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Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain.

ABSTRACT: Assessments of health-related quality of life and particularly utility values are important components of health economic analyses. Several instruments have been developed to measure utilities. However no consensus has emerged regarding the most appropriate instrument within a therapeutic area such as chronic pain. The study compared two instruments - EQ-5D and SF-6D - for their performance and validity in patients with chronic pain.Pooled data from three randomised, controlled clinical trials with two active treatment groups were used. The included patients suffered from osteoarthritis knee pain or low back pain. Differences between the utility measures were compared in terms of mean values at baseline and endpoint, Bland-Altman analysis, correlation between the dimensions, construct validity, and responsiveness.The analysis included 1977 patients, most with severe pain on the Numeric Rating Scale. The EQ-5D showed a greater mean change from baseline to endpoint compared with the SF-6D (0.43 to 0.58 versus 0.59 to 0.64). Bland-Altman analysis suggested the difference between two measures depended on the health status of a patient. Spearmans rank correlation showed moderate correlation between EQ-5D and SF-6D dimensions. Construct validity showed both instruments could differentiate between patient subgroups with different severities of adverse events and analgesic efficacies but larger differences were detected with the EQ-5D. Similarly, when anchoring the measures to a disease-specific questionnaire - Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) - both questionnaires could differentiate between WOMAC severity levels but the EQ-5D showed greater differences. Responsiveness was also higher with the EQ-5D and for the subgroups in which improvements in health status were expected or when WOMAC severity level was reduced the improvements with EQ-5D were higher than with SF-6D.This analysis showed that the mean EQ-5D scores were lower than mean SF-6D scores in patients with chronic pain. EQ-5D seemed to have higher construct validity and responsiveness in these patients.

SUBMITTER: Obradovic M

PROVIDER: S-EPMC3722016 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain.

Obradovic Marko M Lal Arun A Liedgens Hiltrud H

Health and quality of life outcomes 20130701

<h4>Background</h4>Assessments of health-related quality of life and particularly utility values are important components of health economic analyses. Several instruments have been developed to measure utilities. However no consensus has emerged regarding the most appropriate instrument within a therapeutic area such as chronic pain. The study compared two instruments - EQ-5D and SF-6D - for their performance and validity in patients with chronic pain.<h4>Methods</h4>Pooled data from three rando ...[more]

PMID: 23815777

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Project description:BackgroundEvidence of health utility changes in patients who suffer from longstanding health complaints attributed to dental amalgam fillings are limited. The change in health utility outcomes enables calculating quality-adjusted life-year (QALY) and facilitates the comparison with other health conditions. The purpose of this study was to estimate the validity and responsiveness of the EQ-5D-5L and SF-6D utilities following removal of dental amalgam fillings in patients with health complaints attributed to their amalgam fillings, and examine the ability of these instruments to detect minimally important changes over time.MethodsPatients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, were recruited to a prospective cohort study in Norway. Two health state utility instruments, EQ-5D-5L and SF-6D, as well as self-reported general health complaints (GHC-index) and visual analogue scale (EQ-VAS) were administered to all patients (n = 32) at baseline and at follow-up. The last two were used as criteria measures. Concurrent and predictive validities were examined using correlation coefficients. Responsiveness was assessed by the effect size (ES), standardized response mean (SRM), and relative efficiency. Minimally important change (MIC) was examined by distribution and anchor-based approaches.ResultsConcurrent validity of the EQ-5D-5L was similar to that of SF-6D utility. EQ-5D-5L was more responsive than SF-6D: the ES were 0.73 and 0.58 for EQ-5D-5L and SF-6D, respectively; SRM were 0.76 and 0.67, respectively. EQ-5D-5L was more efficient than SF-6D in detecting changes, but both were less efficient compared to criteria-based measures. The estimated MIC of EQ-5D-5L value set was 0.108 and 0.118 based on distribution and anchor-based approaches, respectively. The corresponding values for SF-6D were 0.048 and 0.064, respectively.ConclusionsIn patients with health complaints attributed to dental amalgam undergoing amalgam removal, both EQ-5D-5L and SF-6D showed reasonable concurrent and predictive validity and acceptable responsiveness. The EQ-5D-5L utility appears to be more responsive compared to SF-6D. Trial registration The research was registered at ClinicalTrials.gov., NCT01682278. Registered 10 September 2012, https://clinicaltrials.gov/ct2/show/NCT01682278 .

Project description:BACKGROUND:The EuroQol-5 Dimension (EQ-5D), developed in 1990, is a most widely used generic tool to measure the health-related quality of life (HRQoL) and considered suitable for patients with asthma. In 2009, the EuroQol Group developed a new EQ-5D version to overcome limitations related to its consistently reported high ceiling effect. To enhance the sensitivity for assessing the HRQoL in further patient populations, the number of responses of EQ-5D was increased from 3 to 5 levels (EQ-5D-5L). Moreover, the availability of well-defined requirements for its Web-based administration allows EQ-5D-5L use to monitor the HRQoL in electronic health (eHealth) programs. No study has evaluated the metric properties of the new EQ-5D-5L in patients with asthma yet. OBJECTIVE:This study aims to examine the distribution, construct validity, and reliability of the new EQ-5D-5L questionnaire administered online to adults with asthma. METHODS:We evaluated patients with asthma (age: 18-40 years) from a primary care setting in France and England, who self-completed the EQ-5D-5L questionnaire online. The inclusion criteria were persistent asthma defined as >6 months of prescribed inhaled corticosteroids and long-acting beta-agonists or inhaled corticosteroids alone during the 12 months prior to inclusion. The EQ-5D index was obtained by applying the English preference value set for the new EQ-5D-5L and the French 3L-5L crosswalk value set. Both value sets produced single preference-based indices ranging from 1 (best health state) to negative values (health states valued as worse than death), where 0=death, allowing the calculation of quality-adjusted life years. Responses to dimensions and index distribution, including ceiling and floor effects, were examined. The construct validity was assessed by comparing the means of known groups by analyses of variance and calculation of effect sizes. RESULTS:Of 312 patients answering the baseline Web-based survey, 290 completed the EQ-5D-5L (93%). The floor effect was null, and the ceiling effect was 26.5% (74/279). The mean EQ-5D-5L index was 0.88 (SD 0.14) with the English value set and 0.83 (SD 0.19) with the French 3L-5L crosswalk value set. In both indices, large effect sizes were observed for known groups defined by the Asthma Control Questionnaire (1.06 and 1.04, P<.001). Differences between extreme groups defined by chronic conditions (P=.002 and P=.003 for the English value set and French 3L-5L crosswalk value set, respectively), short-acting beta-agonists (SABAs) canisters in the last 12 months (P=.02 and P=.03), or SABA use during the previous 4 weeks (P=.03 and P=.01) were of moderate magnitude with effect sizes around 0.5. CONCLUSIONS:The new EQ-5D-5L questionnaire has an acceptable ceiling effect, a good construct validity based on the discriminant ability for distinguishing among health-related known groups, and high reliability, supporting its adequacy for assessing the HRQoL in patients with asthma. EQ-5D-5L completion by most Web-based respondents supports the feasibility of this administration form.

Project description:BACKGROUND: In the United Kingdom patient-reported outcome measures (PROMS) have been adopted as a key measure of foot surgery outcomes. The intention of this study was to evaluate the responsiveness of a regional outcome measure; the Manchester Oxford Foot Questionnaire (MOXFQ) and a generic measure; the EuroQol EQ-5D, in the context of day care Podiatric Surgery. METHODS: A prospective audit of 375 consecutive day care surgical admissions was undertaken. All patients attending for surgery, who agreed to participate, were included. Pre operation patients completed the MOXFQ and the EQ-5D. Both questionnaires were completed again at 6?months post operation. Additional data was collected on patient demographics, surgical procedures and complications. RESULTS: Few complications were encountered and most patients (84%) returned for a final review 6?months post operation. Mean MOXFQ scores improved for each domain: pain; 51.7 pre-operation, reduced to 16.5 post-operation, walking; 50.2 reduced to 14.1 and social interaction; 45.7 reduced to 10.6. The minimal clinically important differences (MCID) estimates for the pain domain were exceeded by 82.6% of patients, while 74.8% exceeded the MCID for walking and 68.5% exceeded the MCID for social interaction. A small number of patients (2.9%) deteriorated across all three MOXFQ domains.The EQ-5D Index, summary of health related quality of life, improved from 0.66 pre-operation to 0.86 post operation. The EQ-5D index MCID was exceeded by 79.2% of patients. Index scores deteriorated for 1.8% of patients following surgery. Effect sizes measured following surgery were largest for the MOXFQ domains: Walking; 1.39, Pain; 1.52 and Social Interaction: 1.39. The EQ-5D index effect size was 0.83. The EQ-5D visual analogue scale (VAS) was not influenced by surgery. CONCLUSION: Both the MOXFQ and EQ-5D index (but not the VAS) appear sensitive to changes in health status at 6?months following elective foot surgery. Both instruments were particularly responsive to changes in pain, mobility and activity or social interaction following treatment. The MOXFQ was developed specifically for foot surgery and as such appears to be the more sensitive instrument. However the generic EQ-5D may allow comparison of general health states in the wider health community. Both instruments when used together appear well suited to the measurement of change in perceived health status following foot surgery.

Project description:BackgroundThe EQ-5D-5 L and the SF-12 are the most commonly used generic measures of health-related quality of life among people with arthritis. However, there is little evidence on the extent to which the individual dimensions and domains of these instruments perform among this population. The objective was to examine the discriminative validity of the EQ-5D-5 L and the SF-12 version 2 (and SF-6D) in capturing the burden of arthritis on health-related quality of life in older adults.MethodsCross-sectional data from the Alberta Retired Teachers Association survey were used. A known-groups approach, with a-priori hypotheses, was used to examine the discriminative validity of the domain and summary scores of the EQ-5D-5 L and the SF-12 version 2 (and SF-6D). Groups were defined based on self-reported of arthritis, chronic pain level, presence and number of comorbidities, and self-reported health status.ResultsMean age of respondents (N = 2844) was 68.6 (standard deviation [SD] 5.9) years; 54.8% were female, with mean body mass index (BMI) of 27.2 kg/m2 (SD 4.8), and 36.6% reported having arthritis. The overall mean EQ-5D-5 L index score was 0.86 (SD 0.11) and that of SF-6D was 0.79 (SD 0.13). Participants with arthritis had lower EQ-5D-5 L index score (0.83, SD 0.13) and SF-6D index score (0.75, SD 0.13) compared to those without arthritis (0.88, SD 0.09 and 0.81, SD 0.12, respectively). EQ-5D-5 L and SF-6D index scores demonstrated moderate discriminative validity with a moderate effect size (0.5). Related dimensions and domains between the EQ-5D-5 L and SF-12 (e.g., mobility with physical functioning score, pain/discomfort with bodily pain and anxiety/depression with mental health) were moderately to strongly correlated (r = 0.6-0.7). Both instruments could not adequately discriminate between participants with moderate and severe chronic pain of 6-month duration.ConclusionOverall, the EQ-5D-5 L pain/discomfort and mobility dimensions, and the SF-12 bodily pain scale had moderate discriminative ability among older adults with arthritis. However, both instruments had limited discriminative ability for chronic pain. The importance and nature of chronic pain assessment in a given application need to be considered when choosing any of these instruments for measuring health-related quality of life in this patient population.

Dataset Information

Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain.

Publications

Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain.

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