The added value of the EQ-5D with a cognition dimension in injury patients with and without traumatic brain injury

Abstract

Purpose This study investigated the psychometric gain, if any, from the extension of the EQ-5D with a cognition bolt-on (EQ-5D + C) in a large cohort injury patients with and without traumatic brain injury (TBI). Methods Hospitalized adult injury patients filled out a survey 1 month after initial admission. The survey included the EQ-5D-3L, the cognition bolt-on item in EQ-5D format, and the visual analogue scale (EQ-VAS). We compared ceiling and other distributional effects between EQ-5D and EQ-5D + C and TBI and non-TBI group, and assessed convergent validity using the predictive association with EQ-VAS. Also, we assessed explanatory power using regression analysis, and classification efficiency using Shannon indices. Results In total, 715 TBI patients and 1978 non-TBI patients filled out the EQ-5D + C and EQ-VAS. Perfect health was reported by 7.9% ( N = 214) on the EQ-5D, and 7.3% ( N = 197) on the EQ-5D + C. Convergent validity was highest for EQ-5D + C in the TBI group (Spearman’s rank correlation coefficient = − 0.736) and lowest for EQ-5D in the non-TBI group (Spearman’s rank correlation coefficient = − 0.652). For both TBI and non-TBI groups, the explanatory power of EQ-5D + C was slightly higher than of EQ-5D ( R 2 = 0.56 vs. 0.53 for TBI; R 2 = 0.47 vs. 0.45 for non-TBI). Absolute classification efficiency was higher for EQ-5D + C than for EQ-5D in both TBI groups, whereas relative classification efficiency was similar. Conclusions Psychometric performance in general of both the EQ-5D and EQ-5D + C was better in TBI patients. Adding a cognitive bolt-on slightly improved the psychometric performance of the EQ-5D-3L.

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

“…Their results are in agreement with our findings on the ceiling effects of the EQ-5D-5L and EQ-5D-5L+C, namely that fewer respondents reported perfect health when the EQ-5D+C is used. Furthermore, both the studies by Geraerds et al [17] and Ophuis et al [18] concluded that adding a cognitive domain slightly increased the explanatory power of the EQ-5D-3L. This is in line with the findings in this study, for the EQ-5D-5L.…”

“…In our study, we found high ceiling effects, especially 12 months post-trauma, most likely due to the fact that the majority of our study sample sustained mild to moderate trauma and most patients had recovered fully over 12 months. A previous study by Geraerds et al [17] compared ceiling effects of the EQ-5D-3L and EQ-5D-3L+C in a sample of trauma patients in the Brabant region of the Netherlands who were admitted to the hospital due to injury. Their results are in agreement with our findings on the ceiling effects of the EQ-5D-5L and EQ-5D-5L+C, namely that fewer respondents reported perfect health when the EQ-5D+C is used.…”

“…One of the proposed bolt-ons, which is often already added to the EQ-5D, is a cognitive domain (EQ-5D-3L+C). Various studies showed that measurement properties improved slightly if the cognitive domain is added to the EQ-5D-3L when comparing EQ-5D and EQ-5D+C cross-sectionally [17,18]. One of these studies assessed the added value of the cognitive domain in a sample of trauma patients in the Brabant region of the Netherlands who were admitted to the hospital due to a traumatic brain injury (TBI) [17].…”

“…Various studies showed that measurement properties improved slightly if the cognitive domain is added to the EQ-5D-3L when comparing EQ-5D and EQ-5D+C cross-sectionally [17,18]. One of these studies assessed the added value of the cognitive domain in a sample of trauma patients in the Brabant region of the Netherlands who were admitted to the hospital due to a traumatic brain injury (TBI) [17]. However, measurement properties and responsiveness of the EQ-5D-5L extended with cognition in a general trauma population, including patients with cognitive conditions (such as TBI, but also post-traumatic stress disorder (PTSD)), has not been studied using the current methodology developed for 3L/5L comparisons.…”

Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged “no-problems”

“…This means that different types of instruments are sometimes needed [9]. Several researchers, including a working group established by the EuroQol Group (which developed the EQ-5D), are undertaking studies to examine the use of "bolt-on" dimensions [9,[13][14][15][16][17][18][19][20][21][22][23][24].…”