Abstract
BackgroundElectronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice. This study evaluated the validity and psychometric properties of an electronic version of the EQ-5D-5L (e-EQ-5D-5L) in Chinese patients with chronic knee and/or back problems.Methods151 Chinese subjects completed an electronic version of the Chinese (Hong Kong) EQ-5D-5L when they attended a primary care or orthopedics specialist out-patient clinic in Hong Kong. They also completed the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a Pain Rating Scale, and a structured questionnaire on socio-demographics, co-morbidities and health service utilization. 32 subjects repeated the e-EQ-5D-5L two weeks after the baseline. 102 subjects completed e-EQ-5D-5L and 99 completed the Global Rating on Change Scale at three-month clinic follow up. Construct validity was assessed by the association of EQ-5D-5L scores with external criterion of WOMAC scores. We tested mean differences of WOMAC scores between adjacent response levels of the EQ-5D-5L dimensions by one-way ANOVA, test–retest reliability by intra-class correlation, sensitivity by known group comparisons and responsiveness by changes in EQ-5D-5L scores over 3 months.ResultsThere was an association between EQ-5D-5L and WOMAC scores. Mean WOMAC scores increased with the increase in adjacent response levels of EQ-5D-5L dimensions. Test–retest intraclass correlation coefficient (ICC) of EQ-5D-5L utility and EQ-VAS scores were 0.76 and 0.83, respectively, indicating good reliability. There were significant differences in the proportions reporting limitations in the EQ-5D-5L dimensions, the utility and VAS scores between the mild and severe pain groups (utility = 0.28, p = 0.001; VAS = 11.46, p < 0.001), and between primary care and specialist out-patient clinic patients (utility = 0.15, p = 0.001; VAS = 10.21, p < 0.001), supporting sensitivity. Among those reporting ‘better’ global health at three-months, their EQ-5D-5L utility and EQ-VAS scores were significantly increased from baseline (utility = 0.18, p < 0.001; VAS = 10.75, p = 0.005).ConclusionsThe electronic version of the EQ-5D-5L is valid, reliable, sensitive and responsive in the measurement of HRQOL in Chinese patients with chronic knee or back pain in routine clinical practice.
Highlights
Electronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice
We missed the follow up of two General outpatient clinic (GOPC) subjects who attended follow up consultations during the weekends when our research assistants were off duty. 102 subjects (85 from GOPC and 17 from Specialist out-patient clinic (SOPC)) completed the three-month follow-up assessment, but 3 subjects from the SOPC group did not respond to the Global Rating Scale (GRS)
We explored whether educational level had an effect on the e-EQ-5D-5L results, and found no statistically significant difference in the EQ-5D-5L, utility and EQ-Visual analogue scale (VAS) scores among three education level groups
Summary
Electronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice. Lam et al Health and Quality of Life Outcomes (2021) 19:266 to assess the impact of illnesses and the effect of interventions on patients, monitor the health conditions of individual patients, and evaluation of quality of care [2,3,4]. The original version, the EQ-5D three-level (EQ-5D-3L), contains three response options: ‘no problems’, ‘some/ moderate problems’ and ‘extreme problems/unable to’ for each of the five items [14, 15]. The EQ-5D has been shown to be a useful HRQOL measure in providing a more holistic picture of the health of patients [11, 18], for monitoring responses to treatment/surgery [19, 20], assessing the quality of care [21] and for health-economic evaluation [19]. The completion of HRQOL measures has been found to enable patients to be more aware of their health conditions and how the diseases affect them, which empower them to raise any issues or concerns with their clinicians [22, 23]
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