Abstract
This study compares the empirical performance of a commonly used functional-status measure, the Barthel Index (BI), to that of a widely used generic preference-based instrument, the EuroQoL-5-Dimensions 3 Level (EQ-5D-3L), in older people. Data from older people receiving rehabilitation services were used to test the validity of the BI and EQ-5D-3L. Convergent validity was investigated using Spearman’s correlation, exploratory factor analysis (EFA), scatter plots, Krippendorff’s alpha and modified Bland-Altman plots. Discriminant validity was examined using Kruskal Wallis tests, ceiling effects and EFA. A total of 1690 participants were included in the analysis. The BI total and EQ-5D-3L utility scores showed moderate correlation (r = 0.51; Krippendorff’s alpha = 0.52). Kendall’s Tau-B correlations between BI items and EQ-5D-3L dimensions measuring the same construct were weak to moderate (0.05 ≤ absolute r ≤ 0.54). In the EFA, some BI items cross-loaded onto the same factors as EQ-5D-3L dimensions, suggesting that the instruments were interrelated. The BI, however, focuses more on physical functioning, while the EQ-5D-3L measures broader wellbeing concepts. Both instruments showed good discriminant validity and would therefore be equally valuable for measuring subgroup differences. Researchers should consider using the BI in rehabilitation to capture more physical functioning-specific constructs not measured by the EQ-5D-3L.
Highlights
Health-related quality of life (HRQoL) and functional status are interrelated concepts that reflect important outcomes for older people receiving rehabilitation interventions.HRQoL indicates a person’s overall health status applicable in different contexts, including clinical studies, health care economic evaluations and population health surveys [1]
When considering health status measures for potential use in economic evaluation within rehabilitation research targeted at older people, our analysis shows that the two instruments are both suitable as they were able to demonstrate discriminant validity
There is no gold standard for measuring outcomes in populations of older people due to the heterogeneous impacts that conditions affecting them may have on health status, physical functioning and quality of life
Summary
Health-related quality of life (HRQoL) and functional status are interrelated concepts that reflect important outcomes for older people receiving rehabilitation interventions.HRQoL indicates a person’s overall health status applicable in different contexts, including clinical studies, health care economic evaluations and population health surveys [1]. Health-related quality of life (HRQoL) and functional status are interrelated concepts that reflect important outcomes for older people receiving rehabilitation interventions. Functional status and preventing functional decline, in particular, is seen as one of the prime objectives of health care for older people during rehabilitation [2], with a reduction in physical function linked to loss of independence, the need for hospital and long-term nursing-home care, premature death and quality of life decline [3,4,5,6]. Functional status is critical when assessing the effectiveness of rehabilitation interventions as such interventions are organized and provided to ensure attainment of optimal functional improvement [8]. The assessment of an individual’s functional status is central to the process of rehabilitation [9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
