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RehabMeasures Instrument

EuroQOL-5 Dimension Questionnaire

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Purpose

EQ-5D™ is a standardized instrument for use as a measure of health for clinical and economic appraisal.

Link to Instrument

Instrument Details

Acronym EQ-5D

Cost

Not Free

Cost Description

Fee involved for licensing

Diagnosis/Conditions

  • Arthritis + Joint Conditions
  • Pain Management
  • Pulmonary Disorders
  • Stroke Recovery

Key Descriptions

  • Applicable to a wide range of health conditions and treatments, the EQ-5D health questionnaire provides a simple descriptive profile and a single index value for health status.
  • Measures the 5 dimensions of:
    1) mobility
    2) self-care
    3) usual activities
    4) pain/discomfort
    5) anxiety/depression
  • Each dimension is described by 3 possible levels of problems:
    1) none
    2) mild to moderate
    3) severe
  • Respondent’s answer to different hypothetical choices are translated into a preference-based score, yielding an index score based on a scale from 0.000 (death) to 1.000 (perfect health).
  • The five dimensions measuring health status can be converted to a single utility value (EQ-Index score)

Number of Items

6

Equipment Required

  • Paper and pencil

Time to Administer

Less than 5 minutes

Required Training

No Training

Instrument Reviewers

Initially reviewed by Sue Saliga, PT, PHSc, CEEAA and the TBI EDGE task force of the Neurology Section of the APTA in 10/2012

Updated by Rie Yoshida and Heather Anderson of the StrokEDGE II task force of the Neurology Section of the APTA in 2016.

ICF Domain

Body Structure
Body Function
Participation

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

R

R

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

R

R

R

R

TBI EDGE

NR

LS

NR

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

No

Yes

Yes

Not reported

TBI EDGE

No

Yes

Yes

Not reported

Considerations

  • Translations available in over 150 languages
  • Recommended by the Core Data Elements Workgroup as a supplemental measure in TBI research (Wilde et al, 2010) 
  • In TBI, the instrument has been used in some outcome studies with good success

EuroQOL translations:

Other languages available at https://euroqol.org/eq-5d-instruments/eq-5d-5l-available-modes-of-administration/self-complete-on-paper/

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Brain Injury

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Test/Retest Reliability

Traumatic Brain Injury: (Van Agt et al., n=208; mean age=49.3 (18.3); gender=43.3% female; Dutch population)

  • Generalizability Theory was used for test-retest reliability assessment; results interpreted as there are some respondents who value some health states very differently the first or the second time, hence, good test retest reliability

Construct Validity

Traumatic Brain Injury: (Klose et al.; n=104; mean age=41; gender=male n=78)

  • Decreased scores on the EuroQoL Visual Analog Scale (VAS) in patients with posttraumatic hypopituitarism 12mo after injury

 

Traumatic Brain Injury: (Bell et al, 2005; n=171; telephone intervention n=85 and standard follow up n=86; mean age = 36 (15)

  • significantly increased EuroQoL scores as an effect of a scheduled telephone intervention in patients with moderate to severe TBI

Floor/Ceiling Effects

General population (British sample): (Brazier et al, 1993; n=1463; age range=16-74; male gender=655)

  • Ceiling effects were larger for the EuroQOL dimensions than for the SF-36 dimensions

Domains

% at ceiling

% at floor

Mobility

97.0

0.1

Self-Care

99.1

0.1

Main Activity

96.5

3.5

Family/leisure

95.2

4.8

Pain/discomfort

64.1

1.9

Anxiety/depression

81.1

29.9

Total Score

54.6

0

Responsiveness

Traumatic Brain Injury (moderate and severe): (Bell et al, 2005; =171; telephone intervention n=85 and standard follow up n=86; mean age =36 (15)

  • Small treatment effect: 0.10

Non-Specific Patient Population

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Construct Validity

General Population (British sample): (Brazier et al., n=1453; visited general practitioner in previous 2 weeks, attended outpatient in previous 3 months, inpatient in previous year, chronic physical health problem)

  • The Spearman Rank correlation coefficients of the total score and the UK SF-36 dimensions were found to be in the range 0.48-0.60 (p < 0.01)

Floor/Ceiling Effects

General population (British sample): (Brazier et al, 1993; n=1463; age range=16-74; male gender=655)

  • Ceiling effects were larger for the EuroQOL dimensions than for the SF-36 dimensions

 

Domains

% at ceiling

% at floor

Mobility

97.0

0.1

Self-Care

99.1

0.1

Main Activity

96.5

3.5

Family/leisure

95.2

4.8

Pain/discomfort

64.1

1.9

Anxiety/depression

81.1

29.9

Total Score

54.6

0

Stroke

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Criterion Validity (Predictive/Concurrent)

(Chen et al, 2015; n=65; median time since stroke 19.7 months (range 0.4-94); mean age 52.8 + 11.6 years)

Measures of predictive validity for the 5 item version (EQ-5D-5L):

  • Fair predictive validity (ρ = 0.25; P <0.05) between EQ-Index at the pre-intervention session with the Stoke Impact Scale (SIS)-ADL at the post-intervention session
  • Fair predictive validity (ρ = -0.27; P <0.05) between the mobility dimension of the EQ-5D and the Functional Independence Measure (FIM)
  • Fair predictive validity between the pain/discomfort dimension of the EQ-5D and the following SIS subscales:
    -strength (ρ = -0.28; P <0.05)
    -emotion (ρ = -0.27; P <0.05)
    -mobility (ρ = -0.33; P <0.05)
    -physical score (ρ = -0.34; P <0.05)
  • Fair predictive validity (ρ = -0.26; P <0.05) between the anxiety/depression dimension of the EQ-5D and the SIS hand function

 

Measures of concurrent validity for EQ-Index, EQ-VAS and individual dimension of EQ-5D

 

  • Fair to good concurrent validity between EQ-Index with FIM, SIS-ADL, SIS mobility and SIS physical scores (ρ = 0.255-0.703, P < 0.05)
  • Low to fair concurrent validity between EQ-VAS with FIM, SIS mobility and SIS physical scores (ρ = 0.249-0.345, P < 0.05)
  • Fair to good concurrent validity between mobility and self care dimensions with physical function criterion measures (SIS strength, SIS mobility and SIS physical scores) and ADL criterion measures (FIM and SIS ADL) (ρ = -0.249 to -0.771, P < 0.05)
  • Fair concurrent validity between usual activity dimension and FIM, SIS-ADL, SIS mobility and SIS physical scores as well as between pain/discomfort and anxiety/depression dimensions and SIS emotion (ρ = -0.298 to -0.412, P < 0.05)

Construct Validity

(Golicki et al, 2015; n=112; mean age 70.6 (SD=11.0); patients assessed at 1 week and 4 months post stroke with the modified Rankin Scale (mRS), Barthel Index (BI) and both the EQ-5D-5L and EQ-5D-3L, including the EQ-VAS.

Spearman’s rank correlation coefficient between change scores of studied measures:

 

EQ-5D-5L Index

EQ-5D-3L Index

EQ
VAS

Barthel
Index

mRS

EQ-5D-5L Index

1.00

 

 

 

 

EQ-5D-3L Index

0.74

1.00

 

 

 

EQ VAS

0.48

0.41

1.00

 

 

Barthel Index

0.43

0.56

0.27

1.00

 

mRS

-0.31

-0.41

-0.32

-0.42

1.00

Interpretation of extent of correlation: Absent (< 0.20), poor (0.20 - 0.34), moderate (0.35 - 0.50) or strong (> 0.50)

Responsiveness

Chen et al, 2015; n =65; mean age 52.8 + 11.6; median months since stroke onset 19.7 (range 0.4 – 94)

Measures of responsiveness for the 5 item version (EQ-5D-5L):

  • Small effect size (ES) (observed change in scores between pre-intervention and post-intervention divided by the standard deviation of the baseline score) for both the EQ-Index (0.40) and the EQ-VAS (0.30)
  • Moderate Standardized Response Mean (SRM) (the change in scores between pre-intervention measures divided by the SD of the change scores) for the EQ-Index (0.63)
  • Limited SRM for the EQ-VAS = 0.34
  • Small criterion-based responsiveness (determined using the Stroke Impact Scale (SIS) 3.0 as a criterion by calculating the Spearman correlation between the change in EQ-5D and the change in perceived recovery score of the SIS 3.0) for the EQ-Index (0.46)
  • Limited criterion-based responsiveness for the EQ-VAS (0.29).

(Golicki et al, 2015; n=112; mean age 70.6 (SD=11.0); patients assessed at 1 week and 4 months post stroke with the modified Rankin Scale (mRS), Barthel Index (BI) and both the EQ-5D-5L and EQ-5D-3L, including the EQ-VAS.

ES calculated as the ratio of the mean change to the Standard Deviation of initial measurement

  • Moderate to large ES (0.63-0.82) for the EQ-5D-3L
  • Moderate ES (0.51-0.71) for the EQ-5D-5L
  • Moderate ES (0.51-0.65) for the EQ VAS

SRM calculated as the ratio of the mean change to the Standard Deviation of that change

  • Moderate to large SRM (0.77-1.06) for the EQ-5D-3L
  • Moderate to large SRM (0.69-0.86) for the EQ-5D-5L
  • Moderate SRM (0.59-0.69) for the EQ VAS

Bibliography

Bell, K. R., Temkin, N. R., et al. (2005). "The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic brain injury: a randomized trial." Arch Phys Med Rehabil 86(5): 851-856. Find it on PubMed

Brazier, J., Jones, N., et al. (1993). "Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire." Qual Life Res 2(3): 169-180. Find it on PubMed

Chen, P., Keh-Chung L., et al. (2015). “Validity, responsiveness and minimum clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation.” Qual Life Res. DOI 10.1007/s11136-015-1196-z. Find it on PubMed

Golicki D., Niewada M., et al. (2015). “Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients.” Qual Live Res 24:1555-1563. Find it on PubMed

Klose, M., Watt, T., et al. (2007). "Posttraumatic hypopituitarism is associated with an unfavorable body composition and lipid profile, and decreased quality of life 12 months after injury." J Clin Endocrinol Metab 92(10): 3861-3868. Find it on PubMed

van Agt, H. M., Essink-Bot, M. L., et al. (1994). "Test-retest reliability of health state valuations collected with the EuroQol questionnaire." Soc Sci Med 39(11): 1537-1544. Find it on PubMed

Wilde, E. A., Whiteneck, G. G., et al. (2010). "Recommendations for the use of common outcome measures in traumatic brain injury research." Arch Phys Med Rehabil 91(11): 1650-1660 e1617. Find it on PubMed

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