腰痛患者的 EQ-5D-3L 和 5L 版本评估。
Evaluation of the EQ-5D-3L and 5L versions in low back pain patients.
机构信息
Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
Department of Surgery, Innlandet Hospital Gjøvik, Gjøvik, Norway.
出版信息
Health Qual Life Outcomes. 2021 May 28;19(1):155. doi: 10.1186/s12955-021-01792-y.
BACKGROUND
The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP).
METHODS
LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25).
RESULTS
At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon's indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L.
CONCLUSION
The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended.
TRIAL REGISTRATION
retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677 .
背景
EuroQol EQ-5D 是全球应用最广泛的患者报告结局测量之一。原始的 EQ-5D-3L 和最近的 EQ-5D-5L 分别包含三个和五个反应类别。来自健康人群和患病人群的证据表明，增加的两个反应类别可以改善测量特性，但在腰痛（LBP）患者中尚未同时比较这两个版本。
方法
参与腰椎全椎间盘置换和保守治疗的多中心随机对照试验的 LBP 患者在八年随访问卷中完成了 EQ-5D-3L 和 5L。根据先前的假设，从数据质量的各个方面评估了 3L 和 5L，包括缺失数据、地板和天花板效应、反应一致性，并与 Oswestry 残疾指数（ODI）、疼痛视觉模拟量表和 Hopkins 症状清单（HSCL-25）进行了关联。
结果
在八年随访时，151 名（87%）患者可用于研究，其中 146 名患者同时完成了 3L 和 5L。两种版本的缺失数据水平相同。与 EQ-5D-5L 相比，EQ-5D-3L 具有明显更高的地板（疼痛不适）和天花板效应（移动性、自我护理、疼痛/不适、焦虑/抑郁）。对于这些患者，EQ-5D-5L 描述了 73 种健康状态，而 EQ-5D-3L 仅描述了 28 种。Shannon 指数表明，5L 在分类效率测试中优于 3L。与 ODI、疼痛 VAS 和 HSCL-25 的相关性在很大程度上符合假设，5L 的相关性略高于 3L。
结论
EQ-5D 评估了 LBP 患者健康的重要方面，并且在这方面，5L 优于 3L。建议优先使用 EQ-5D-5L 版本，然而，建议在其他腰痛人群中进一步测试，并进行其他测量特性的测试，包括对变化的反应性。
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