What is measured by the composite, single-item pain/discomfort dimension of the EQ-5D-5L? An exploratory analysis

Engel, Lidia; Whitehurst, David G. T.; Haagsma, Juanita A.; Janssen, Mathieu F.; Mulhern, Brendan

doi:10.1007/s11136-022-03312-x

Cited by 4 publications

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“…A recent measurement characteristic of EQ-5D-5L that has received attention in the literature is the use of 'composite' dimensions that measure two constructs (PD and AD) [30][31][32]. The correlations between EQ PD and PROMIS PA, and EQ AD and PROMIS A and D inform this issue to some extent.…”

Section: Discussionmentioning

confidence: 99%

Understanding the measurement relationship between EQ-5D-5L, PROMIS-29 and PROPr

et al. 2023

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Purpose Many generic patient-reported instruments are available for the measurement of health outcomes, including EQ-5D-5L, and the Patient-Reported Outcome Measurement Information System (PROMIS). Assessing their measurement characteristics informs users about the consistency between, and limits of, evidence produced. The aim was to assess the measurement relationship between the EQ-5D-5L descriptive system and value sets, the PROMIS-29 and PROPr (PROMIS value set). Methods Data were extracted from a cross-sectional survey administering measures of quality of life online in Australia. Descriptive analysis, agreement and construct validity assessment methods were used to compare instruments at the item, domain and value set level. Results In total, 794 Australians completed the survey. Convergent validity analysis found that similar dimensions across instruments were highly correlated (> 0.50), but the PROMIS-29 assesses additional health concepts not explicitly covered by EQ-5D (sleep and fatigue). Known-group assessment found that EQ-5D-5L and PROPr were able to detect those with and without a condition (ES range 0.78–0.83) but PROPr could more precisely detect differing levels of self-reported health. Both instruments were sensitive to differences in levels of pain. Discussion There is some consistency in what the EQ-5D-5L, PROMIS-29 and PROPr measure. Differences between value set characteristics can be linked to differences what is measured and the valuation approaches used. This has implications for the use of each in assessing health outcomes, and the results can inform decisions about which instrument should be used in which context.

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Section: Discussionmentioning

confidence: 99%

Understanding the measurement relationship between EQ-5D-5L, PROMIS-29 and PROPr

et al. 2023

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“…itching) or because pain is mentioned first in the composite dimension. Without explicit descriptors, respondents may interpret discomfort as a mild form of pain and not associate other forms of discomfort [6]. In another study, respondents described pain, such as headaches or musculoskeletal pain, as a kind of discomfort [4].…”

Section: Introductionmentioning

confidence: 99%

“…For instance, if a patient feels slightly depressed and moderately anxious, it may be challenging to obtain an appropriate report on the composite dimension of the EQ-5D. To date, only a few studies have explored the use and interpretation of the composite dimensions of the EQ-5D in self-report and valuation [4][5][6][7][8]. The results suggest that respondents mainly use the P/D dimension to report pain, while the A/D dimension is largely used to report problems on the component that is considered most severe [7].…”

Section: Introductionmentioning

confidence: 99%

“…A recent study explored the measurement properties of the EQ-5D-5L P/D by drawing comparisons to pain or discomfort items included in the EQ Health and Wellbeing (EQ-HWB) measure [6,9]. It demonstrated that the EQ-5D-5L P/D dimension captures aspects of pain more than aspects of discomfort, which could be driven by the absence of descriptors for discomfort (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…While previous studies have consistently demonstrated that people respond differently to the composite dimensions compared with its split versions [4][5][6][7][8], there is a lack of studies that examined the psychometric properties of these by drawing comparisons to widely validated and accepted disease-specific tools. Further research is required to explore the validity of the composite versus split version of the A/D dimension of the EQ-5D-5L in comparison with other valid tools, such as the Generalised Anxiety Disorder-7 (GAD-7) scales for measuring the severity of anxiety [10] or the Patient Health Questionnaire-9 (PHQ-9) scales for measuring the severity of depression [11].…”

Section: Introductionmentioning

confidence: 99%

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Examining the psychometric properties of a split version of the EQ-5D-5L anxiety/depression dimension in patients with anxiety and/or depression

et al. 2023

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Purpose This study explored differences in self-reported responses and the psychometric performance of the composite EQ-5D-5L anxiety/depression (A/D) dimension compared with a split version of the dimension where ‘anxiety’ and ‘depression’ are measured separately. Methods People with anxiety and/or depression who visited the Amanuel Mental Specialized Hospital in Ethiopia completed the standard EQ-5D-5L with the added subdimensions. Correlation analysis was used to examine convergent validity with validated measures of depression (PHQ-9) and anxiety (GAD-7), while ANOVA was used to assess known-groups’ validity. Agreement between ratings for composite and split dimensions was compared using percent agreement and Cohen’s Kappa, while the proportion of ‘no problems’ reports was compared using the chi-square test. Discriminatory power analysis was undertaken using the Shannon index (H’) and Shannon Evenness index (J’). Open-ended questions explored participants' preferences. Results Of the 462 respondents, 30.5% reported no problems with the composite A/D, while 13.2% reported no problems on both subdimensions. Agreement between ratings for composite and split dimensions was highest for respondents with comorbid anxiety and depression. The depression subdimension had higher correlation with PHQ-9 (r = 0.53) and GAD-7 (r = 0.33) than the composite A/D dimension (r = 0.36 and r = 0.28, respectively). The split subdimensions and composite A/D could adequately differentiate respondents based on their severity of anxiety or depression. Slightly better informativity was observed in EQ-4D-5L + anxiety (H’ = 5.4; J’ = 0.47) and EQ-4D-5L + depression (H’ = 5.31; J’ = 0.46) than EQ-5D-5L (H’ = 5.19; J’ = 0.45). Conclusions Adopting two subdimensions within the EQ-5D-5L tool appears to perform slightly better than the standard EQ-5D-5L.

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The performance relationship between the EQ-5D-5L composite “Anxiety/Depression” dimension and anxiety and depression symptoms in a large, general population sample

Scott,

Lubetkin,

Janssen

et al. 2024

Qual Life Res

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Purpose This cross-sectional study aims to understand the relationship between responses on the Anxiety/Depression (A/D) dimension of the EQ-5D-5L and symptoms of anxiety and depression on the GAD-7 and PHQ-9 instruments. In doing so, we investigate the comparative performance of the dimension between diagnostic groups (i.e. anxiety (GAD-7); depression (PHQ-9); anxiety & depression versus none). We additionally investigate the discriminatory performance between sub-populations based on gender, age, education and self-reported chronic conditions. Methods 19,902 general population participants completed a health survey in May/June 2020, from five European countries and the United States. Performance of A/D was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC), and was compared to having anxiety (GAD-7 ≥ 8), depression (PHQ-9 ≥ 10) and both versus none for the total population and sub-populations. Several additional sensitivity analyses were conducted, including calculations of the optimal A/D cut-off. Results The performance in the total sample was good (AUROC > 0.8) and did not differ significantly between diagnostic groups. The performance differed significantly between the age groups, with worse performance in the younger groups, and differed between those with a singular chronic condition, with worse performance in those indicating having an anxiety or depression disorder. The performance did not differ significantly by gender, education, nor total chronic conditions. Conclusion The A/D dimension captures symptoms of anxiety, depression or both equally well. Performance is worse in the younger population. Interpretation in those with a self-reported anxiety or depression disorder should be further investigated. This is the first-of-its-kind large population sample performance analysis, where we present evidence that the performance of the A/D dimension differs between ages, and thus intra-age comparative results may be flawed.

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What is measured by the composite, single-item pain/discomfort dimension of the EQ-5D-5L? An exploratory analysis

Cited by 4 publications

References 30 publications

Understanding the measurement relationship between EQ-5D-5L, PROMIS-29 and PROPr

Understanding the measurement relationship between EQ-5D-5L, PROMIS-29 and PROPr

Examining the psychometric properties of a split version of the EQ-5D-5L anxiety/depression dimension in patients with anxiety and/or depression

The performance relationship between the EQ-5D-5L composite “Anxiety/Depression” dimension and anxiety and depression symptoms in a large, general population sample

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