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. 2023 Feb;32(2):583-592.
doi: 10.1007/s11136-022-03244-6. Epub 2022 Nov 10.

Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: a qualitative study

M E Carrière  1   2   3   4 , L B Mokkink  5 , Z Tyack  6 , M J Westerman  5   7 , A Pijpe  8   9 , J Pleat  10 , A L van de Kar  11 , J Brown  12 , H C W de Vet  5 , P P M van Zuijlen  8   9   13
Affiliations

Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: a qualitative study

M E Carrière et al. Qual Life Res. 2023 Feb.

Abstract

Purpose: The Patient and Observer Scar Assessment Scale (POSAS) is widely used for measurements of scar quality. This encompasses visual, tactile and sensory characteristics of the scar. The Patient Scale of previous POSAS versions was lacking input from patients. Therefore, the aim of this study was to develop the POSAS3.0, Patient Scale with involvement of adults patients with all scar types, complying with the highest clinimetric standards.

Methods: From February 2018 to April 2019, a series of six focus group interviews were performed in the Netherlands and Australia to identify scar quality characteristics that adults with scars consider to be important. All focus groups were transcribed, anonymized and analysed using a thematic analysis. Relevant characteristics were formulated into items, resulting in a Dutch and English version of the Patient Scale. These drafts were pilot tested in Australia, the Netherlands and the United Kingdom, and refined accordingly.

Results: A total of 21 relevant scar quality characteristics were identified during the focus groups. Two distinct versions of the POSAS3.0, Patient Scale were developed. The Generic version contains 16 items and can be used for all scar types, except linear scars. The Linear Scar version of the Patient Scale contains the same 16 items, with an extra item referring to the widening of scar margins. All included items are rated on a verbal rating scale with five response options.

Conclusion: Two versions of the POSAS3.0 Patient Scale were developed. Further field tests are being performed to establish the measurement properties and scoring algorithm of the scales.

Keywords: Content validity; Instrument development; POSAS; PROM; Scar assessment; Scar quality.

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Conflict of interest statement

Non-financial interests one of the authors (P.P.M. van Zuijlen) is the developer of the Patient and Observer Scar Assessment Scale, and another author (Z. Tyack) is the developer of the Brisbane Burn Impact Profile. Financial interests Non-commercial use of the POSAS is always free, but we request a fee for the commercial use of the POSAS (i.e. the use by or on behalf of a pharmaceutical company, medical device manufacturer or any other for-profit stakeholder). Fees apply for research or non-research purposes. This compensation will be used to maintain the POSAS website and for research purposes.

Figures

Fig. 1
Fig. 1
Flowchart illustrating the study procedure. *Focus groups in which individuals with scars caused by burns and necrotizing fasciitis took part. The remaining focus groups included individuals with surgical (linear), traumatic, and acne scars
Fig. 2
Fig. 2
Characteristics that were identified during phase 1 of the study (i.e. concept elicitation), categorized into two groups: (1) visual and tactile characteristics and (2) sensory characteristics. The sensory group is further subdivided into symptoms that occur within the scar, and symptoms that are caused by the trauma or injury and can be experienced in the body as a whole (i.e. systemic symptoms). Characteristics that are marked grey were not included in the final version(s) of the POSAS3.0, Patient Scale
Fig. 3
Fig. 3
Development of the response options throughout phase 2 of this study
See this image and copyright information in PMC

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