Responsiveness of the EQ-5D-3L in elective shoulder surgery: Does it adequately represent patient experience?

Purpose The aim was to investigate the measurement properties of the EQ-5D-5L utility index in patients after arthroscopic rotator cuff repair (RCR), total shoulder arthroplasty (TSA) or thumb carpometacarpal (CMC I) arthroplasty. Methods In this prospective study, all patients completed the EQ-5D-5L before surgery and 6 months and 1 year after surgery. In addition, RCR patients completed the Oxford Shoulder Score (OSS), TSA patients completed the Shoulder Pain and Disability Index (SPADI) and CMC I patients completed the brief Michigan Hand Outcomes Questionnaire (brief MHQ) at each designated time point. Construct validity (Pearson’s correlation coefficient, r), responsiveness (effect size), minimal important difference (MID), minimal important change (MIC), and floor and ceiling effects of the EQ-5D-5L were determined. To test discriminative ability, EQ-5D-5L utility indices of patients who were in a patient acceptable symptom state (PASS) or not at follow-up were compared using the Mann–Whitney U test. Results We included 153 RCR, 150 TSA, and 151 CMC I patients. The EQ-5D-5L utility index correlated with the OSS (r = 0.73), SPADI (r = − 0.65) and brief MHQ (r = 0.61). The effect sizes were 1.3 (RCR and CMC I group) and 1.1 (TSA). The MID and MIC ranged from 0.027 to 0.209. Ceiling effects were found. The EQ-5D-5L utility index differed significantly between patients being in a PASS versus patients who were not in a PASS. Conclusion The EQ-5D-5L utility index shows good construct validity, responsiveness and discriminative ability in patients after arthroscopic RCR, TSA and CMC I arthroplasty and is suitable to quantify quality of life. Clinical trial registration: This auxiliary analysis is part of a primary study that was originally registered at ClinicalTrials.gov (NCT01954433) on October 1, 2013.

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“…A similar effect size of 1.186 was reported for EQ-5D (version unknown) assessments of patients after TSA [8]. Evans et al [9] and Olerud et al…”

Section: Responsivenesssupporting

confidence: 61%

“…For patients with proximal humeral fractures and carpal tunnel syndrome, the EQ-5D shows good reliability and construct validity [4][5][6][7]. Responsiveness was found to be high in patients after various elective shoulder surgery procedures [8,9], but only moderate to good after interventions targeting the hand [6,10,11].…”

Section: Introductionmentioning

confidence: 99%

Validity, responsiveness and minimal important change of the EQ-5D-5L in patients after rotator cuff repair, shoulder arthroplasty or thumb carpometacarpal arthroplasty

2021

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“…This score gives a self-reported value of 0-100 mm of overall health. Qualityof-life measures contribute with an important aspect of medical treatments, but the responsiveness (the ability to capture clinically meaningful change over time) in shoulder surgery can be questioned for EQ-5D 78,127 . The EQ-5D-3L has also been noted to have a ceiling effect of 46% 78 , and an acceptable ceiling effect is considered to be 15% of scores at the highest levels of functioning.…”

Section: Eq-vasmentioning

confidence: 99%

“…Qualityof-life measures contribute with an important aspect of medical treatments, but the responsiveness (the ability to capture clinically meaningful change over time) in shoulder surgery can be questioned for EQ-5D 78,127 . The EQ-5D-3L has also been noted to have a ceiling effect of 46% 78 , and an acceptable ceiling effect is considered to be 15% of scores at the highest levels of functioning. In a test of external responsiveness against Oxford Shoulder score in rotator cuff patients, EQ-VAS showed a weak but significant external responsiveness, while the EQ-5D-3L showed no responsiveness 78 .…”

Section: Eq-vasmentioning

confidence: 99%

“…The EQ-5D-3L has also been noted to have a ceiling effect of 46% 78 , and an acceptable ceiling effect is considered to be 15% of scores at the highest levels of functioning. In a test of external responsiveness against Oxford Shoulder score in rotator cuff patients, EQ-VAS showed a weak but significant external responsiveness, while the EQ-5D-3L showed no responsiveness 78 .…”

Section: Eq-vasmentioning

confidence: 99%

See 1 more Smart Citation

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

Ranebo

2020

Linköping University Medical Dissertations

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Reversed shoulder arthroplasty for the treatment of proximal humerus fracture in the elderly

Fitschen-Oestern

Behrendt

Martens

et al. 2020

Journal of Orthopaedics

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focused on patients with RSA in view of range of motion, strength, Constant score and a standardized questionnaire. Methods PatientsTwenty three patients at the age of 52-90 years who were operated due to proximal humerus fractures from September 2011 to February 2017 were included in this retrospective study. All patients were provided with a DELTA XTEND prosthesis (DePuy Synthes). Indications for RSA were an extended rotator cuff defect and fracture displacement. An extended rotator cuff defect was defined as tears ≥5 cm or defects with two or more tendons involved. 5 Rotator cuff defects were diagnosed by magnetic resonance imaging (MRI).Patients with severe neurologic, cardiac or pulmonal comorbidities were excluded. All patients gave written informed consent to participate in the study. Ethics approval was obtained from the local ethics committee (No. D463/16). DELTA XTEND prosthesis (DePuy Synthes)The DELTA XTEND prosthesis is a total semi-constrained shoulder arthroplasty. The scapula-humeral joint center of rotation is moved medially and inferiorly, which increases the deltoid lever arm and deltoid tension.Therefore the deltoid muscle can compensate for impaired rotator

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Responsiveness of the EQ-5D-3L in elective shoulder surgery: Does it adequately represent patient experience?

Abstract: The EQ-5D-3L is adequately internally responsive to change following elective shoulder surgery but is unable to differentiate patients demonstrating minimal clinically important change. The EQ-5D therefore only partially reflects patient experience.

Cited by 9 publications

References 34 publications

Validity, responsiveness and minimal important change of the EQ-5D-5L in patients after rotator cuff repair, shoulder arthroplasty or thumb carpometacarpal arthroplasty

Validity, responsiveness and minimal important change of the EQ-5D-5L in patients after rotator cuff repair, shoulder arthroplasty or thumb carpometacarpal arthroplasty

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

Reversed shoulder arthroplasty for the treatment of proximal humerus fracture in the elderly

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