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Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement

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Abstract

Purpose

To assess the test–retest reliability of the EQ-5D-5L (5L) and compare the validity of the 5L and EQ-5D-3L (3L) in osteoarthritis patients referred to an orthopaedic surgeon for total joint replacement.

Methods

We mailed questionnaires to 306 consecutive patients following referral and a second questionnaire after 2 weeks to assess reliability. Questionnaires included the 5L, EQ-VAS, Short Form-12, Oxford hip and knee scores, pain VAS, and the 3L. We compared the ceiling effect, redistribution properties, convergent and discriminant validity, and discriminatory power of the 5L and 3L.

Results

We obtained 176 respondents (response rate 58 %), 60 % female, 64 % knee patients, mean age 65 years (SD 11), with no significant differences between responders versus non-responders. Intraclass correlation coefficients were 0.61–0.77 for the 5L dimensions and 0.87 for the 5L index. For the 3L, most patients used level 2 (some/moderate problems) for mobility (87 %), usual activities (78 %), and pain/discomfort (71 %). In comparison, 5L responses were spread out with only 52, 42, and 50 %, respectively, using the middle level. All convergent validity coefficients were stronger with the 5L (Spearman coefficients 0.51–0.75). Absolute informativity (Shannon’s index) showed higher results for all dimensions of the 5L compared with the 3L (average difference 0.74). Relative informativity (Shannon’s evenness index) showed an increase from the 3L to the 5L in mobility, usual activities, and pain/discomfort.

Conclusions

The 5L provided stronger validity evidence than the 3L, especially for dimensions relevant to this patient population—mobility, usual activities, and pain/discomfort.

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Acknowledgments

This study was funded by Canadian Institutes of Health Research (CIHR) (Grant #ETG92252) and Alberta Innovates-Health Solutions (Grant # 200700596). We thank the research personnel who were responsible for project management and patient recruitment: Allan Hennigar and Sarah Tran.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Community Health Sciences, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Barbara L. Conner-Spady, Deborah A. Marshall & Tom W. Noseworthy

  2. Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3T 2N2, Canada

    Eric Bohm

  3. Division of Orthopaedic Surgery, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada

    Michael J. Dunbar

  4. Concordia Hip and Knee Institute, 310-1155 Concordia Avenue, Winnipeg, MB, R2K 2M9, Canada

    Lynda Loucks

  5. QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada

    Ammar Al Khudairy

Authors
  1. Barbara L. Conner-Spady
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  2. Deborah A. Marshall
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  7. Tom W. Noseworthy
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Correspondence to Barbara L. Conner-Spady.

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Conner-Spady, B.L., Marshall, D.A., Bohm, E. et al. Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Qual Life Res 24, 1775–1784 (2015). https://doi.org/10.1007/s11136-014-0910-6

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