Health-related quality of life in injury patients: the added value of extending the EQ-5D-3L with a cognitive dimension

Robbin H Ophuis,Gouke J Bonsel,Martien J Panneman,Suzanne Polinder,Juanita A Haagsma,Mathieu F Janssen

doi:10.1007/s11136-019-02156-2

Robbin H Ophuis, Gouke J Bonsel + Show 4 more

Open Access

https://doi.org/10.1007/s11136-019-02156-2

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Abstract

IntroductionThe EQ-5D is frequently used to understand the development of health-related quality of life (HRQL) following injury. However, the lack of a cognition dimension is generally felt as disadvantageous as many injuries involve cognitive effects. We aimed to assess the added value of a cognitive dimension in a cohort of injury patients.MethodsWe analyzed EQ-5D-3L extended with cognition (EQ-5D + C) dimension responses of 5346 adult injury patients. We studied dimension dependency, assessed the additional effect of the cognitive dimension on the EQ-VAS, and, using the EQ-VAS as a dependent variable, determined the impact of EQ-5D and EQ-5D + C attributes in multivariate regression analyses.ResultsExtreme cognitive problems combined with no problems on other dimensions are uncommon, whereas severe problems on other dimensions frequently occur without cognitive problems. The EQ-VAS significantly decreased when cognitive problems emerged. Univariate regression analyses indicated that all EQ-5D + C dimensions were significantly associated with the EQ-VAS. Exploratory analyses showed that using any set of five of the six EQ-5D + C dimensions resulted in almost identical explained variance, and adding the remaining 6th dimension resulted in a similar additional impact.ConclusionsThe addition of the cognition dimension increased the explanatory power of the EQ-5D-3L. Although the increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQoL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions.

Highlights

The EQ-5D-3L attributes model from 45.6% (EQ-5D) is frequently used to understand the development of health-related quality of life (HRQL) following injury
We considered the profiles with level 3 (L3; extreme problems) on one dimension (A) and level 1 (L1; no problems) on another dimension (B)
The ratio of the relative frequencies of cognition L3 & dimension L1 and cognition L1 & dimension L3 was < 1.0 for all the dimensions. These findings indicate that cognition is dominant over the other dimensions: extreme cognitive problems and no problems on other dimensions are uncommon, whereas extreme problems on other dimensions frequently occur with no cognitive problems

Summary

Introduction

The EQ-5D is frequently used to understand the development of health-related quality of life (HRQL) following injury. The increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQoL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions. Assessing variations of health-related quality of life (HRQL) following injury is. The question whether dimensions should be added to the EQ-5D from a generic perspective has been debated and researched since its launch in the beginning of the 1990s. These additional dimensions are referred to as bolt-on dimensions (‘bolt-ons’); dimensions that describe additional specific health problems.

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