PurposeTo assess EQ-5D-5L (5L) validity in patients with acute stroke, in comparison with EQ-5D-3L (3L).MethodsCross-sectional study of 408 patients during index hospitalization. We compared 5L and 3L in terms of feasibility, frequency of unique health states, ceiling effect and discriminatory power (informativity). We assessed construct validity in terms of known-groups validity and convergent validity of 5L dimensions with other stroke outcome measures.ResultsThe overall proportion of patients with acute stroke reporting ‘no problems’ with 3L—6.1 % was further reduced to 5.6 % with 5L (relative reduction of 8.2 %). The highest improvement in relative discriminatory power, when moving from 3L to 5L, was noticed in pain/discomfort and anxiety/depression dimensions (Shannon Evenness Index 0.91 for both 5L dimensions; relative increase 34.4 and 29.1 %, respectively). Known-groups validity tests confirmed prior hypotheses: Health state utilities were lower in following subpopulations—females, patients with high modified Rankin Scale (mRS) score, low Barthel Index (BI) or VAS score, patients with subarachnoid hemorrhage or intracerebral hemorrhage, and when proxy respondent was used. Convergence of EQ-5D-5L dimensions with mRS, BI and EQ VAS was improved or at least the same as for 3L dimensions.ConclusionsResults support the validity of the EQ-5D-5L descriptive system as a generic health outcome measure in patients with acute stroke, demonstrating some psychometric advantages in comparison with EQ-5D-3L.
AimsTo date, evidence to support the construct validity of the EQ-5D-5L has primarily focused on cross-sectional data. The aims of this study were to examine the responsiveness of EQ-5D-5L in patients with stroke and to compare it with responsiveness of EQ-5D-3L and visual analogue scale (EQ VAS).MethodsWe performed an observational longitudinal cohort study of patients with stroke. At 1 week and 4 months post-stroke, patients were assessed with modified Rankin Scale (mRS) and Barthel Index (BI) and were administered the EQ-5D-5L and EQ-5D-3L, including the EQ VAS. The EQ-5D-5L index scores were derived using the crosswalk methodology developed by the EuroQol Group. We classified patients according to two external criteria, based on mRS or BI, into 3 categories: ‘improvement,’ ‘stable’ or ‘deterioration’. We assessed the responsiveness of each measure in each patient subgroup using: effect size (ES), standardized response mean (SRM), F-statistic, relative efficiency and area under the receiver operating characteristic curve.ResultsA total of 112 patients (52 % females; mean age 70.6 years; 93 % ischemic stroke) completed all the instruments at both occasions. In subjects with clinical improvement, EQ-5D-5L was consistently responsive, showing moderate ES (0.51–0.71) and moderate to large SRM (0.69–0.86). In general, EQ-5D-3L index appeared to be more responsive (ES 0.63–0.82; SRM 0.77–1.06) and EQ VAS less responsive (ES 0.51–0.65; SRM 0.59–0.69) than EQ-5D-5L index.ConclusionsThe EQ-5D-5L index, based on the crosswalk value set, seems to be appropriately responsive in patients with stroke, 4 months after disease onset. As far as EQ-5D-5L index is scored according to crosswalk approach, the EQ-5D-3L index appears to be more responsive in stroke population.
objeCtives: To assess EQ-5D-5L validity in patients with acute stroke, in comparison to EQ-5D-3L, EQ VAS, modified Rankin Scale (mRS) and Barthel Index (BI). Methods: Cross-sectional study of 408 patients (51.5% males; mean age 69 years), after median 8 days from stroke onset. We assessed: construct validity in terms of known-groups validity, convergent validity of EQ-5D-5L dimensions with other stroke outcome measures, and criterion-related validity in terms of concurrent validity, with mRS as a gold standard. Results: A total of 2.9% EQ-5D-5L and 3.7% EQ-5D-3L questionnaires had at least one missing answer, indicating good feasibility of both instruments in patients with stroke. The proportion of patients reporting 'no problems' was 38.2% for BI, 6.1% for EQ-5D-3L, 5.6% for EQ-5D-5L, 5.0% for mRS and 2.5% for EQ VAS. Results of the known-groups validity tests confirmed prior hypotheses: health state utilities were lower in females, patients with high mRS score, low BI or VAS score, patients with subarachnoid hemorrhage or intracerebral hemorrhage, and when proxy respondent was used. Convergence of EQ-5D-5L dimensions with mRS, BI and EQ VAS was improved or at least the same as EQ-5D-3L dimensions. For predicting outcome in patients with stroke, the sum of mRS related EQ-5D-5L dimensions (Mobility, Self-care, Usual activities), gave 1% of false positive and 0% of false negative results. ConClusions: Results support the validity of the EQ-5D-5L descriptive system as a generic measure assessed by self-report and proxy in patients with acute stroke, demonstrating some psychometric advantages in comparison to EQ-5D-3L and substantially lower ceiling effect in comparison to Barthel Index.
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