Skip to main content

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

Quality of Life Research volume 24, pages 1775–1784 (2015)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Bombardier, C., Melfi, C. A., Paul, J., Green, R., Hawker, G., Wright, J., et al. (1995). Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Medical Care, 33(4 Suppl), AS131–AS144.

    CAS  PubMed  Google Scholar 

  2. Guccione, A. A., Felson, D. T., & Anderson, J. J. (1990). Defining arthritis and measuring functional status in elders: Methodological issues in the study of disease and physical disability. American Journal of Public Health, 80(8), 945–949.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  3. Laupacis, A., Bourne, R., Rorabeck, C., Feeny, D., Wong, C., Tugwell, P., et al. (1993). The effect of elective total hip replacement on health-related quality of life. Journal of Bone and Joint Surgery. American Volume, 75(11), 1619–1626.

    CAS  Google Scholar 

  4. Hawker, G. A., Stewart, L., French, M. R., Cibere, J., Jordan, J. M., March, L., et al. (2008). Understanding the pain experience in hip and knee osteoarthritis: an OARSI/OMERACT initiative. Osteoarthritis Cartilage, 16(4), 415–422.

    CAS  PubMed  Article  Google Scholar 

  5. Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37(1), 53–72.

    CAS  PubMed  Article  Google Scholar 

  6. Brazier, J., Roberts, J., Tsuchiya, A., & Busschbach, J. (2004). A comparison of the EQ-5D and SF-6D across seven patient groups. Health Economics, 13(9), 873–884.

    PubMed  Article  Google Scholar 

  7. Sullivan, P. W., Lawrence, W. F., & Ghushchyan, V. (2005). A national catalog of preference-based scores for chronic conditions in the United States. Medical Care, 43(7), 736–749.

    PubMed  Article  Google Scholar 

  8. Janssen, M. F., Pickard, A. S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., et al. (2013). Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: A multi-country study. Quality of Life Research, 22(7), 1717–1727.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  9. Johnson, J. A., & Pickard, A. S. (2000). Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, Canada. Medical Care, 38(1), 115–121.

    CAS  PubMed  Article  Google Scholar 

  10. Giesinger, K., Hamilton, D. F., Jost, B., Holzner, B., & Giesinger, J. M. (2014). Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthritis Cartilage, 22(2), 184–189.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  11. Conner-Spady, B., & Suarez-Almazor, M. E. (2003). Variation in the estimation of quality-adjusted life-years by different preference-based instruments. Medical Care, 41(7), 791–801.

    PubMed  Article  Google Scholar 

  12. Ostendorf, M., van Stel, H. F., Buskens, E., Schrijvers, A. J., Marting, L. N., Verbout, A. J., et al. (2004). Patient-reported outcome in total hip replacement. A comparison of five instruments of health status. Journal of Bone and Joint Surgery. British Volume, 86(6), 801–808.

    CAS  Article  Google Scholar 

  13. Fransen, M., & Edmonds, J. (1999). Reliability and validity of the EuroQol in patients with osteoarthritis of the knee. Rheumatology (Oxford), 38(9), 807–813.

    CAS  Article  Google Scholar 

  14. Wolfe, F., & Hawley, D. J. (1997). Measurement of the quality of life in rheumatic disorders using the EuroQol. British Journal of Rheumatology, 36(7), 786–793.

    CAS  PubMed  Article  Google Scholar 

  15. Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research, 20(10), 1727–1736.

  16. van Hout, B., Janssen, M. F., Feng, Y. S., Kohlmann, T., Busschbach, J., Golicki, D., et al. (2012). Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health, 15(5), 708–715.

    PubMed  Article  Google Scholar 

  17. Luo, N., Li, M., Chevalier, J., Lloyd, A., & Herdman, M. (2013). A comparison of the scaling properties of the English, Spanish, French, and Chinese EQ-5D descriptive systems. Quality of Life Research, 22(8), 2237–2243.

    PubMed  Article  Google Scholar 

  18. Kim, T. H., Jo, M. W., Lee, S. I., Kim, S. H., & Chung, S. M. (2013). Psychometric properties of the EQ-5D-5L in the general population of South Korea. Quality of Life Research, 22(8), 2245–2253.

    PubMed  Article  Google Scholar 

  19. Hinz, A., Kohlmann, T., Stobel-Richter, Y., Zenger, M., & Brahler, E. (2014). The quality of life questionnaire EQ-5D-5L: Psychometric properties and normative values for the general German population. Quality of Life Research, 23(2), 443–447.

    PubMed  Article  Google Scholar 

  20. Kim, S. H., Kim, H. J., Lee, S. I., & Jo, M. W. (2012). Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Quality of Life Research, 21(6), 1065–1073.

    PubMed  Article  Google Scholar 

  21. Jia, Y. X, Cui, F. Q., Li, L., Zhang, D. L., Zhang, G. M., Wang, F. Z., et al. (2014). Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B. Quality of Life Research, 23(8), 2355–2363.

  22. Pickard, A. S., De Leon, M. C., Kohlmann, T., Cella, D., & Rosenbloom, S. (2007). Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Medical Care, 45(3), 259–263.

    PubMed  Article  Google Scholar 

  23. Scalone, L., Ciampichini, R., Fagiuoli, S., Gardini, I., Fusco, F., Gaeta, L., et al. (2013). Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases. Quality of Life Research, 22(7), 1707–1716.

    PubMed  Article  Google Scholar 

  24. Ware, J, Jr, Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    PubMed  Article  Google Scholar 

  25. Dawson, J., Fitzpatrick, R., Carr, A., & Murray, D. (1996). Questionnaire on the perceptions of patients about total hip replacement. Journal of Bone and Joint Surgery. British Volume, 78(2), 185–190.

    CAS  Google Scholar 

  26. Dawson, J., Fitzpatrick, R., Murray, D., & Carr, A. (1998). Questionnaire on the perceptions of patients about total knee replacement. Journal of Bone and Joint Surgery. British Volume, 80(1), 63–69.

    CAS  Article  Google Scholar 

  27. Murray, D. W., Fitzpatrick, R., Rogers, K., Pandit, H., Beard, D. J., Carr, A. J., et al. (2007). The use of the Oxford hip and knee scores. Journal of Bone and Joint Surgery. British Volume, 89(8), 1010–1014.

    CAS  Article  Google Scholar 

  28. Crocker, L., & Algina, J. (1986). Introduction to classical and modern test theory. Orlando, FL: Harcourt Brace Jovanovich.

    Google Scholar 

  29. Feldt, L. S., Brennan, R. L. (2002). Reliability. In R. L. Linn (Ed.), Educational measurement (pp. 105–146). New York: Macmillan Publishing Company.

  30. Streiner, D. L., & Norman, G. R. (1995). Health measurement scales A practical guide to their development and use (2nd ed.). Oxford: Oxford University Press.

    Google Scholar 

  31. Janssen, M. F., Birnie, E., Haagsma, J. A., & Bonsel, G. J. (2008). Comparing the standard EQ-5D three-level system with a five-level version. Value Health, 11(2), 275–284.

    PubMed  Article  Google Scholar 

  32. Validity, M. S. (1989). In R. Linn (Ed.), Educational measurement (pp. 13–103). New York: Macmillan Publishing Company.

    Google Scholar 

  33. Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin, 56(2), 81–105.

    CAS  PubMed  Article  Google Scholar 

  34. Juniper, E. F., Guyatt, G. H., & Jaeschke, R. (1996). How to develop and validate a new health-related quality of life instrument. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (pp. 49–56). Philadelphia: Lippincott-Raven.

    Google Scholar 

  35. Shannon, C. E. (1948). A mathematical theory of communication. The Bell System Technical Journal, 27, 379–423.

    Article  Google Scholar 

  36. Bas Janssen, M. F., Birnie, E., & Bonsel, G. J. (2007). Evaluating the discriminatory power of EQ-5D, HUI2 and HUI3 in a US general population survey using Shannon’s indices. Quality of Life Research, 16(5), 895–904.

    PubMed  Article  Google Scholar 

  37. Polinder, S., Haagsma, J. A., Bonsel, G., Essink-Bot, M. L., Toet, H., & van Beeck, E. F. (2010). The measurement of long-term health-related quality of life after injury: Comparison of EQ-5D and the health utilities index. Injury Prevention, 16(3), 147–153.

    PubMed  Article  Google Scholar 

  38. Lee, C. F., Luo, N., Ng, R., Wong, N. S., Yap, Y. S., Lo, S. K., et al. (2013). Comparison of the measurement properties between a short and generic instrument, the 5-level EuroQoL Group’s 5-dimension (EQ-5D-5L) questionnaire, and a longer and disease-specific instrument, the Functional Assessment of Cancer Therapy-Breast (FACT-B), in Asian breast cancer patients. Quality of Life Research, 22(7), 1745–1751.

    PubMed  Article  Google Scholar 

  39. Lin, F. J., Samp, J., Munoz, A., Wong, P. S., & Pickard, A. S. (2014). Evaluating change using patient-reported outcome measures in knee replacement: The complementary nature of the EQ-5D index and VAS scores. The European Journal of Health Economics, 15(5), 489–496.

    PubMed  Article  Google Scholar 

  40. Rolfson, O., Karrholm, J., Dahlberg, L. E., & Garellick, G. (2011). Patient-reported outcomes in the Swedish Hip Arthroplasty Register: Results of a nationwide prospective observational study. Journal of Bone and Joint Surgery. British Volume, 93(7), 867–875.

    CAS  Article  Google Scholar 

  41. Brazier, J. E., Harper, R., Munro, J., Walters, S. J., & Snaith, M. L. (1999). Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford), 38(9), 870–877.

    CAS  Article  Google Scholar 

  42. Oppe, M., Devlin, N., & Black, N. (2011). Comparison of the underlying constructs of the EQ-5D and Oxford Hip Score: Implications for mapping. Value Health, 14(6), 884–891.

    PubMed  Article  Google Scholar 

  43. Wu, A. W., Jacobson, K. L., Frick, K. D., Clark, R., Revicki, D. A., Freedberg, K. A., et al. (2002). Validity and responsiveness of the euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trial. Quality of Life Research, 11(3), 273–282.

    CAS  PubMed  Article  Google Scholar 

  44. Tran, B. X., Ohinmaa, A., & Nguyen, L. T. (2012). Quality of life profile and psychometric properties of the EQ-5D-5L in HIV/AIDS patients. Health Qual Life Outcomes, 10, 132.

    PubMed Central  PubMed  Article  Google Scholar 

  45. Swan, J. S., Hur, C., Lee, P., Motazedi, T., & Donelan, K. (2013). Responsiveness of the testing morbidities index in colonoscopy. Value Health, 16(6), 1046–1053.

    PubMed  Article  Google Scholar 

Download references

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

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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah A. Marshall
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric Bohm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael J. Dunbar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lynda Loucks
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ammar Al Khudairy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tom W. Noseworthy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara L. Conner-Spady.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-014-0910-6

Keywords

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