Does the EQ-5D-5L benefit from extension with a cognitive domain: Testing a multi-criteria psychometric strategy in trau
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Does the EQ‑5D‑5L benefit from extension with a cognitive domain: Testing a multi‑criteria psychometric strategy in trauma patients A. J. L. M. Geraerds1 · Gouke J. Bonsel1 · Suzanne Polinder1 · M. J. M. Panneman2 · M. F. Janssen3 · Juanita A. Haagsma1 Accepted: 30 March 2020 © The Author(s) 2020
Abstract Purpose This study investigated the psychometric yield of extension of the EQ-5D-5L with a cognitive domain (EQ-5D+C) in a mixed cohort of trauma patients with repeated data. Methods A stratified sample of patients that presented at the emergency department filled out a follow-up survey 6 and 12 months after trauma. The surveys included the EQ-5D-5L+C, EQ-VAS, and the impact of events scale-revised (IES-R), a validated post-traumatic stress disorder (PTSD) self-assessment scale. Generally, results of the EQ-5D and EQ-5D+C were compared. Psychometrics included the following: distributional features (ceiling/floor effects), discriminatory performance, convergent validity with the EQ-VAS as reference, and responsiveness to change. Psychometric properties were compared between predefined subgroups based on conditions with cognitive impact (Traumatic Brain Injury (TBI)/PTSD). Results In total, 1799 trauma patients responded 6 and 12 months after trauma, including 107 respondents with PTSD, and 273 with TBI. Six months post-trauma, ceiling of the EQ-5D (26.3%) was reduced with 2.2% with the additional cognitive domain. Using EQ-VAS as reference, convergent validity increased slightly with the addition of the cognitive domain: correlation increasing from 0.651 to 0.664. Cognitive level was found to slightly improve over time in TBI (delta: 0.04) and PTSD patients (delta: 0.05), while (almost) no change was found in patients without TBI and PTSD. Conclusion Adding a cognitive domain to the EQ-5D-5L slightly improved measurement properties and better captured change in health status for trauma patients with TBI and PTSD. Inclusion of the cognitive domain in the EQ-5D-5L when measuring in populations with cognitive problems should be considered. Keywords HRQL · EQ-5D-5L · Cognition · Bolt-on · Responsiveness
Background Measuring health-related quality of life (HRQL) is an important aspect of research in trauma patients [1]. HRQL can be measured with either a generic or a disease-specific measurement instrument [2]. One of the most widely used preference-based generic health status instruments is the EQ-5D [3]. The EQ-5D is a measurement instrument based on * A. J. L. M. Geraerds [email protected] 1
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
2
Consumer and Safety Institute, Amsterdam, the Netherlands
3
Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
self-assessment that consists of five domains: mobility, selfcare, usual activities, pain/discomfort and anxiety/depression [4]. Each domain contains one item that informs on the degree of problems. The maj
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