Does the EQ-5D-5L benefit from extension with a cognitive domain: Testing a multi-criteria psychometric strategy in trauma patients

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.

Sensitivity of the EQ-5D-5L for fatigue and cognitive problems and their added value in Q-fever patients

“…In addition, a frequently used item on cognitive problems in EQ-5D-5L format was included in the survey, informing on problems with memory/understanding/coherence/thinking. The item has been tested in multiple studies on its psychometric performance [ 23 , 24 ]. The wording of the item was: ‘Cognition, such as memory, understanding, concentration, thinking’.…”

“…The addition of a cognition dimension to the EQ-5D has been studied more extensively than fatigue, and cognition has in many studies already been applied as an additional dimension of the EQ-5D [17]. However, while often suggested [16,32,33] and also tested for added value [23,24,28,34,[37][38][39][40], the cognition dimension is not an official EQ-5D dimension. Therefore, it is relevant to analyze the extent to which cognition is captured in a patient population with cognitive problems.…”

Methods Used to Identify, Test, and Assess Impact on Preferences of Bolt-Ons: A Systematic Review

“…Of the 28 articles that were included, 3 articles were studies that identified possible bolt-ons (category A "identification or development of possible suitable bolt-ons"), [23][24][25] 13 articles were psychometric performance studies (category B "psychometric performance studies"), 8,26-37 and 6 articles were valuation studies of EQ-5D 1 bolt-on (category C "health state valuation studies"). 19,20,[38][39][40][41][42] Furthermore, 3 articles were categorized as both categories A and B, [43][44][45] and 3 articles as both categories A and C. 13,21,38 Study populations consisted of a healthy population (n = 17 articles: general public, 13,[19][20][21]24,25,27,30,36,38,[40][41][42][43] random households, 44,45 faculty members 39 ) and patients (n = 11 articles: individuals with a chronic condition, 23 visitors of an outpatient eye clinic, 26 cognitive impaired elderly patients, 18 patients with diabetes, 28 general injury patients, 29,31,35 patients listed for cataract surgery, 32,34 stroke patients, …”

“…Most of the included studies were cross-sectional survey studies (N = 23), 13,[19][20][21][23][24][25][26][27][28][29][30][31]33,[36][37][38][39][40][41][42]44,45 of which 1 study also performed qualitative analysis. 21 In addition, there were 4 longitudinal survey studies 18,32,34,35 and 1 case study. 43 Furthermore, approximately half of the studies analyzed the 5-level version of the EQ-5D (N = 16).…”

“…21,38 For category B, 3 studies scored inadequate, 26,34,36 6 studies doubtful, 18,27,28,30,32,33 and 4 studies adequate. 29,31,35,37 Furthermore, 1 study in category C was judged inadequate, 19 3 studies doubtful, 21,38,39 1 study adequate, 41 and 4 studies very good. 13,20,40,42…”