la escasa sensibilidad a los cambios cl&#237;nicos asociados a la psoriasis de los cuestionarios gen&#233;ricos de HRQoL validados en Espa&#241;a&#58; Short Form 36 &#40;SF-36&#41;&#44; EuroQol 5D &#40;EQ-5D&#41; y Nottingham Health Profile &#40;NHP&#41;&#46; De entre ellos&#44; posiblemente el m&#225;s &#250;til sea el EQ-5D<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a>&#44; empleado en sus diferentes versiones en pacientes con psoriasis<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10&#44;11</span></a>&#44; y que ha permitido desarrollar algoritmos que permitan establecer puntuaciones de utilidad <span class="elsevierStyleItalic">&#40;utility scores&#41;</span> a partir de los valores del DLQI en pacientes con psoriasis<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a>&#44; y eventualmente definir en estudios farmacoecon&#243;micos los a&#241;os de vida con ajuste de calidad &#40;QALY&#41; ganados por una determinada intervenci&#243;n terap&#233;utica&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Finalmente&#44; cabr&#237;a destacar las cualidades &#40;consistencia interna&#44; fiabilidad&#44; validez del contenido y estructural&#41; del cuestionario de satisfacci&#243;n con el tratamiento desarrollado en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> comparado con otras medidas espec&#237;ficas de psoriasis&#44; dermatol&#243;gicas o gen&#233;ricas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>&#46;</p></span>"
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Información del artículo
ISSN: 00017310
Idioma original: Español
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