Quality of Life Research

, Volume 25, Issue 10, pp 2481–2496 | Cite as

Health state descriptions, valuations and individuals’ capacity to walk: a comparative evaluation of preference-based instruments in the context of spinal cord injury

  • David G. T. Whitehurst
  • Nicole Mittmann
  • Vanessa K. Noonan
  • Marcel F. Dvorak
  • Stirling Bryan
Article

Abstract

Purpose

This study explores variation in health state descriptions and valuations derived from preference-based health-related quality of life instruments in the context of spinal cord injury (SCI).

Methods

Individuals living with SCI were invited to complete a web-based, cross-sectional survey. The survey comprised questions regarding demographics, SCI classifications and characteristics, secondary health complications and conditions, quality of life and SCI-specific functioning in activities of daily living. Four preference-based health status classification systems were included; Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D), EQ-5D-5L, Health Utilities Index (HUI) and SF-6D (derived from the SF-36v2). In addition to descriptive comparisons of index scores and item/dimension responses, analyses explored dimension-level correlation and absolute agreement (intraclass correlation coefficient (ICC)). Subgroup analyses examined the influence of individuals’ self-reported ability to walk.

Results

Of 609 invitations, 364 (60 %) individuals completed the survey. Across instruments, convergent validity was seen between pain and mental health dimensions, while sizeable variation pertaining to issues of mobility was observed. Mean index scores were 0.248 (HUI-3), 0.492 (EQ-5D-5L), 0.573 (AQoL-8D) and 0.605 (SF-6D). Agreement ranged from ‘slight’ (HUI-3 and SF-6D; ICC = 0.124) to ‘moderate’ (AQoL-8D and SF-6D; ICC = 0.634). Walking status had a markedly different impact on health state valuations across instruments.

Conclusions

Variation in the way that individuals are able to describe their health state across instruments is not unique to SCI. Further research is necessary to understand the significant differences in index scores and, in particular, the implications of framing mobility-related questions in the context of respondents’ ability to walk.

Keywords

Health-related quality of life Quality-adjusted life years Spinal cord injury Disability Utility measurement Health state valuation 

Notes

Acknowledgments

Financial support for this study was provided entirely by a grant from the Rick Hansen Institute (Rick Hansen Institute Translational Research Program, Grant #2012-29: Spinal Cord Injury and Secondary Complications: A Mixed-Methods Evaluation of Preference-Based Instruments). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the report. We would also like to thank Health Utilities Inc. for the New Investigator Grant awarded to Dr. David Whitehurst, Dr. Davene Wright for her discussion of an early draft of this paper at the 2015 Vancouver Health Economics Methodology (VanHEM) meeting, Lidia Engel for her assistance with generating Fig. 1, and the two anonymous reviewers for their constructive and comprehensive comments.

Compliance with ethical standards

The study was approved by the University of British Columbia Behavioural Research Ethics Board (H12-01138) and Vancouver Coastal Health Authority (Research Study #V12-01138).

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • David G. T. Whitehurst
    • 1
    • 2
    • 3
  • Nicole Mittmann
    • 4
    • 5
  • Vanessa K. Noonan
    • 6
  • Marcel F. Dvorak
    • 2
    • 6
  • Stirling Bryan
    • 3
    • 7
    • 8
  1. 1.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  2. 2.International Collaboration on Repair Discoveries (ICORD), Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.Centre for Clinical Epidemiology and EvaluationVancouver Coastal Health Research InstituteVancouverCanada
  4. 4.Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
  5. 5.Department of PharmacologyUniversity of TorontoTorontoCanada
  6. 6.Rick Hansen InstituteVancouverCanada
  7. 7.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  8. 8.Health Economics Research UnitUniversity of AberdeenAberdeenUK

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