2017-18 HSC Section 4 Green Book

Fig. 1. (Continued).

Before our scale could be validated, reliability was established. The overall test showed a test-retest correla- tion of 0.70 between visits 1 and 2 improving to 0.77 between visits 2 and 3, which we consider to be very reli- able. The greatest decrease in test-retest correlation between the visits was the physical symptoms. Patients received steroid injections at each visit. If the steroids were able to decrease the physical symptoms such as itch- ing, size, pain, etc., it would be expected that the physical complaints would begin to decrease. Therefore, the sever- ity of the physical exam scores should decrease the most quickly, leading to less reproducibility (patient answering the same way at each visit) as the condition improves. Internal consistency represents the degree to which items or subscales relate to the same underlying con- cept, in this case the QOL burden of keloids for each subscale. The higher the Cronbach’s alpha, the greater the internal consistency of the questions being asked, with 0.9 showing excellent consistency and 0.7 a 0.9 showing good consistency. 8 The greatest internal consis- tency were the physical symptoms questions (0.86). This is likely because this is the most overt sign of a keloid, and the questions are most easily designed and consist- ent with previous studies. 7 The subscale with the lowest internal consistency was the motivation for seeking med- ical care. This would be expected given the multiple rea- sons for which patients may desire medical therapy, including both the physical but also the mental and social reasons. Although validation of the scale was not a primary goal of this investigation, it bears noting in this initial

entire scale was 0.57; PSS was 0.77; SES was 0.73; and SFS was 0.72 (Table IV).

DISCUSSION Keloids can affect a patient both physically and mentally. Global QOL scales have failed to demonstrate the burden faced by patients with head and neck keloids. 6 Furtado et al. attempted to determine which factors of keloids affected the QOL. 7 This study showed that physical symptoms were the most likely impacted, but psychological effects were also present. This study has limited applicability to the head and neck because it included keloids from all portions of the body and the visible keloids were grouped together (head and neck, arms, legs). Furthermore, the questions were found to be least responsive to visible keloids. In the present study, although physical manifesta- tions were the most common reason for patients to pres- ent for treatment, problems with social interactions (problems at work, school, social life, family urging) pro- vided motivation 40% of the time, further supporting the QOL burden faced by these patients. The questions were designed to assess physical symptoms as well as try to determine which psychological symptoms were most affected by keloids, including self- esteem, social function, and motivation for seeking medi- cal care, because these are frequently the complaints that patients had presented with to our clinic. Multiple ques- tions were designed within each subscale, and all ques- tions within each subscale were included in analysis.

Laryngoscope 125: December 2015

Guy et al.: Head and Neck Keloid QOL Questionnaire

186