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What is measured by the composite, single-item pain/discomfort dimension of the EQ-5D-5L? An exploratory analysis

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Abstract

Purpose

This study examines the EQ-5D-5L pain/discomfort dimension by drawing comparisons with five other pain and discomfort items (pain severity, discomfort severity, pain frequency, discomfort frequency and pain interference) collected in the Australian psychometric study for the EQ Health and Wellbeing instrument.

Methods

Participants, recruited via a market research company, completed an online survey. Methods of analyses included the assessment of descriptive statistics, variation in reporting patterns using chi-square tests and cross-tabulations, correlation analyses, ordered univariate logistic regression, and discriminatory power analyses (Shannon index (H′) and Shannon Evenness index (J′)).

Results

Survey data from 514 participants were used. Compared with EQ-5D-5L pain/discomfort, there was a higher proportion of respondents reporting some level of impairment on at least one of the pain severity and discomfort severity items (74% versus 81%). Correlation with EQ-5D-5L pain/discomfort was strongest for pain severity (r = 0.83) and weakest for discomfort frequency (r = 0.41); the same inferences were drawn for predictive ability. Adding any additional pain or discomfort items to the EQ-5D-5L increased the absolute informativity (H′) but not the relative informativity (J′). When replacing EQ-5D-5L pain/discomfort with separate pain and/or discomfort items – i.e., adding items to a modified ‘EQ-4D-5L’—absolute informativity increased, while relative informativity increased only when pain interference and frequency-related items (independently or in combination) were added.

Conclusion

The EQ-5D-5L pain/discomfort dimension captures aspects of pain more than aspects of discomfort. Potential reasons include the absence of descriptors or because pain is mentioned first in the composite item.

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Data availability

Data cannot be shared publicly. However interested researchers are invited to contact the corresponding author to discuss data access options.

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Acknowledgements

We thank Professor Aki Tsuchiya for her discussion of an earlier draft of our paper at the 37th virtual EuroQol Plenary in 2020.

Funding

This study was funded by the EuroQol Research Foundation. Views expressed in this paper are not necessarily those of the EuroQol Research Foundation.

Author information

Authors and Affiliations

  1. Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia

    Lidia Engel

  2. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    David G. T. Whitehurst

  3. Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia

    David G. T. Whitehurst & Brendan Mulhern

  4. Department of Public Health, Erasmus MC, Rotterdam, The Netherlands

    Juanita Haagsma

  5. Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands

    M. F. Janssen

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  1. Lidia Engel
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  4. M. F. Janssen
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  5. Brendan Mulhern
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by LE and BM. Data analysis was performed by LE. The first draft of the manuscript was written by LE and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lidia Engel.

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Competing interests

All authors are members of the EuroQol Group Association.

Ethical approval

Ethical approval for the study was granted by the University of Technology Sydney Human Research Ethics Committee (ref. ETH18-2507). All participants provided implied consent by completing the online survey.

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Engel, L., Whitehurst, D.G.T., Haagsma, J. et al. What is measured by the composite, single-item pain/discomfort dimension of the EQ-5D-5L? An exploratory analysis. Qual Life Res 32, 1175–1186 (2023). https://doi.org/10.1007/s11136-022-03312-x

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