EQ-5D-5L Index Research Articles

Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients.

The primary aim was to investigate the health-related quality of life (HRQOL) in patients treated for a patella fracture. The explorative aim was to report the associations between HRQOL, knee osteoarthritis, muscle strength and gait function. The study design was a cohort study. Patients who were treated for patella fractures at Aalborg University Hospital, Denmark between January 2006 and December 2009 were identified. Patients between the age of 18 and 80 were included. The main outcome was assessed by the EQ5D-5L questionnaire. Classifications by Sperner and Kellgren/Lawrence were applied to evaluate osteoarthritis. Moreover, functional outcomes were evaluated by: KOOS, muscle strength and gait analysis. Forty-nine patients were included with a mean follow-up time of 8.5years. The mean age was 53.9years. The mean EQ5D-5L index value was 0.741, and was significantly worse compared to a reference population. X-rays taken at the time of diagnosis and the time of follow-up showed progression towards a higher degree of osteoarthritis in the injured knee for both the patellofemoral and tibiofemoral joints. Patients demonstrated significantly lower knee extension strength in the injured leg compared to the non-injured leg (P = 0.011). No significant difference in gait speed and cadence were observed compared to the reference population. Knee osteoarthritis, muscle strength and gait patterns were not associated with HRQOL (R < 0.35). At 8.5years following a patella fracture, HRQOL was significantly worse compared to an age-matched reference population.

Evaluación de los cuidados recibidos por pacientes con enfermedades crónicas

ObjectiveThe aim of this study is to assess the care received by chronic patients from their point of view and objectify the factors related with a better assessment of care. DesignCross-sectional descriptive study realized between September 2014 and April 2015. LocationNine Health Centers of Navarra (6 urban and 3 rural), Spain. ParticipantsSampling opportunity of 196 patients aged over 65years presenting at least one chronic disease. Main measuresOutcome variable: Evaluation of the care received through the Patient Assessment of Chronic Illness Care (PACIC) test (score 1 to 5, higher values indicate better perception about quality of care). Explanatory variables: quality of life employing the EQ5D instrument, Katz index and Gijón's socio-family evaluation scale. Other variables studied were: sex, age, education, Charlson index and number of chronic diseases. The association between the PACIC numerical value with the rest of the variables was calculated. ResultsThe assessment of the care received according to the PACIC was higher with more chronic diseases (rho: 0.196; p=0.006), with less autonomy (mild or no disability: mean 2.9; SD: 0.6 vs. moderate or severe disability: mean 3.3; SD: 0.2; P=.003), in those with worse quality of life (EQ5D5L Index value rho: −0.227; P=.001. EQ VAS rho: −0.145; P=.043), and in those with a more favorable social situation (rho: −0.167; P=.022). ConclusionsThe perception of chronic patients about the received care is better with an increased number of chronic diseases and with less autonomy and quality of life. The social environment influences the care perception of the patient, being this worse in environments with higher social risk.

A prospective observational study of 56 patients treated with ring fixator after a complex tibial fracture

The objective of this prospective study was to evaluate the patient-reported outcomes for patients with complex tibial fractures treated with a ring fixator. The secondary aim was to analyse the variables affecting patient-reported outcomes and time to union. Fifty-six patients participated in the study. The mean age at the time of fracture was 56.5 years (range 30–86). All fractures united during the study period. The ring fixator was removed at an average of 25.3 weeks (range 9–53). During treatment, the function and QOL increased with time. Compared with an established reference population, the study population showed a significantly worse EQ5D-5L index both throughout the treatment period and 8 weeks after frame removal. 18% of patients reported mild to severe depression 8 weeks after frame removal.

Comparison of 3-Month Stroke Disability and Quality of Life across Modified Rankin Scale Categories

Background and Purpose: Modified Rankin Scale (mRS) score 0-2 has been used to define “good outcome” while stroke patients with mRS 3 are grouped with mRS 4-6 as having “poor outcome.” Long-term data comparing quality of life (QoL), particularly across the mRS 2, 3, and 4 subgroups, are sparse. Methods: Participants in the Interventional Management of Stroke 3 (IMS3) trial with documented 3-month mRS, functional disability (Barthel index [BI]), and self-reported EQ5D-3L QoL questionnaires at 3 months after stroke were included. EQ5D-3L summary indices were calculated using published utility weights for the US population. BI and EQ5D-3L indices were compared across mRS categories using multiple pairwise comparisons with appropriate alpha error corrections. Results: Four hundred twenty-three patients were included (mean age 64 ± 13 years, median baseline NIHSS 16 [IQR 12-19], mean BI 84.1 ± 25.3, and mean EQ5D-3L index 0.73 ± 0.24). While significant differences in BI were observed across mRS categories, QoL in the mRS 2 and 3 categories was similar. Based on BI and EQ5D-3L index, mRS 3 status was more similar to mRS 2 than to mRS 4 status, and large heterogeneity in the mRS 3 group was observed. Conclusions: Ischemic stroke patients who achieve mRS 2 and 3 functional outcomes seem to have similar health-related QoL scores. mRS 0-3, rather than 0-2, should be considered a good outcome category in moderate to severe ischemic stroke.

One-year development of QOL following orthopaedic polytrauma: a prospective observational cohort study of 53 patients.

Most studies of polytrauma examined highly mixed patient groups. The objective of the present study was to report the development of patient-reported quality of life (QOL), in a patient group with musculoskeletal polytrauma, excluding patients with major thoracic, abdominal, and brain injuries. The study design was a 1-year cohort follow-up study. Recordings of injury severity were measured with the ISS and NISS. Patient-reported QOL was measured with the questionnaires Eq5d-5L and SF-36 and compared to age-matched reference populations. Moreover, patients return to work status was measured. Data were collected prospectively at discharge, 3, 6, and 12months. 53 patients were included. The mean age was 42.3years, ranging from 17 to 78years. Twelve months after trauma admission, the mean Eq5d-5L index was 0.601 (95% CI 0.546-0.657). A progressive increasing Eq5d-5L index and SF-36 PCS was observed between the discharge and the 12-month follow-up (p<0.001). The development in QOL from 6 to 12 months almost shows identically scores. Throughout the study period, patients reported significant worse QOL compared with the established reference population. 32% of patients have resumed earlier employment status at 1-year follow-up. Throughout the 12-month observational period, patients reported worse QOL compared to the age-matched reference population. The development of QOL from 6- to 12-month time points almost showed identically scores with only little improvement. At the end of 1-year follow-up, 32% of patients had resumed prior employment status.

Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture: a prospective 1-year follow-up cohort study

To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12months postoperatively after intramedullary nailing of a tibial shaft fracture. The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6weeks, 3, 6, and 12months postoperatively. Ipsilateral MVCs were recorded at 6 and 12months. Forty-nine patients were included. The mean age at the time of fracture was 43.1years (18-79years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95% CI 0.747-0.837). Throughout the 12months postoperatively, patients reported worse QOL compared to the reference population. Six and 12months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P<0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R=0.541, P<0.001). Throughout the 12months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12months compared with the injured leg.

Quality of survival the 1st year with glioblastoma: a longitudinal study of patient-reported quality of life.

By exploring longitudinal patient-reported health-related quality of life (HRQoL), the authors sought to assess the quality of survival for patients in the 1st year after diagnosis of glioblastoma. Thirty unselected patients ≥ 18 years who underwent primary surgery for glioblastoma in the period 2011-2013 were included. Using the generic HRQoL questionnaire EQ-5D 3L, baseline HRQoL was assessed before surgery and at postoperative follow-up after 1, 2, 4, 6, 8, 10, and 12 months. There was an apparent correlation between deterioration in HRQoL scores and tumor progression. Patients with permanent deterioration in HRQoL early after surgery represented a subgroup with rapid progression and short survival. Both positive and negative changes in HRQoL were more often seen after surgery than after radio- or chemotherapy. Patients with gross-total resection (GTR) reported better and more stable HRQoL. In a multivariable analysis preoperative cognitive symptoms (p = 0.02), preoperative functional status (p = 0.03), and GTR (p = 0.01) were independent predictors of quality of survival (area under the curve for EQ-5D 3L index values). The results indicate that progression-free survival is not only a surrogate marker for survival, but also for quality of survival. Quality of survival seems to be associated with GTR, which adds further support for opting for extensive resections in glioblastoma patients with good preoperative functional levels.

The outcome after lateral tibial plateau fracture treated with percutaneus screw fixation show a tendency towards worse functional outcome compared with a reference population.

The objective of this study was to evaluate the functional and radiological outcome after lateral tibial plateau fractures (Müller AO classification (AO) 41-B1, B2 and B3) treated with minimal invasive bone tamp reduction and percutaneous screw fixation. Retrospective, cross-sectional study. Review and clinical examination of 37 patients treated between 2005 and 2010. The patients completed a clinical examination, Knee Injury and Osteoarthritis Outcome Score (KOOS) and questionnaire evaluating QOL (Eq5D-5L). Thirty-seven patients agreed to participate (76%). Mean time of follow-up was 5.2years. At final follow-up, maintained anatomical joint reduction was achieved in 34 patients. The mean KOOS score was pain=84.4, ADL=88.4, symptoms=80.7, QOL=70.3, sport=59.6. Compared with the established KOOS reference population patients, the current study reports a tendency towards worse KOOS scores but is only significant for KOOS sport. The mean Eq5D-5L index was 0.815 and shows a tendency towards worse outcome compared with the reference population. Mean knee flexion: 125.7° (95-135). A reduced number of sit-to-stands in the mean 30-s chair stand test showed a significant negative association with KOOS. The study showed a significant association between younger age at surgery and worse KOOS outcome. At 5.2-year follow-up, the patients reported a tendency towards worse KOOS and Eq5D-5L scores compared with established reference populations. This study shows a significant association between a decrease in muscle strength and worse KOOS outcome. Furthermore, a significant association between younger age at the time of surgery and worse KOOS outcome score was observed.

Quality of life assessed with EQ-5D in patients undergoing glioma surgery: What is the responsiveness and minimal clinically important difference?

To evaluate the responsiveness of EQ-5D 3L in patients undergoing intracranial glioma surgery and estimate the minimal clinically important difference (MCID). EQ-5D 3L index values from 164 patients who underwent glioma surgery in the period 2007-2012 were analysed. Responsiveness and MCID were estimated using a combination of distribution-based and anchor-based methods. Karnofsky performance status served as an anchor. Patients who improved functionally did not report significantly higher EQ-5D 3L scores post operatively with a standardized response mean (SRM) of 0.04 (p=0.13). Patients who deteriorated functionally reported significantly lower EQ-5D 3L scores post operatively with a SRM of 0.72 (p<0.001). With different approaches, we determined a range of MCID values from 0.13 to 0.15. EQ-5D 3L is responsive to changes when glioma patients are deteriorating functionally after surgery but not responsive when the patients are improving. The MCID values for EQ-5D 3L in glioma surgery seem higher than reported MCID values for other types of cancers.

Health‐related quality of life in genotype 1 treatment‐naïve chronic hepatitis C patients receiving telaprevir combination treatment in the ADVANCE study

Chronic hepatitis C virus (HCV) infection and its treatment impact patients' health-related quality of life (HRQL). To report on treatment impact and predictors of HRQL among treatment-naïve patients with genotype 1 chronic HCV infection who received 12-week telaprevir (T) with 24 (T12PR24) or 48 weeks (T12PR48) peginterferon alpha-2a/ribavirin (PR), or 48 weeks of PR in the ADVANCE study. The EQ-5D-3L (EQ-5D) questionnaire (index range: 0-1) was completed at baseline and weeks 4, 12, 24, 36, 48 and 72. Patients indicated their health state on five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Descriptive statistics for the EQ-5D index and descriptive system and area under the curve from baseline to week 12 were calculated. Predictors of EQ-5D index were identified using multivariate analyses. Data from 722 patients were included. The mean EQ-5D index decreased during the first 12 weeks and returned to baseline by week 72 (T12PR24 by week 36) across treatments. In multivariate analysis, sustained virological response (SVR) at week 72 was associated (P < 0.0001) with improved EQ-5D index [mean; SVR+ (0.90), SVR- (0.86)], a 4% difference, within the published range of minimal clinically important difference. Post hoc analyses of data from ADVANCE suggested that HRQL worsened during the first 12 weeks of therapy and returned to baseline by week 72 across treatments. Improvements were observed early following completion of a 24-week treatment (T12PR24). Telaprevir combination therapy was associated with slightly higher reductions in HRQL during the first 12 weeks (vs. PR). SVR was a statistically significant and meaningful predictor of HRQL at week 72.