Quality of Life Research

, Volume 24, Issue 7, pp 1775–1784 | Cite as

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

  • Barbara L. Conner-Spady
  • Deborah A. Marshall
  • Eric Bohm
  • Michael J. Dunbar
  • Lynda Loucks
  • Ammar Al Khudairy
  • Tom W. Noseworthy



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.


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.


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.


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


EQ-5D-5L EQ-5D-3L Reliability Validity Total joint replacement Osteoarthritis 



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



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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Barbara L. Conner-Spady
    • 1
  • Deborah A. Marshall
    • 1
  • Eric Bohm
    • 2
  • Michael J. Dunbar
    • 3
  • Lynda Loucks
    • 4
  • Ammar Al Khudairy
    • 5
  • Tom W. Noseworthy
    • 1
  1. 1.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada
  2. 2.Department of Surgery, Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  3. 3.Division of Orthopaedic SurgeryDalhousie UniversityHalifaxCanada
  4. 4.Concordia Hip and Knee InstituteWinnipegCanada
  5. 5.QEII Health Sciences CentreDalhousie UniversityHalifaxCanada

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