Psychometric properties of the EQ-5D-5L: a systematic review of the literature
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REVIEW
Psychometric properties of the EQ‑5D‑5L: a systematic review of the literature You‑Shan Feng1,2 · Thomas Kohlmann1 · Mathieu F. Janssen3 · Ines Buchholz1 Accepted: 26 October 2020 © The Author(s) 2020
Abstract Purpose Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L. Methods Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test–retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models. Results Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health. Conclusions The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed. Keywords EQ-5D · EQ-5D-5L · Systematic review · Health-Related Quality of Life · Psychometricproperties
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11136-020-02688-y) contains supplementary material, which is available to authorized users. * You‑Shan Feng you‑[email protected]‑tuebingen.de 1
Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
2
Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Silcherstraße 5, 72076 Tübingen, Germany
3
Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Erasmus University, Rotterdam, The Netherlands
Abbreviations 15D 15 measure of health-related quality of life ADL Activities of Daily Living AQoL-8D Assessment of Quality of Life (AQoL)-8D Multi-Attribute Utility Instrument BMI Body Mass Index BREAST
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