Abstract
BackgroundPressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration.MethodsA survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman’s correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables.ResultsThe total number of participants was 307, including 273 from the acute setting (52 % response rate) and 41 from the community (32 %). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score.ConclusionsThe results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from this group of patients related to poor clinical condition and mental capacity. The most effective method for obtaining survey data was through the hand held devices and interviewers.
Highlights
Interventions to prevent and treat pressure ulcers have been identified as a major cost for healthcare providers [1]
There are a number of concerns with the use of condition specific preference-based Patient reported outcome measures (PROMS)
The utilities derived cannot be compared, and secondly the impact of comorbidities and/or side-effects may not incorporated into any assessment of quality of life [10]
Summary
Interventions to prevent and treat pressure ulcers have been identified as a major cost for healthcare providers [1]. The cost of treating pressure ulcers depends on their severity and category, and has been estimated as £1214 for the least severe (Category 1) and £14,108 for the most severe (Category 4) [3] Despite these costs evidence for the cost effectiveness of treatment and prevention strategies is poor [4]. In order to undertake economic evaluations of treatments and prevention strategies for pressure ulcers one essential component is the ability to evaluate their impact on quality of life. This can be done using preference-based patient reported outcome measures (PROMs) which can be used to derive utility values that, when combined with mortality data, can be used to generate Quality Adjusted life Years (QALYs) [5]. The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration
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