Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review.

Abstract

The EuroQol-5 Dimension (EQ-5D) is the most widely used generic instrument to measure quality of life (QoL), yet its application in upper extremity orthopaedics as well as its measurement properties remain largely undefined. We implemented a systematic literature review to provide an overview of the application of EQ-5D in patients with upper extremity disorders and analyse its measurement properties. We searched Medline, EMBASE, Cochrane and Scopus databases for clinical studies including orthopaedic patients with surgical interventions of the upper extremity who completed the EQ-5D. For all included studies, the use of EQ-5D and quantitative QoL data were described. Validation studies of EQ-5D were assessed according to COSMIN guidelines and standard measurement properties were examined. Twenty-three studies were included in the review, 19 of which investigated patients with an intervention carried out at the shoulder region. In 15 studies, EQ-5D assessed QoL as the primary outcome. Utility index scores in non-trauma patients generally improved postoperatively, whereas trauma patients did not regain their recalled pre-injury QoL levels. EQ-5D measurement properties were reported in three articles on proximal humerus fractures and carpal tunnel syndrome. Positive ratings were seen for construct validity (Spearman correlation coefficient ≥ 0.70 with the Short Form (SF)-12 or SF-6D health surveys) and reliability (intraclass correlation coefficient ≥ 0.77) with intermediate responsiveness (standardised response means: 0.5-0.9). However, ceiling effects were identified with 16-48% of the patients scoring the maximum QoL. The methodological quality of the three articles varied from fair to good. For surgical interventions of the upper extremity, EQ-5D was mostly applied to assess QoL as a primary outcome in patients with shoulder disorders. Investigations of the measurement properties were rare, but indicate good reliability and validity as well as moderate responsiveness in patients with upper extremity conditions.