Abstract
Introduction
The EuroQol-5 Dimension (EQ-5D) is the most widely used generic instrument to measure quality of life (QoL), yet its application in upper extremity orthopaedics as well as its measurement properties remain largely undefined. We implemented a systematic literature review to provide an overview of the application of EQ-5D in patients with upper extremity disorders and analyse its measurement properties.
Materials and methods
We searched Medline, EMBASE, Cochrane and Scopus databases for clinical studies including orthopaedic patients with surgical interventions of the upper extremity who completed the EQ-5D. For all included studies, the use of EQ-5D and quantitative QoL data were described. Validation studies of EQ-5D were assessed according to COSMIN guidelines and standard measurement properties were examined.
Results
Twenty-three studies were included in the review, 19 of which investigated patients with an intervention carried out at the shoulder region. In 15 studies, EQ-5D assessed QoL as the primary outcome. Utility index scores in non-trauma patients generally improved postoperatively, whereas trauma patients did not regain their recalled pre-injury QoL levels. EQ-5D measurement properties were reported in three articles on proximal humerus fractures and carpal tunnel syndrome. Positive ratings were seen for construct validity (Spearman correlation coefficient ≥ 0.70 with the Short Form (SF)-12 or SF-6D health surveys) and reliability (intraclass correlation coefficient ≥ 0.77) with intermediate responsiveness (standardised response means: 0.5–0.9). However, ceiling effects were identified with 16–48% of the patients scoring the maximum QoL. The methodological quality of the three articles varied from fair to good.
Conclusions
For surgical interventions of the upper extremity, EQ-5D was mostly applied to assess QoL as a primary outcome in patients with shoulder disorders. Investigations of the measurement properties were rare, but indicate good reliability and validity as well as moderate responsiveness in patients with upper extremity conditions.
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References
Brauer CA, Rosen AB, Olchanski NV, Neumann PJ (2005) Cost-utility analyses in orthopaedic surgery. J Bone Joint Surg Am 87:1253–1259. https://doi.org/10.2106/JBJS.D.02152
Bozic KJ, Rosenberg AG, Huckman RS, Herndon JH (2003) Economic evaluation in orthopaedics. J Bone Joint Surg Am 85-A:129–142. https://doi.org/10.1016/S0883-5403(03)00456-X
Kaplan RM, Bush JW, Berry CC (1976) Health status: types of validity and the index of well-being. Health Serv Res 11:478–507
Kaplan RM, Sieber WJ, Ganiats TD (1997) The quality of well-being scale: Comparison of the interviewer-administered version with a self-administered questionnaire. Psychol Health 12:783–791. https://doi.org/10.1080/08870449708406739
Torrance GW, Furlong W, Feeny D, Boyle M (1995) Multi-attribute preference functions. Health Utilities Index Pharmacoeconomics 7:503–520
Brazier J, Roberts J, Deverill M (2002) The estimation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292. https://doi.org/10.1016/S0167-6296(01)00130-8
Brazier JE, Roberts J (2004) The estimation of a preference-based measure of health from the SF-12. Med Care 42:851–859
Devlin NJ, Brooks R (2017) EQ-5D and the EuroQol group: past, present and future. Appl Health Econ Health Policy 15:127–137. https://doi.org/10.1007/s40258-017-0310-5
Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72
Rasanen P, Roine E, Sintonen H, Semberg-Konttinen V, Ryynanen OP, Roine R (2006) Use of quality-adjusted life years for the estimation of effectiveness of health care: a systematic literature review. Int J Technol Assess Health Care 22:235–241. https://doi.org/10.1017/S0266462306051051
Devlin NJ, Krabbe PF (2013) The development of new research methods for the valuation of EQ-5D-5L. Eur J Health Econ 14 Suppl 1:S1-3. https://doi.org/10.1007/s10198-013-0502-3
Oak SR, Strnad GJ, Bena J et al (2016) Responsiveness comparison of the EQ-5D, PROMIS Global Health, and VR-12 questionnaires in knee arthroscopy. Orthop J Sports Med 4:2325967116674714. https://doi.org/10.1177/2325967116674714
Burton M, Walters SJ, Saleh M, Brazier JE (2012) An evaluation of patient-reported outcome measures in lower limb reconstruction surgery. Qual Life Res 21:1731–1743. https://doi.org/10.1007/s11136-011-0090-6
Giesinger K, Hamilton DF, Jost B, Holzner B, Giesinger JM (2014) Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthritis Cartilage 22:184–189. https://doi.org/10.1016/j.joca.2013.11.001
Barton GR, Sach TH, Avery AJ, Doherty M, Jenkinson C, Muir KR (2009) Comparing the performance of the EQ-5D and SF-6D when measuring the benefits of alleviating knee pain. Cost Eff Resour Alloc 7:12. https://doi.org/10.1186/1478-7547-7-12
Zampelis V, Ornstein E, Franzen H, Atroshi I (2014) A simple visual analog scale for pain is as responsive as the WOMAC, the SF-36, and the EQ-5D in measuring outcomes of revision hip arthroplasty. Acta Orthop 85:128–132. https://doi.org/10.3109/17453674.2014.887951
Chotai S, Parker SL, Sivaganesan A, Godil SS, McGirt MJ, Devin CJ (2015) Quality of life and general health after elective surgery for cervical spine pathologies: determining a valid and responsive metric of health state utility. Neurosurgery 77:553–560 (discussion 560). https://doi.org/10.1227/NEU.0000000000000886
Lin FJ, Samp J, Munoz A, Wong PS, Pickard AS (2014) Evaluating change using patient-reported outcome measures in knee replacement: the complementary nature of the EQ-5D index and VAS scores. Eur J Health Econ 15:489–496. https://doi.org/10.1007/s10198-013-0489-9
Soer R, Reneman MF, Speijer BL, Coppes MH, Vroomen PC (2012) Clinimetric properties of the EuroQol-5D in patients with chronic low back pain. Spine J 12:1035–1039. https://doi.org/10.1016/j.spinee.2012.10.030
Payakachat N, Ali MM, Tilford JM (2015) Can the EQ-5D detect meaningful change? A systematic review. Pharmacoeconomics 33:1137–1154. https://doi.org/10.1007/s40273-015-0295-6
Marti C, Hensler S, Herren DB, Niedermann K, Marks M (2016) Measurement properties of the EuroQoL EQ-5D-5L to assess quality of life in patients undergoing carpal tunnel release. J Hand Surg Eur Vol 41:957–962. https://doi.org/10.1177/1753193416659404
Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Terwee CB, Bot SD, de Boer MR et al (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012
Mokkink LB, Terwee CB, Knol DL et al (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10:22. https://doi.org/10.1186/1471-2288-10-22
Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC (2012) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res 21:651–657. https://doi.org/10.1007/s11136-011-9960-1
Butt U, Whiteman A, Wilson J, Paul E, Roy B (2015) Does arthroscopic subacromial decompression improve quality of life. Ann R Coll Surg Engl 97:221–223. https://doi.org/10.1308/003588414X14055925061478
Dattani R, Ramasamy V, Parker R, Patel VR (2013) Improvement in quality of life after arthroscopic capsular release for contracture of the shoulder. Bone Joint J 95-B:942–946. https://doi.org/10.1302/0301-620X.95B7.31197
Djukanovic I, Brudin L, Hagberg M, Tillander B, Cöster M (2011) Health-related quality of life in patients before and after planned orthopedic surgery—a prospective follow-up study. Int J Orthop Trauma Nurs 15:185–195. https://doi.org/10.1016/j.ijotn.2011.04.002
Fevang BT, Lygre SH, Bertelsen G, Skredderstuen A, Havelin LI, Furnes O (2012) Good function after shoulder arthroplasty. Acta Orthop 83:467–473. https://doi.org/10.3109/17453674.2012.720118
Fevang BT, Lygre SH, Bertelsen G, Skredderstuen A, Havelin LI, Furnes O (2013) Pain and function in eight hundred and fifty nine patients comparing shoulder hemiprostheses, resurfacing prostheses, reversed total and conventional total prostheses. Int Orthop 37:59–66. https://doi.org/10.1007/s00264-012-1722-3
Hultenheim Klintberg I, Karlsson J, Svantesson U (2011) Health-related quality of life, patient satisfaction, and physical activity 8–11 years after arthroscopic subacromial decompression. J Shoulder Elbow Surg 20:598–608. https://doi.org/10.1016/j.jse.2010.08.021
James M, St Leger S, Rowsell KV (1996) Prioritising elective care: a cost utility analysis of orthopaedics in the north west of England. J Epidemiol Community Health 50:182–189
Jansson KA, Granath F (2011) Health-related quality of life (EQ-5D) before and after orthopedic surgery. Acta Orthop 82:82–89. https://doi.org/10.3109/17453674.2010.548026
Kralinger F, Blauth M, Goldhahn J et al (2014) The influence of local bone density on the outcome of one hundred and fifty proximal humeral fractures treated with a locking plate. J Bone Joint Surg Am 96:1026–1032. https://doi.org/10.2106/JBJS.M.00028
Merschin D, Stangl R (2016) [Proximal humeral fractures in the elderly: quality of life, clinical results and institutionalization following primary reverse fracture arthroplasty]. Unfallchirurg 119:1015–1022. https://doi.org/10.1007/s00113-015-0009-8
Naimark M, Dufka FL, Han R et al (2016) Plate fixation of midshaft clavicular fractures: patient-reported outcomes and hardware-related complications. J Shoulder Elbow Surg 25:739–746. https://doi.org/10.1016/j.jse.2015.09.029
Odenbring S, Wagner P, Atroshi I (2008) Long-term outcomes of arthroscopic acromioplasty for chronic shoulder impingement syndrome: a prospective cohort study with a minimum of 12 years’ follow-up. Arthroscopy 24:1092–1098. https://doi.org/10.1016/j.arthro.2008.04.073
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20:1025–1033. https://doi.org/10.1016/j.jse.2011.04.016
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20:747–755. https://doi.org/10.1016/j.jse.2010.12.018
Renfree KJ, Hattrup SJ, Chang YH (2013) Cost utility analysis of reverse total shoulder arthroplasty. J Shoulder Elbow Surg 22:1656–1661. https://doi.org/10.1016/j.jse.2013.08.002
Rupel VP, Ogorevc M (2014) Use of the EQ-5D instrument and value scale in comparing health states of patients in four health care programs among health care providers. Value Health Reg Issues 4:95–99. https://doi.org/10.1016/j.vhri.2014.07.001
Vitale MA, Vitale MG, Zivin JG, Braman JP, Bigliani LU, Flatow EL (2007) Rotator cuff repair: an analysis of utility scores and cost-effectiveness. J Shoulder Elbow Surg 16:181–187. https://doi.org/10.1016/j.jse.2006.06.013
Wild JR, DeMers A, French R et al (2011) Functional outcomes for surgically treated 3- and 4-part proximal humerus fractures. Orthopedics 34:e629-633. https://doi.org/10.3928/01477447-20110826-14
Slobogean GP, Noonan VK, O’Brien PJ (2010) The reliability and validity of the Disabilities of Arm, Shoulder, and Hand, EuroQol-5D, Health Utilities Index, and Short Form-6D outcome instruments in patients with proximal humeral fractures. J Shoulder Elbow Surg 19:342–348. https://doi.org/10.1016/j.jse.2009.10.021
Olerud P, Tidermark J, Ponzer S, Ahrengart L, Bergstrom G (2011) Responsiveness of the EQ-5D in patients with proximal humeral fractures. J Shoulder Elbow Surg 20:1200–1206. https://doi.org/10.1016/j.jse.2011.06.010
Kadum B, Mafi N, Norberg S, Sayed-Noor AS (2011) Results of the Total Evolutive Shoulder System (TESS): a single-centre study of 56 consecutive patients. Arch Orthop Trauma Surg 131:1623–1629. https://doi.org/10.1007/s00402-011-1368-4
Kadum B, Mukka S, Englund E, Sayed-Noor A, Sjoden G (2014) Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS(R)) reverse shoulder arthroplasty: a prospective comparative non-randomised study. Int Orthop 38:1001–1006. https://doi.org/10.1007/s00264-013-2277-7
Cai M, Tao K, Yang C, Li S (2012) Internal fixation versus shoulder hemiarthroplasty for displaced 4-part proximal humeral fractures in elderly patients. Orthopedics 35:e1340-1346. https://doi.org/10.3928/01477447-20120822-19
Scholten AC, Haagsma JA, Steyerberg EW, van Beeck EF, Polinder S (2017) Assessment of pre-injury health-related quality of life: a systematic review. Popul Health Metr 15:10. https://doi.org/10.1186/s12963-017-0127-3
Walters SJ, Brazier JE (2005) Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res 14:1523–1532. https://doi.org/10.1007/s11136-004-7713-0
Dritsaki M, Petrou S, Williams M, Lamb SE (2017) An empirical evaluation of the SF-12, SF-6D, EQ-5D and Michigan Hand Outcome Questionnaire in patients with rheumatoid arthritis of the hand. Health Qual Life Outcomes 15:20. https://doi.org/10.1186/s12955-016-0584-6
Nazari G, MacDermid JC, Bain J, Levis CM, Thoma A (2017) Estimation of health-related-quality of life depends on which utility measure is selected for patients with carpal tunnel syndrome. J Hand Ther 30:299–306. https://doi.org/10.1016/j.jht.2016.11.001
Obradovic M, Lal A, Liedgens H (2013) Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual Life Outcomes 11:110. https://doi.org/10.1186/1477-7525-11-110
Cheung PWH, Wong CKH, Samartzis D et al (2016) Psychometric validation of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) in Chinese patients with adolescent idiopathic scoliosis. Scoliosis Spinal Disord 11:19. https://doi.org/10.1186/s13013-016-0083-x
Solberg TK, Olsen JA, Ingebrigtsen T, Hofoss D, Nygaard OP (2005) Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery. Eur Spine J 14:1000–1007. https://doi.org/10.1007/s00586-005-0898-2
Conner-Spady BL, Marshall DA, Bohm E et al (2015) 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. https://doi.org/10.1007/s11136-014-0910-6
Rundgren J, Enocson A, Mellstrand Navarro C, Bergstrom G (2017) Responsiveness of EQ-5D in patients with a distal radius fracture. Hand (N Y):1558944717725378. https://doi.org/10.1177/1558944717725378
Godil SS, Parker SL, Zuckerman SL, Mendenhall SK, Glassman SD, McGirt MJ (2014) Accurately measuring the quality and effectiveness of lumbar surgery in registry efforts: determining the most valid and responsive instruments. Spine J 14:2885–2891. https://doi.org/10.1016/j.spinee.2014.04.023
Haywood KL, Garratt AM, Fitzpatrick R (2005) Quality of life in older people: a structured review of generic self-assessed health instruments. Qual Life Res 14:1651–1668. https://doi.org/10.1007/s11136-005-1743-0
Tordrup D, Mossman J, Kanavos P (2014) Responsiveness of the EQ-5D to clinical change: is the patient experience adequately represented? Int J Technol Assess Health Care 30:10–19. https://doi.org/10.1017/S0266462313000640
Kuspinar A, Mayo NE (2014) A review of the psychometric properties of generic utility measures in multiple sclerosis. Pharmacoeconomics 32:759–773. https://doi.org/10.1007/s40273-014-0167-5
Wu J, Han Y, Zhao FL, Zhou J, Chen Z, Sun H (2014) Validation and comparison of EuroQoL-5 dimension (EQ-5D) and Short Form-6 dimension (SF-6D) among stable angina patients. Health Qual Life Outcomes 12:156. https://doi.org/10.1186/s12955-014-0156-6
Lutomski JE, Krabbe PF, Bleijenberg N et al (2017) Measurement properties of the EQ-5D across four major geriatric conditions: findings from TOPICS-MDS. Health Qual Life Outcomes 15:45. https://doi.org/10.1186/s12955-017-0616-x
Brazier J, Roberts J, Tsuchiya A, Busschbach J (2004) A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 13:873–884. https://doi.org/10.1002/hec.866
Fransen M, Edmonds J (1999) Reliability and validity of the EuroQol in patients with osteoarthritis of the knee. Rheumatology 38:807–813
Herdman M, Gudex C, Lloyd A et al (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736. https://doi.org/10.1007/s11136-011-9903-x
Greene ME, Rader KA, Garellick G, Malchau H, Freiberg AA, Rolfson O (2015) The EQ-5D-5L improves on the EQ-5D-3L for health-related quality-of-life assessment in patients undergoing total hip arthroplasty. Clin Orthop Relat Res 473:3383–3390. https://doi.org/10.1007/s11999-014-4091-y
Konnopka A, Koenig HH (2017) The “no problems"-problem: an empirical analysis of ceiling effects on the EQ-5D 5L. Qual Life Res 26:2079–2084. https://doi.org/10.1007/s11136-017-1551-3
Frihagen F, Grotle M, Madsen JE, Wyller TB, Mowinckel P, Nordsletten L (2008) Outcome after femoral neck fractures: a comparison of Harris Hip Score, Eq-5d and Barthel Index. Injury 39:1147–1156. https://doi.org/10.1016/j.injury.2008.03.027
Janssen MF, Pickard AS, Golicki D et al (2013) Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res 22:1717–1727. https://doi.org/10.1007/s11136-012-0322-4
Acknowledgements
The authors thank Prof. Dr. K. Eichler from the Winterthur Institute of Health Economics for his advice and support in the initiation of this project, Dr. sc. nat. M. Gosteli from the University of Zurich for searching the literature and Dr. M. Wilhelmi from the Schulthess Klinik for editing the manuscript.
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Grobet, C., Marks, M., Tecklenburg, L. et al. Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review. Arch Orthop Trauma Surg 138, 953–961 (2018). https://doi.org/10.1007/s00402-018-2933-x
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DOI: https://doi.org/10.1007/s00402-018-2933-x