title: Validation of the Vitiligo Noticeability Scale: a patient-reported outcome measure of vitiligo treatment success.
abstract: BACKGROUND
  Patient-reported outcome measures are rarely used in vitiligo trials. The Vitiligo Noticeability Scale (VNS) is a new patient-reported outcome measure assessing how 'noticeable' vitiligo patches are after treatment. The noticeability of vitiligo after treatment is an important indicator of treatment success from the patient's perspective.
  
  
  OBJECTIVE
  To evaluate the construct validity, acceptability and interpretability of the VNS.
  
  
  METHODS
  Clinicians (n = 33) and patients with vitiligo (n = 101) examined 39 image pairs, each depicting a vitiligo lesion pre- and post-treatment. Using an online questionnaire, respondents gave a global assessment of treatment success and a VNS score for treatment response. Clinicians also estimated percentage repigmentation of lesions (< 25%; 25-50%; 51-75%; > 75%). Treatment success was defined as 'yes' on global assessment, a VNS score of 4 or 5, and > 75% repigmentation. Agreement between respondents and the different scales was assessed using kappa (κ) statistics.
  
  
  RESULTS
  Vitiligo Noticeability Scale scores were associated with both patient- and clinician-reported global treatment success (κ = 0·54 and κ = 0·47, respectively). Percentage repigmentation showed a weaker association with patient- and clinician-reported global treatment success (κ = 0·39 and κ = 0·29, respectively). VNS scores of 4 or 5 can be interpreted as representing treatment success. Images depicting post-treatment hyperpigmentation were less likely to be rated as successful.
  
  
  CONCLUSIONS
  The VNS is a valid patient-reported measure of vitiligo treatment success. Further validation of the VNS is required, using larger sets of clinical pre- and post-treatment images, affecting a wider range of anatomical sites.
authors.affiliation: Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K.
authors.forename: J M
authors.initials: JM
authors.lastname: Batchelor
authors.affiliation: Nottingham Clinical Trials Unit, Queen's Medical Centre, C Floor, South Block, Nottingham, NG7 2UH, U.K.
authors.forename: W
authors.initials: W
authors.lastname: Tan
authors.affiliation: Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K.
authors.forename: S
authors.initials: S
authors.lastname: Tour
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, NR4 7UY, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Yong
authors.affiliation: Nottingham Clinical Trials Unit, Queen's Medical Centre, C Floor, South Block, Nottingham, NG7 2UH, U.K.
authors.forename: A A
authors.initials: AA
authors.lastname: Montgomery
authors.affiliation: Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, U.K.
authors.forename: K S
authors.initials: KS
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014820:Vitiligo / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D055815:Young Adult