Abstract
PurposeThis study investigated the psychometric yield of extension of the EQ-5D-5L with a cognitive domain (EQ-5D+C) in a mixed cohort of trauma patients with repeated data.MethodsA stratified sample of patients that presented at the emergency department filled out a follow-up survey 6 and 12 months after trauma. The surveys included the EQ-5D-5L+C, EQ-VAS, and the impact of events scale-revised (IES-R), a validated post-traumatic stress disorder (PTSD) self-assessment scale. Generally, results of the EQ-5D and EQ-5D+C were compared. Psychometrics included the following: distributional features (ceiling/floor effects), discriminatory performance, convergent validity with the EQ-VAS as reference, and responsiveness to change. Psychometric properties were compared between predefined subgroups based on conditions with cognitive impact (Traumatic Brain Injury (TBI)/PTSD).ResultsIn total, 1799 trauma patients responded 6 and 12 months after trauma, including 107 respondents with PTSD, and 273 with TBI. Six months post-trauma, ceiling of the EQ-5D (26.3%) was reduced with 2.2% with the additional cognitive domain. Using EQ-VAS as reference, convergent validity increased slightly with the addition of the cognitive domain: correlation increasing from 0.651 to 0.664. Cognitive level was found to slightly improve over time in TBI (delta: 0.04) and PTSD patients (delta: 0.05), while (almost) no change was found in patients without TBI and PTSD.ConclusionAdding a cognitive domain to the EQ-5D-5L slightly improved measurement properties and better captured change in health status for trauma patients with TBI and PTSD. Inclusion of the cognitive domain in the EQ-5D-5L when measuring in populations with cognitive problems should be considered.
Highlights
Measuring health-related quality of life (HRQL) is an important aspect of research in trauma patients [1]
Comparing the diversity of the different subgroups, taking sample size into account, we found that respondents with post-traumatic stress disorder (PTSD) showed the highest Shannon indices (H′ = 6.32 and J′ = 0.54 for EQ-5D and H′ = 6.60 and J′ = 0.47 for EQ-5D-5L with a cognitive domain (EQ-5D+C)), indicating that the group of respondents with PTSD was more heterogeneous in terms of health profiles (Table 2)
This study investigated the potential gain of adding a cognitive domain to the EQ-5D-5L and analysed the distributional effects, construct validity and responsiveness to change of the instrument in a group of trauma patients with measurement of HRQL at 6 and 12 months after trauma
Summary
Measuring health-related quality of life (HRQL) is an important aspect of research in trauma patients [1]. HRQL can be measured with either a generic or a disease-specific measurement instrument [2]. One of the most widely used preference-based generic health status instruments is the EQ-5D [3]. The EQ-5D is a measurement instrument based on. The EQ-5D-3L is known to show a ceiling distribution, which implies that the ability to measure small changes in the upper part of the health scale is limited [7]. Stated otherwise: the instrument does not artificially increase distances in the upper part of the scale for the sake of discrimination. The three-level version and five-level version have been compared in previous studies to determine whether a 5-level response scale adds value to the measurement instrument. Janssen et al [8], for example, reported that
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