Advertisement

Quality of Life Research

, Volume 12, Issue 8, pp 1069–1079 | Cite as

Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fractures

  • J. Tidermark
  • G. Bergström
  • O. Svensson
  • H. Törnkvist
  • S. Ponzer
Article

Abstract

Objectives: To evaluate the responsiveness of the EuroQol (EQ-5D) and Short-Form 36 (SF-36) instruments, i.e. their ability to capture clinically important changes, in elderly patients with a displaced femoral neck fracture. The study was part of a prospective randomised study comparing two different surgical procedures, internal fixation (IF) and total hip replacement (THP). Setting: University hospital. Patients: A total of 110 patients, mean age 80 years with an acute displaced femoral neck fracture (Garden III and IV). The inclusion criteria were age ≥70, absence of severe cognitive dysfunction, independent living status and independent walking capability. Intervention: The patients were randomised to IF or to a THR. Main outcome measurements: Health-related quality of life according to EQ-5D and SF-36. Responsiveness measured by the ability of the EQ-5D and the SF-36 to detect clinically relevant differences in the study population according to an external criterion (EC) for outcome (good or less good clinical outcome). Responsiveness was measured in terms of change scores, standardised effect size (SES) and standardised response mean (SRM). Results: The rated prefracture EQ-5Dindex scores and SF-36 scores showed good correspondence with the scores of age-matched Swedish reference populations. The relationship between the EC and EQ-5Dindex score and the SF-36 global score showed significant differences in both comparisons (p < 0.001). The responsiveness expressed with the SES and SRM were large for both the EQ-5D (1.37 and 0.90, respectively) and for the SF-36 global score (0.89 and 0.82, respectively). The correlation between the change scores for the SF-36 global score and the EQ-5D was 0.39 (p < 0.001). Conclusion: The results showed high responsiveness for both the EQ-5D and the SF-36, indicating that both instruments are suitable for use as outcome measures in clinical trials in elderly hip fracture patients.

EQ-5D Femoral neck fractures Health-related quality of life (HRQoL) Responsiveness Short-Form 36 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sernbo I, Johnell O, B å åth L, et al. Internal fixation of 410 cervical hip fractures. A randomized comparison of a single nail versus two hook-pins. Acta Orthop Scand 1990; 61: 411–414.Google Scholar
  2. 2.
    Olerud C, Rehnberg L, Hellquist E. Internal fixation of femoral neck fractures. Two methods compared. J Bone Joint Surg [Br] 1991; 73: 16–19.Google Scholar
  3. 3.
    Strömqvist B, Nilsson LT, Thorngren KG. Femoral neck fracture fixation with hook-pins. 2-year results and learning curve in 626 prospective cases. Acta Orthop Scand 1992; 63: 282–287.Google Scholar
  4. 4.
    Johansson T, Jacobsson SA, Ivarsson I, et al. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: A prospective randomized study of 100 hips. Acta Orthop Scand 2000; 71: 597–602.Google Scholar
  5. 5.
    Butcher JL, MacKenzie EJ, Cushing B, et al. Long-term outcomes after lower extremity trauma. J Trauma 1996; 41: 4–9.Google Scholar
  6. 6.
    MacKenzie EJ, Burgess AR, McAndrew MP, et al. Patient-oriented functional outcome after unilateral lower extremity fracture. J Orthop Trauma 1993; 7: 393–401.Google Scholar
  7. 7.
    Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30: 473–483.Google Scholar
  8. 8.
    Sullivan M, Karlsson J, Ware Jr JE. The Swedish SF-36 Health Survey-I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med 1995; 41: 1349–1358.Google Scholar
  9. 9.
    Ware JE. SF-36 health survey update. Spine 2000; 25: 3130–3139.Google Scholar
  10. 10.
    Brooks R. EuroQol: The current state of play. Health Policy 1996; 37: 53–72.Google Scholar
  11. 11.
    Brazier JE, Walters SJ, Nicholl JP, et al. Using the SF-36 and Euroqol on an elderly population. Qual Life Res 1996; 5: 195–204.Google Scholar
  12. 12.
    Dorman P, Slattery J, Farrell B, et al. Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. Stroke 1998; 29: 63–68.Google Scholar
  13. 13.
    Harper R, Brazier JE, Waterhouse JC, et al. Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting. Thorax 1997; 52: 879–887.Google Scholar
  14. 14.
    Hurst NP, Kind P, Ruta D, et al. Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 1997;36: 551–559.Google Scholar
  15. 15.
    Coast J, Peters TJ, Richards SH, et al. Use of the EuroQoL among elderly acute care patients. Qual Life Res 1998; 7: 1–10.Google Scholar
  16. 16.
    Tidermark J, Zethraeus N, Svensson O, et al. Femoral neck fractures in the elderly: Functional outcome and quality of life according to EuroQol. Qual Life Res 2002; 11: 473–481.Google Scholar
  17. 17.
    Dolan P, Gudex C, Kind P, et al. The time trade-off method: Results from a general population study. Health Econ 1996; 5: 141–154.Google Scholar
  18. 18.
    Macran S, Kind P. 'Death' and the valuation of healthrelated quality of life. Med Care 2001; 39: 217–227.Google Scholar
  19. 19.
    Burström K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001; 10: 621–635.Google Scholar
  20. 20.
    Drummond M, Stoddart G, Torrance G. Methods for the Economic Evalution of Health Care Programmes. Oxford: Oxford Medical Publications, 1997.Google Scholar
  21. 21.
    Bronfort G, Bouter LM. Responsiveness of general health status in chronic low back pain: A comparison of the COOP charts and the SF-36. Pain 1999; 83: 201–209.Google Scholar
  22. 22.
    Beaton DE, Hogg-Johnson S, Bombardier C. Evaluating changes in health status: Reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders. J Clin Epidemiol 1997; 50: 79–93.Google Scholar
  23. 23.
    Katz JN, Larson MG, Phillips CB, et al. Comparative measurement sensitivity of short and longer health status instruments. Med Care 1992; 30: 917–925.Google Scholar
  24. 24.
    Ware JE, Kosinski M, Keller SD, SF-36 Physical and Mental Health Summary Scales: A Users's Manual, ed. H. Institute, Boston, 1994.Google Scholar
  25. 25.
    Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials 1991; 12: 142S–158S.Google Scholar
  26. 26.
    Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg 1961; 43-B: 647.Google Scholar
  27. 27.
    Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975; 23: 433–441.Google Scholar
  28. 28.
    Ceder L, Thorngren KG, Wallden B. Prognostic indicators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop 1980; Oct:173–184.Google Scholar
  29. 29.
    Katz S, Ford A, Moskowitz R, et al. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychological function. JAMA 1963; 185: 94–99.Google Scholar
  30. 30.
    Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br 1972; 54: 61–76.Google Scholar
  31. 31.
    Marottoli RA, Berkman LF, Cooney Jr LM. Decline in physical function following hip fracture. J Am Geriatr Soc 1992; 40: 861–866.Google Scholar
  32. 32.
    Randell AG, Nguyen TV, Bhalerao N, et al. Deterioration in quality of life following hip fracture: A prospective study. Osteoporos Int 2000; 11: 460–466.Google Scholar
  33. 33.
    Tidermark J, Zethraeus N, Svensson O, et al. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. J Orthop Trauma 2002; 16: 34–38.Google Scholar
  34. 34.
    Jaglal S, Lakhani Z, Schatzker J. Reliability, validity, and responsiveness of the lower extremity measure for patients with a hip fracture. J Bone Joint Surg Am 2000; 82-A: 955–962.Google Scholar
  35. 35.
    Cohen J, Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Associates, New Jersey: LE Associates, 1988.Google Scholar
  36. 36.
    Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; 27: S178–S189.Google Scholar
  37. 37.
    Skoog A, Söderqvist A, Törnkvist H, et al. One-year outcome after tibial shaft fractures: Results of a prospective fracture registry. J Orthop Trauma 2001; 15: 210–215.Google Scholar
  38. 38.
    Lu-Yao GL, Keller RB, Li</del>ttenberg B, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 1994; 76: 15–25.Google Scholar
  39. 39.
    Deyo RA, Centor RM. Assessing the responsiveness of functional scales to clinical change: An analogy to diagnostic test performance. J Chronic Dis 1986; 39: 897–906.Google Scholar
  40. 40.
    Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire [see comments]. Qual Life Res 1993; 2: 169–180.Google Scholar
  41. 41.
    Brazier J, Usherwood T, Harper R, et al. Deriving a preference-based single index from the UK SF-36 Health Survey. J Clin Epidemiol 1998; 51: 1115–1128.Google Scholar
  42. 42.
    Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002; 21: 271–292.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • J. Tidermark
    • 1
  • G. Bergström
    • 2
  • O. Svensson
    • 3
  • H. Törnkvist
    • 1
  • S. Ponzer
    • 1
  1. 1.Department of Orthopedics atStockholm Söder HospitalSweden
  2. 2.Section for Personal Injury PreventionKarolinska InstitutetStockholmSweden
  3. 3.Department of Surgery and Perioperative Sciences, Division of OrthopedicsUmeå University HospitalUmeåSweden

Personalised recommendations