Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
Department of Surgery, Innlandet Hospital Gjøvik, Gjøvik, Norway.
Health Qual Life Outcomes. 2021 May 28;19(1):155. doi: 10.1186/s12955-021-01792-y.
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).
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).
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.
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.
retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677 .
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。
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。
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。
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。
