How was the POSAS 3.0 developed?

The results from a qualitative study have been published in the Journal Quality of Life Research in 2022. In this manuscript, the results from a series of focus groups were analysed, and used to formulate items for the POSAS 3.0 patient scale.

What methods were used?

The aim was to develop the POSAS 3.0 patient scale together with adult patients with all scar types, complying with the highest clinimetric standards. A series of six focus group interviews were performed in the Netherlands and Australia in 2018-2019, to identify scar quality characteristics that adults with scars consider to be important. Audio from focus groups was transcribed, anonymized and analysed using a thematic analysis. Relevant characteristics were formulated into items, resulting in a Dutch and English version of the POSAS 3.0 patient scale. These drafts were pilot tested in Australia, the Netherlands and the United Kingdom, and refined accordingly.


A total of 21 relevant scar quality characteristics were identified during the focus groups. Two versions of the POSAS 3.0 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. Currently, the patient scale of the POSAS 3.0 is being tested in patients with different types of scars to establish how valid and reliable the scale is able to measure scar quality.


Carrière, M.E., Mokkink, L.B., Tyack, Z. et al. Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: a qualitative study. Qual Life Res (2022).