EQ-5D-3L 和 EQ-5D-5L 在记录有大量合并症和多种药物治疗的老年患者自报健康状况方面的测量性能。
Measurement properties of EQ-5D-3L and EQ-5D-5L in recording self-reported health status in older patients with substantial multimorbidity and polypharmacy.
机构信息
Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
Academic Unit for Health Economics, Institute for Health Sciences, University of Leeds, Leeds, UK.
出版信息
Health Qual Life Outcomes. 2020 Sep 29;18(1):317. doi: 10.1186/s12955-020-01564-0.
BACKGROUND
The EQ-5D-3L and EQ-5D-5L are two generic health-related quality of life measures, which may be used in clinical and health economic research. They measure impairment in 5 aspects of health: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The aim of this study was to assess the performance of the EQ-5D-3L and EQ-5D-5L in measuring the self-reported health status of older patients with substantial multimorbidity and associated polypharmacy.
METHODS
Between 2017 and 2019, we administered EQ-5D-3L and EQ-5D-5L to a subset of patients participating in the OPERAM trial at 6 months and 12 months after enrolment. The OPERAM trial is a two-arm multinational cluster randomised controlled trial of structured medication review assisted by a software-based decision support system versus usual pharmaceutical care, for older people (aged ≥ 70 years) with multimorbidity and polypharmacy. In the psychometric analyses, we only included participants who completed the measures in full at 6 and 12 months. We assessed whether responses to the measures were consistent by assessing the proportion of EQ-5D-5L responses, which were 2 or more levels away from that person's EQ-5D-3L response. We also compared the measures in terms of informativity, and discriminant validity and responsiveness relative to the Barthel Index, which measures independence in activities of daily living.
RESULTS
224 patients (mean age of 77 years; 56% male) were included in the psychometric analyses. Ceiling effects reported with the EQ-5D-5L (22%) were lower than with the EQ-5D-3L (29%). For the mobility item, the EQ-5D-5L demonstrated better informativity (Shannon's evenness index score of 0.86) than the EQ-5D-3L (Shannon's evenness index score of 0.69). Both the 3L and 5L versions of EQ-5D demonstrated good performance in terms of discriminant validity, i.e. (out of all items of the EQ-5D-3L and EQ-5D-5L, the pain/discomfort and anxiety/depression items had the weakest correlation with the Barthel Index. Both the 3L and 5L versions of EQ-5D demonstrated good responsiveness to changes in the Barthel Index.
CONCLUSION
Both EQ-5D-3L and EQ-5D-5L demonstrated validity and responsiveness when administered to older adults with substantial multimorbidity and polypharmacy who were able to complete the measures.
背景
EQ-5D-3L 和 EQ-5D-5L 是两种通用的健康相关生活质量测量方法，可用于临床和健康经济研究。它们衡量五个方面的健康损害：移动能力、自理能力、日常活动、疼痛/不适和焦虑/抑郁。本研究旨在评估 EQ-5D-3L 和 EQ-5D-5L 在测量患有大量多种疾病和相关多种药物的老年患者的自我报告健康状况方面的表现。
方法
在 2017 年至 2019 年期间，我们在登记后 6 个月和 12 个月时，向 OPERAM 试验的一部分参与者发放了 EQ-5D-3L 和 EQ-5D-5L。OPERAM 试验是一项针对患有多种疾病和多种药物的老年人（年龄≥70 岁）的基于软件的决策支持系统辅助的结构化药物审查与常规药物治疗的多国、两臂、集群随机对照试验。在心理测量分析中，我们仅纳入了在 6 个月和 12 个月时完整完成测量的参与者。我们通过评估 EQ-5D-5L 反应与该人 EQ-5D-3L 反应相差 2 个或更多水平的比例，来评估反应是否一致。我们还根据与测量日常生活活动独立性的巴氏量表的信息性、判别有效性和反应性来比较这些测量方法。
结果
224 名患者（平均年龄 77 岁；56%为男性）纳入心理测量分析。EQ-5D-5L 报告的上限效应（22%）低于 EQ-5D-3L（29%）。对于移动性项目，EQ-5D-5L 的信息性更好（香农均匀度指数评分为 0.86），而 EQ-5D-3L 的香农均匀度指数评分为 0.69。EQ-5D 的 3L 和 5L 版本在判别有效性方面均表现良好，即（EQ-5D-3L 和 EQ-5D-5L 的所有项目中，疼痛/不适和焦虑/抑郁项目与巴氏量表的相关性最弱。EQ-5D 的 3L 和 5L 版本对巴氏量表的变化均具有良好的反应性。
结论
当用于能够完成测量的患有大量多种疾病和多种药物的老年患者时，EQ-5D-3L 和 EQ-5D-5L 均表现出有效性和反应性。
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