Refinement and Validation of the ItchyQoL using Classical Test Theory and Item Response Theory resulted in a reduction of the response categories from a 5-point to a 3-point scale.

PURPOSE The ItchyQoL is an itch-specific patient-reported outcome measure (PROM) assessing quality of life (QoL) in patients with chronic pruritus (CP). We aimed to assess and extend the psychometric properties of the ItchyQoL using classical test theory (CTT) and item response theory (IRT). METHODS Item characteristic curves (ICCs) were analysed in order to see whether the response categories are functioning optimally. Confirmatory factor analyses were carried out on the ItchyQoL prior to and after rescoring of the response categories. We conducted a Rasch analysis on the ItchyQoL with revised response options and assessed the mean fit residuals as well as the assumptions of unidimensionality and local independence. RESULTS Five hundred and fifty-one patients with CP from nine European countries completed the 22 items of the ItchyQoL. IRT analysis supported the revision of response options from five to three. This revision was supported by excellent structural validity using CTT. The overall fit to the Rasch model was adequate. Unidimensionality was supported by the ItchyQoL overall scale as well as by the single subscales, however local independence was violated in eight cases. CONCLUSION We suggest a revision of the response categories of the ItchyQoL from a 5-point to a 3-point scale. Applying this revision, the ItchyQoL showed excellent structural validity according to CTT and IRT/Rasch. The calculation of an overall ItchyQoL sum score is allowed.