Abstract
PurposeThis study investigated the psychometric gain, if any, from the extension of the EQ-5D with a cognition bolt-on (EQ-5D + C) in a large cohort injury patients with and without traumatic brain injury (TBI).MethodsHospitalized adult injury patients filled out a survey 1 month after initial admission. The survey included the EQ-5D-3L, the cognition bolt-on item in EQ-5D format, and the visual analogue scale (EQ-VAS). We compared ceiling and other distributional effects between EQ-5D and EQ-5D + C and TBI and non-TBI group, and assessed convergent validity using the predictive association with EQ-VAS. Also, we assessed explanatory power using regression analysis, and classification efficiency using Shannon indices.ResultsIn total, 715 TBI patients and 1978 non-TBI patients filled out the EQ-5D + C and EQ-VAS. Perfect health was reported by 7.9% (N = 214) on the EQ-5D, and 7.3% (N = 197) on the EQ-5D + C. Convergent validity was highest for EQ-5D + C in the TBI group (Spearman’s rank correlation coefficient = − 0.736) and lowest for EQ-5D in the non-TBI group (Spearman’s rank correlation coefficient = − 0.652). For both TBI and non-TBI groups, the explanatory power of EQ-5D + C was slightly higher than of EQ-5D (R2 = 0.56 vs. 0.53 for TBI; R2 = 0.47 vs. 0.45 for non-TBI). Absolute classification efficiency was higher for EQ-5D + C than for EQ-5D in both TBI groups, whereas relative classification efficiency was similar.ConclusionsPsychometric performance in general of both the EQ-5D and EQ-5D + C was better in TBI patients. Adding a cognitive bolt-on slightly improved the psychometric performance of the EQ-5D-3L.
Highlights
The measurement of health-related quality of life (HRQoL) is standard practice in evaluating the impact of health interventions [1]
The added value was analyzed in the form of the distributional benefit, the convergent validity, explanatory power, and classification efficiency of the EQ-5D and EQ-5D + C in a large sample of traumatic brain injury (TBI) and non-TBI patients who were admitted to the hospital due to their injury. We explored this by comparing ceiling and other distribution effects and convergent validity using the predictive association with the EQ-visual analogue scale (VAS)
One in four was diagnosed with TBI (n = 715; 26.6%), where the majority of the TBI patients suffered from mild TBI (n = 550; 76.9%)
Summary
The measurement of health-related quality of life (HRQoL) is standard practice in evaluating the impact of health interventions [1]. HRQoL instruments can be categorized as generic and disease-specific measures, where a. One of the generic instruments that is widely implemented is the EQ-5D. One major advantage of the EQ-5D over other generic HRQoL measurement instruments is its brevity and subsequent low burden to fill out [4, 5]. A downside of the brevity may be that important information for HRQoL is not included in the EQ-5D dimensions, resulting in an instrument that may be unable to capture certain health effects and that is not sensitive for the measurement of HRQoL of all conditions [6, 7]. The EQ-5D is known to measure mainly physical dimensions of health, and lacking information
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