Capturing and reporting topical treatment use in children with eczema

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

3E.7

Presenter:

Katherine E. Memory

Twitter:

@KatherineMemory

Co-authors:

Stephanie J. MacNeill, Matthew J. Ridd

Author institutions:

Population Health Sciences Institute, Bristol Medical School, University of Bristol, Bristol, UK; Clinical Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK

Problem

Topical therapies treat many dermatological conditions. With eczema, emollients and topical corticosteroids (TCS) prevent and treat flares. However, only 11/77 studies in the 2017 Cochrane Review of ‘Emollients and moisturisers for eczema’ reported on topical treatment use. Furthermore, multiple instruments exist, including electronic or self-report measures, with no clear consensus of how to use these. Using data from the Best Emollients for Eczema (BEE) trial, we aimed to compare different ways of capturing and reporting emollient and TCS use.

Approach

In BEE, 550 children were randomly allocated to use one type of emollient (lotion, cream, gel, or ointment) ‘twice daily and when required’ for 16 weeks. Parents completed weekly the Patient-Orientated Eczema Measure (POEM) and questions about topical therapy use. Two versions of topical treatment use questionnaires were used, both underwent Patient and Public Involvement (PPI) review, but Version 2 was tested more thoroughly with advisory groups using cognitive interviewing techniques. Version 1 asked parents to report treatment use on days 1 to 7, starting the day of randomisation. Version 2 asked parents to complete by day of the week (Monday to Sunday), starting the first Monday after randomisation. Analysis was descriptive with Chi-squared test for differences between groups.

Findings

450 participants provided ≥1 topical therapy use questionnaire and/or two consecutively paired POEMs. Overall, questionnaire completion at weeks 1 and 16 were 84.7% (381/450) and 58.9% (265/450) for emollient use, and 94.2% (424/450) and 80.4% (362/450) for TCS use, respectively. In keeping with feedback that led to the change in questionnaire design (confusion about days of the weeks with number of days used), fewer emollient use questionnaires were completed by the 44.9% (n=202) participants given Version 1 (p<0.001). Completion of emollient use questions were 31.5% (1082/3434 patient-weeks) for Version 1 and 82.8% (3489/4216 patient-weeks) for Version 2. TCS use question completion were 82.8% (3489/4216 patient-weeks) for Version 1 and 82.3% (3468/4216 patient-weeks) for Version 2; no difference between versions (p=0.52). As part of this presentation, we will demonstrate different numerical and graphical ways of summarising topical treatment use and discuss their advantages and disadvantages.

Consequences

Questionnaire completion for both emollient and TCS use decreased with time, but was higher for emollient use with the second version of the questionnaire. TCS completion was similar with both versions. When designing questionnaires, balancing the detail and complexity of questions is important, especially if being collected as process or secondary outcome measure. Numerous ways of summarising the same data can provide different information. Therefore, future collection and reporting of treatment use should reflect specific aims

Submitted by:

Katherine Memory

Funding acknowledgement:

This research received no specific grant from any funding agency in the public, commercial or not for profit sectors. This project was completed during the first authors Academic Foundation Training. The Best Emollients for Eczema (BEE) study was funded by the NIHR Technology Assessment programme (reference 15/130.07).