Comparison of EQ-5D-3L and 5L versions following operative fixation of closed ankle fractures

Andrew Garratt,Knut Stavem

doi:10.1007/s11136-022-03105-2

Abstract

PurposeTo undertake the first testing and comparison of measurement properties for the EuroQol EQ-5D-3L and 5L in patients with ankle problems.MethodsThe cross-sectional postal survey of 959 patients aged ≥ 18 years, who underwent surgical treatment (ORIF) for unstable and closed ankle fractures in Eastern Norway. Both the EQ-5D-3L and 5L were included in a postal questionnaire in 2015, 3–6 years post surgery. Missing data, floor and ceiling effects, and response consistency were assessed. Tests of validity included comparisons with scores for the SF-36 and widely used ankle-specific instruments. The 5L version was assessed for test–retest reliability.ResultsThere were 567 (59%) respondents; 501 completed both versions and 182 (61%) the 5L retest questionnaire. The 5L outperformed the 3L in tests of data quality and classification efficiency. Correlations with scores for other instruments largely met expectations, those for the 5L being slightly higher. All 5L scores had acceptable levels of reliability. For the 5L index, the smallest detectable differences for group and individual comparisons were 0.02 and 0.20, respectively.ConclusionThe 5L outperformed the 3L in terms of data quality, number of health states assessed and tests of validity. The 5L is recommended in research and other applications following surgery for ankle fracture but further testing including responsiveness to change is recommended at clinically relevant follow-up periods.

Highlights

The EQ-5D is the most widely used short-form generic patient-reported outcome measure (PROM) suitable for economic evaluation
Comprising just six questions or dimensions, the brevity of the EQ-5D has contributed to its application alongside ankle-specific instruments [7], which it complements through its broader focus on general aspects of health and
Systematic literature searches of PubMed show that the EQ-5D has been used in 28 studies of ankle fractures and/or ankle surgery including 8 randomized controlled trials and 5 economic evaluations

Summary

Introduction

The EQ-5D is the most widely used short-form generic patient-reported outcome measure (PROM) suitable for economic evaluation. National applications include the National Health Service’s Patient-Reported Outcome Measures (PROMs) programme for England [3] and Scandinavian medical registers [4,5,6]. Quality of Life Research suitability for economic evaluation. For PROMs to be considered appropriate for such applications it is important that they meet widely recognized measurement criteria including reliability and validity. The scores for ankle-specific PROMs have been compared with those for the EQ-5D in testing the validity of the former [8, 9], there is no published evaluation of the EQ-5D measurement properties in patients with ankle fractures or ankle problems more generally

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Discussion

Conclusion