Zingelman Sally, Wallace Sarah J, Kim Joosup, Harvey Sam, Rose Miranda L, Pierce John E, Bagot Kathleen L, Cadilhac Dominique A
Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Herston, Australia.
Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Australia.
Qual Life Res. 2025 Jul 26. doi: 10.1007/s11136-025-04040-8.
Economic evaluations based on health-related quality of life (HRQOL) inform healthcare decisions. The generic EuroQol 5-Dimensions Health Questionnaire, 3-Level (EQ-5D-3L) permits conversion to utility values required for economic evaluations but is not validated for people with aphasia. The aphasia-specific Stroke and Aphasia Quality of Life Scale-39 g (SAQOL-39g) measures HRQOL, however, cannot be used to generate utility values. This study aimed to compare the performance of these two instruments.
HRQOL was rated at baseline and 12 weeks in participants of the Constraint Induced or Multi-Modal Personalised Aphasia Rehabilitation (COMPARE) randomised controlled trial. We assessed: (1) distribution of self-rated HRQOL scores, (2) convergent validity between EQ-5D-3L (domains; utility values; visual analogue scale) and SAQOL-39g (domain scores; total mean scores) using Spearman's correlations, (3) Construct validity through exploratory factor analysis, and (4) discriminative ability of converted EQ-5D-3L utilities in measuring compromised HRQOL (SAQOL-39g scores ≤ 4).
Participants (n = 201 baseline, n = 190 12 weeks) completed both instruments (69% male, median age 63.6 years, median time since stroke 2.5 years). Ceiling effects were high for the EQ-5D-3L at baseline (45-79%) versus the SAQOL-39g (0-6%). Convergent validity between the SAQOL-39g communication domain and the EQ-5D-3L (r = 0.04-0.28) was weak at both time points. Factor analysis revealed distinct underlying constructs between instruments. EQ-5D-3L utility scores demonstrated reasonable performance (0.80 baseline; 0.78 12-weeks) in measuring poor HRQOL.
Our findings suggest that EQ-5D-3L use in economic evaluations including people with aphasia requires caution. Alternative HRQOL instruments require evaluation to ensure fair prioritisation of aphasia treatments.
基于健康相关生活质量（HRQOL）的经济评估为医疗决策提供依据。通用的欧洲五维健康问卷3级版（EQ-5D-3L）可转换为经济评估所需的效用值，但未在失语症患者中得到验证。特定于失语症的卒中与失语症生活质量量表39项简版（SAQOL-39g）用于测量HRQOL，然而，不能用于生成效用值。本研究旨在比较这两种工具的性能。
在约束诱导或多模式个性化失语症康复（COMPARE）随机对照试验的参与者中，于基线和12周时对HRQOL进行评分。我们评估了：（1）自评HRQOL分数的分布，（2）使用Spearman相关性评估EQ-5D-3L（领域；效用值；视觉模拟量表）和SAQOL-39g（领域分数；总平均分）之间的收敛效度，（3）通过探索性因素分析评估结构效度，以及（4）转换后的EQ-5D-3L效用值在测量受损HRQOL（SAQOL-39g分数≤4）方面的鉴别能力。
参与者（基线时n = 201，12周时n = 190）完成了两种工具的测评（69%为男性，中位年龄63.6岁，卒中后中位时间2.5年）。EQ-5D-3L在基线时的天花板效应较高（45 - 79%），而SAQOL-39g的天花板效应为（0 - 6%）。在两个时间点，SAQOL-39g沟通领域与EQ-5D-3L之间的收敛效度均较弱（r = 0.04 - 0.28）。因素分析揭示了两种工具之间不同的潜在结构。EQ-5D-3L效用分数在测量较差的HRQOL方面表现出合理的性能（基线时为0.80；12周时为0.78）。
我们的研究结果表明，在包括失语症患者在内的经济评估中使用EQ-5D-3L需要谨慎。需要对替代的HRQOL工具进行评估，以确保失语症治疗的公平优先排序。
