A pilot study on the validity and psychometric properties of the electronic EQ-5D-5L in routine clinical practice

Abstract

Background Electronic measurement of health-related quality of life (HRQOL) may facilitate timely and regular assessments in routine clinical practice. This study evaluated the validity and psychometric properties of an electronic version of the EQ-5D-5L (e-EQ-5D-5L) in Chinese patients with chronic knee and/or back problems. Methods 151 Chinese subjects completed an electronic version of the Chinese (Hong Kong) EQ-5D-5L when they attended a primary care or orthopedics specialist out-patient clinic in Hong Kong. They also completed the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), a Pain Rating Scale, and a structured questionnaire on socio-demographics, co-morbidities and health service utilization. 32 subjects repeated the e-EQ-5D-5L two weeks after the baseline. 102 subjects completed e-EQ-5D-5L and 99 completed the Global Rating on Change Scale at three-month clinic follow up. Construct validity was assessed by the association of EQ-5D-5L scores with external criterion of WOMAC scores. We tested mean differences of WOMAC scores between adjacent response levels of the EQ-5D-5L dimensions by one-way ANOVA, test–retest reliability by intra-class correlation, sensitivity by known group comparisons and responsiveness by changes in EQ-5D-5L scores over 3 months. Results There was an association between EQ-5D-5L and WOMAC scores. Mean WOMAC scores increased with the increase in adjacent response levels of EQ-5D-5L dimensions. Test–retest intraclass correlation coefficient (ICC) of EQ-5D-5L utility and EQ-VAS scores were 0.76 and 0.83, respectively, indicating good reliability. There were significant differences in the proportions reporting limitations in the EQ-5D-5L dimensions, the utility and VAS scores between the mild and severe pain groups (utility = 0.28, p = 0.001; VAS = 11.46, p < 0.001), and between primary care and specialist out-patient clinic patients (utility = 0.15, p = 0.001; VAS = 10.21, p < 0.001), supporting sensitivity. Among those reporting ‘better’ global health at three-months, their EQ-5D-5L utility and EQ-VAS scores were significantly increased from baseline (utility = 0.18, p < 0.001; VAS = 10.75, p = 0.005). Conclusions The electronic version of the EQ-5D-5L is valid, reliable, sensitive and responsive in the measurement of HRQOL in Chinese patients with chronic knee or back pain in routine clinical practice.

Feasibility and acceptability of electronic EQ-5D-5L for routine measurement of HRQOL in patients with chronic musculoskeletal problems in Hong Kong primary care

“…An electronic version (e-EQ-5D-5L) is available and has been used in many HRQOL outcome studies [ 16 – 19 ]. Our previous study confirmed the validity, reliability and responsiveness of the e-EQ-5D-5L in Chinese primary care patients in Hong Kong [ 20 ]. Research supports that e-EQ-5D-5L measures in clinical practice identify more HRQOL problems and result in more actions by clinicians to tackle them [ 21 ].…”

“…This study is part of a larger single-blind cluster randomized controlled trial (RCT) to evaluate the effectiveness of measuring and reporting HRQOL in routine clinical practice and the protocol has been published [ 20 ]. All doctors from three public primary care clinics that implement routine measurement of HRQOL by an e-EQ-5D-5L were invited to participate and signed a consent form.…”

“…Doctors were trained to interpret the e-EQ-5D-5L profile and visual analogue scale (VAS) scores (collectively referred to as e-EQ-5D-5L/VAS). All adults aged 18 years or above with symptomatic chronic knee and/or back problems visiting the clinics were invited to participate based on the RCT’s inclusion and exclusion criteria [ 20 ]. In brief, the inclusion criteria were adults aged 18 years or above; had a doctor-diagnosed symptomatic knee and/or back problem that was expected to last for one month or more; scheduled for at least one follow-up visit in the clinic within 12 months; had given written consent to participate in the study.…”

“…Electronic administration can be challenging for older patients who have low education levels [ 40 ] and are not familiar with computer technology [ 41 ]. The Chinese (Hong Kong) e-EQ-5D-5L is a valid, reliable, sensitive, and responsive measurement of HRQOL of Chinese patients with musculoskeletal problems in routine clinical practice [ 20 ]. This study aimed to evaluate the feasibility and acceptability of an electronic platform for timely, regular measurement and reporting of e-EQ-5D-5L HRQOL data in assessing patients with chronic knee and back (collectively referred to as musculoskeletal) problems in primary care.…”

Validation of the Mobile App Version of the EQ-5D-5L Quality of Life Questionnaire Against the Gold Standard Paper-Based Version: Randomized Crossover Study

“…The EQ-5D-5L questionnaire is available in various modes of administration, including smartphones [13]. Several studies have used the electronic version of the EQ-5D-5L questionnaire and indicated the electronic version valid and reliable [10,[14][15][16]. However, the Q1.6 mobile app of the EQ-5D-5L is designed to reduce the response burden of questionnaires by presenting a single question at a time and only querying 2 questions a day rather than the whole questionnaire at once.…”