Skip to main content

Advertisement

SpringerLink
Log in

Using the knee-specific Hughston Clinic Questionnaire, EQ-5D and SF-6D following arthroscopic partial meniscectomy surgery: a comparison of psychometric properties

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

To compare the psychometric properties of the Hughston Clinic Questionnaire (HCQ), EQ-5D and SF-6D in patients following arthroscopic partial meniscectomy surgery.

Methods

A total of 84 participants (86% men; mean age 40) were recruited. The questionnaires were completed on average 5 days, 6 weeks and 6 months after surgery and compared for internal consistency, convergent validity, sensitivity to change and floor and ceiling effects.

Results

Internally, the HCQ was the most consistent instrument (α = 0.923) followed by the SF-6D and EQ-5D. The EQ-5D and SF-6D were moderately correlated with the HCQ (ρ = 0.499 and 0.394, respectively). Six weeks after surgery, the most sensitive measures were the HCQ and EQ-5D (effect size: 2.04 and 0.99, respectively), at 6 months, with a smaller cohort (n = 42), again it was the HCQ and EQ-5D (effect size: 2.03 and 1.04, respectively). The SF-6D demonstrated no ceiling or floor effect during the study; the HCQ demonstrated a ceiling affect for 5% of respondents at 6 months after surgery compared to 26% of respondents for the EQ-5D.

Conclusion

For this patient population, our findings indicated that the EQ-5D was more consistently responsive to change over time, as a utility index was better at distinguishing differences between groups and reflected the results of the joint-specific HCQ for knee recovery better than the SF-6D. It is therefore recommended that for similar populations, the EQ-5D is preferable to the SF-6D for utilisation alongside the HCQ.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

EQ-5D:

Euroqol-5 dimension

SF-6D:

Short form-6 dimensions

SF-36:

36-item short form health survey

HCQ:

Hughston Clinic Questionnaire

HRQL:

Health related quality of life

QALY:

Quality adjusted life year

MID:

Minimally important difference

SRM:

Standardised response mean

SD:

Standard deviation

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

References

  1. Sonline, H. E. (2011). NHS hospital episode statistics: W82.2 endoscopic resection of semilunar cartilage NEC. http://www.hesonline.nhs.uk Accessed 25th January 2011.

  2. Goodwin, P. C., Morrissey, M. C., Omar, R. Z., Brown, M., Southall, K., & McAuliffe, T. B. (2003). Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Physical Therapy, 83(6), 520–535.

    PubMed  Google Scholar 

  3. Brazier, J., Ratcliffe, J., Salomon, J., & Tsuchiya, A. (2007). Measuring and valuing health benefits for economic evaluation. Oxford: Oxford University Press.

    Google Scholar 

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

    Google Scholar 

  5. Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference based measure of health from the SF-36. Journal of Health Economics, 21(2), 271–292.

    Google Scholar 

  6. National Institute for Health, Clinical Excellence. (2004). Guide to the methods of technology appraisal. London: NICE.

    Google Scholar 

  7. Rasanen, P., Roine, E., Sintonen, H., Semberg-Konttinen, V., Ryynanen, O. P., & Roine, R. (2006). Use of quality-adjusted life years for the estimation of effectiveness of health care: A systematic literature review. International Journal of Technology Assessment in Health Care, 22(2), 235–241.

    Article  PubMed  Google Scholar 

  8. Jenkinson, C. D., Layte, R. D., & Lawrence, K. M. (1997). Development and testing of the medical outcomes study 36-item short form health survey summary scale scores in the United Kingdom: Results from a large-scale survey and a clinical trial. Medical Care, 35(4), 410–416.

    Article  PubMed  CAS  Google Scholar 

  9. Perdue, P. S., Jr., Hummer, I. C., Colosimo, A. J., Heidt, R. S., Jr., & Dormer, S. G. (1996). Meniscal repair: Outcomes and clinical follow-up. Arthroscopy, 12(6), 694–698.

    Article  PubMed  Google Scholar 

  10. O’Connor, D. P., Brinker, M. R., & Woods, G. W. (2002). Preoperative health status of patients with four knee conditions treated with arthroscopy. Clinical Orthopaedics & Related Research, 395, 164–173.

    Google Scholar 

  11. Johannesson, M., Jonsson, B., & Karlsson, G. (1996). Outcome measurement in economic evaluation. Health Economics, 5(4), 279–296.

    Article  PubMed  CAS  Google Scholar 

  12. Bharmal, M., & Thomas, I. J. (2006). Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value in Health, 9(4), 262–271.

    Article  PubMed  Google Scholar 

  13. van Stel, H. F., & Buskens, E. (2006). Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease. Health and Quality of Life Outcomes, 4, 20. doi:10.1186/1477-7525-4-20. http://www.hqlo.com/content/4/1/20.

  14. Longworth, L., & Bryan, S. (2003). An empirical comparison of EQ-5D and SF-6D in liver transplant patients. Health Economics, 12(12), 1061–1067.

    Article  PubMed  Google Scholar 

  15. Marra, C. A. P. P., Esdaile, J. M. M. D. M. P. H., Guh, D. M., Kopec, J. A. M. D. P., Brazier, J. E. P., Koehler, B. E. M. D. F., et al. (2004). A comparison of four indirect methods of assessing utility values in rheumatoid arthritis. Medical Care, 42(11), 1125–1131.

    Article  PubMed  Google Scholar 

  16. Marra, C. A., Woolcott, J. C., Kopec, J. A., Shojania, K., Offer, R., Brazier, J. E., et al. (2005). A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Social Science and Medicine, 60(7), 1571–1582.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Bryan, S., & Longworth, L. (2005). Measuring health-related utility: Why the disparity between EQ-5D and SF-6D? European Journal of Health Economics, 6(3), 253–260.

    Article  PubMed  Google Scholar 

  19. Flandry, F., Hunt, J. P., Terry, G. C., & Hughston, J. C. (1991). Analysis of subjective knee complaints using visual analog scales. American Journal of Sports Medicine, 19(2), 112–118.

    Article  PubMed  CAS  Google Scholar 

  20. 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, 38(9), 870–877.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  22. Bennell, K., Bartram, S., Crossley, K., & Green, S. (2000). Outcome measures in patellofemoral pain syndrome: Test retest reliability and inter-relationships. Physical Therapy in Sport, 1, 32–34.

    Article  Google Scholar 

  23. Hoher, J., Munster, A., Klein, J., Eypasch, E., & Tiling, T. (1995). Validation and application of a subjective knee questionnaire. Knee Surgery, Sports Traumatology, Arthroscopy, 3(1), 26–33.

    Article  PubMed  CAS  Google Scholar 

  24. Hooper, D. M., Morrissey, M. C., Drechsler, W. I., McDermott, M., & McAuliffe, T. B. (2001). Validation of the Hughston Clinic subjective knee questionnaire using gait analysis. Medicine and Science in Sports and Exercise, 33(9), 1456–1462.

    Article  PubMed  CAS  Google Scholar 

  25. Carlsson, A. M. (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16, 87–101.

    Article  PubMed  CAS  Google Scholar 

  26. Lysholm, J., & Gillquist, J. (1982). Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. American Journal of Sports Medicine, 10(3), 150–154.

    Article  PubMed  CAS  Google Scholar 

  27. Larson, R. L. (1974). Rating sheet for knee function. In I. Smillie (Ed.), Diseases of the knee joint. Edinburgh: Churchill Livingstone.

    Google Scholar 

  28. Noyes, F. R., & McGinniss, G. H. (1985). Controversy about treatment of the knee with anterior cruciate laxity. Clinical Orthopaedics & Related Research, 198, 61–76.

    Google Scholar 

  29. Kujala, U. M., Jaakkola, L. H., Koskinen, S. K., Taimela, S., Hurme, M., & Nelimarkka, O. (1993). Scoring of patellofemoral disorders. Arthroscopy, 9(2), 159–163.

    Article  PubMed  CAS  Google Scholar 

  30. Chesworth, B. M., Culham, E. G., Tata, G. E., & Peat, M. (1989). Validation of outcome measures in patients with patellofemoral syndrome. Journal of Orthopaedic and Sports Physical Therapy, 10(8), 302–308.

    PubMed  CAS  Google Scholar 

  31. Harrison, E., Quinney, H., Magee, D., Sheppard, M. S., & McQuarrie, A. (1995). Analysis of outcome measures used in the study of patellofemoral pain syndrome. Physiotherapy Canada, 47(4), 264–272.

    PubMed  CAS  Google Scholar 

  32. Eng, J. J., & Pierrynowski, M. R. (1993). Evaluation of soft foot orthotics in the treatment of patellofemoral pain syndrome. Physical Therapy, 73(2), 62–70.

    PubMed  CAS  Google Scholar 

  33. Hurst, N. P., Kind, P., Ruta, D., Hunter, M., & Stubbings, A. (1997). Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). British Journal of Rheumatology, 36(5), 551–559.

    Article  PubMed  CAS  Google Scholar 

  34. Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Williamson, E., Jones, R. H., et al. (2007). Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain. Arthritis & Rheumatoid Arthritis Care & Research, 57(7), 1220–1229.

    Article  CAS  Google Scholar 

  35. Bryan, S., Bungay, H. P., Weatherburn, G., & Field, S. (2004). Magnetic resonance imaging for investigation of the knee joint and economic evaluation. International Journal of Technology Assessment in Health Care, 20, 222–229.

    Article  PubMed  Google Scholar 

  36. Dolan, P. (1997). Modeling valuations for EuroQol health states. Medical Care, 35(11), 1095–1108.

    Article  PubMed  CAS  Google Scholar 

  37. Ware, J., & Sherbourne, C. (1992). The medical outcomes study 36-item short-form health survey (SF-36). Medical Care, 30(6), 473–483.

    Article  PubMed  Google Scholar 

  38. Brazier, J., Usherwood, T., Harper, R., & Thomas, K. (1998). Deriving a preference-based single-index from the UK SF-36 health survey. Journal of Clinical Epidemiology, 51(11), 1115–1128.

    Article  PubMed  CAS  Google Scholar 

  39. Price, C., Arden, N., Coglan, L., & Rogers, P. (2005). Cost-effectiveness and safety of epidural steroids in the management of sciatica. Health Technology Assessment, 9(33), iii, 1–58.

    Google Scholar 

  40. Thomas, K. J., MacPherson, H., Ratcliffe, J., Thorpe, L., Brazier, J., Campbell, M., et al. (2005). Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technology Assessment, 9(32), iii–iv, ix–x, 1–109.

    Google Scholar 

  41. van den Hout, W. B., de Jong, Z., Munneke, M., Hazes, J. M. W., Breedveld, F. C., & Vliet Vlieland, T. P. M. (2005). Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis. Arthritis and Rheumatism, 53(1), 39–47.

    Article  PubMed  Google Scholar 

  42. van den Hout, W. B., Vermeulen, H. M., Rozing, P. M., & Vliet Vlieland, T. P. M. (2005). Impact of adhesive capsulitis and economic evaluation of high-grade and low-grade mobilisation techniques. Australian Journal of Physiotherapy, 51(3), 141–149.

    Article  PubMed  Google Scholar 

  43. Emery, P., Kosinski, M., Li, T., Martin, M., Williams, G. R., Becker, J.-C., et al. (2006). Treatment of rheumatoid arthritis patients with abatacept and methotrexate significantly improved health-related quality of life. Journal of Rheumatology, 33(4), 681–689.

    PubMed  CAS  Google Scholar 

  44. Michaels, J. A., Brazier, J. E., Campbell, W. B., MacIntyre, J. B., Palfreyman, S. J., & Ratcliffe, J. (2006). Randomized clinical trial comparing surgery with conservative treatment for uncomplicated varicose veins. British Journal of Surgery, 93(2), 175–181.

    Article  PubMed  CAS  Google Scholar 

  45. Freeman, B. J. C., Steele, N. A., Sach, T. H., Hegarty, J., & Soegaard, R. (2007). ISSLS prize winner: Cost-effectiveness of two forms of circumferential lumbar fusion: A prospective randomized controlled trial. Spine, 32(25), 2891–2897.

    Article  PubMed  Google Scholar 

  46. Khanna, D., Yan, X., Tashkin, D. P., Furst, D. E., Elashoff, R., Roth, M. D., et al. (2007). Impact of oral cyclophosphamide on health-related quality of life in patients with active scleroderma lung disease: Results from the scleroderma lung study. Arthritis and Rheumatism, 56(5), 1676–1684.

    Article  PubMed  CAS  Google Scholar 

  47. Slatkowsky-Christensen, B., Mowinckel, P., Loge, J. H., & Kvien, T. K. (2007). Health-related quality of life in women with symptomatic hand osteoarthritis: a comparison with rheumatoid arthritis patients, healthy controls, and normative data. Arthritis and Rheumatism, 57(8), 1404–1409.

    Article  PubMed  Google Scholar 

  48. Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Quality of Life Research, 14(6), 1523–1532.

    Article  PubMed  Google Scholar 

  49. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334.

    Article  Google Scholar 

  50. Streiner, D. L., & Norman, G. R. (2003). Health measurement scales: A practical guide to their development and use (3rd ed.). Oxford: Oxford University Press.

    Google Scholar 

  51. Nunnally, J. C., Jr. (1978). Psychometric theory (2nd ed.). New York: McGraw-Hill.

    Google Scholar 

  52. Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  53. Bland, M. J., & Altman, D. G. (1997). Statistics notes: Cronbach’s alpha. British Medical Journal, 314, 572.

    PubMed  CAS  Google Scholar 

  54. McDonough, C. M., & Tosteson, A. N. A. (2007). Measuring preferences for cost-utility analysis: How choice of method may influence decision-making. Pharmacoeconomics, 25(2), 93–106.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the London Regional Office, North Thames Health Authority for their financial support of this study. Thanks also to the following clinicians and researchers who supported this study: M. Klarneta, I. Man, D. Morrissey, P. Knight, M. Brown, G. Southall, J. Dredge, S. Fellows, M. Barry, T. Bucknill, P. Earnshaw, M. El-Zebdeh, D. Goodier, J. Ireland, K. Kong, M. Lamba, T. McAuliffe, B.E. Okafor, V. Siva, and D Sweetnam.

Author information

Authors and Affiliations

  1. Faculty of Health, Psychology and Social Care, Manchester Metropolitan University Elizabeth Gaskell Campus, Hathersage Road, Manchester, UK

    Peter C. Goodwin

  2. Flinders Clinical Effectiveness, Flinders University, Rehabilitation and Aged Care, C block Level 1, Repatriation General Hospital, Daws Road, Daw Park, SA, 5041, Australia

    Julie Ratcliffe

  3. Education and Research Centre, University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester, UK

    Julie Morris

  4. Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia

    Matthew C. Morrissey

Authors
  1. Peter C. Goodwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie Ratcliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew C. Morrissey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter C. Goodwin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goodwin, P.C., Ratcliffe, J., Morris, J. et al. Using the knee-specific Hughston Clinic Questionnaire, EQ-5D and SF-6D following arthroscopic partial meniscectomy surgery: a comparison of psychometric properties. Qual Life Res 20, 1437–1446 (2011). https://doi.org/10.1007/s11136-011-9880-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-011-9880-0

Keywords

Search

Navigation