Comparison between the EQ-5D-3L and the SF-6D quality of life (QOL) questionnaires in patients with chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS)

Comparison of the measurement properties and consistency between the EQ-5D-3L and EQ-5D-Y-3L in adolescents aged 15-17 in China

OBJECTIVE

To evaluate and compare the measurement properties and consistency between the Chinese versions of EQ-5D-3L and EQ-5D-Y-3L among Chinese adolescent populations aged 15-17 years.

METHODS

Chinese adolescents aged 15-17 studying in high school were recruited through online survey. Social-demographic characteristics and self-reported EQ-5D-3L and EQ-5D-Y-3L responses were collected in the survey. The consistency of responses between the two measures was assessed using redistribution property, and the consistency of utility values was assessed by intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman's rank correlation, F-test and effect sizes, respectively. Sensitivity was compared using relative efficiency (RE).

RESULTS

762 respondents (48.8% male; age 15-17 years;) were recruited. The EQ-5D-3L showed a more severe ceiling effect than EQ-5D-Y-3L (78.2% vs. 66.0%). Respondents reported higher proportions of having problems in four dimensions using the EQ-5D-Y-3L than using the EQ-5D-3L. The consistency of corresponding dimensions between the two measures was relatively good, while non-negligible proportions of inconsistency were observed in "pain/discomfort" (11.4%) and "anxiety/depression" (15.7%) dimensions. The ICC of the utility values between the EQ-5D-3L and EQ-5D-Y-3L was 0.852 (p < 0.001). The Spearman's rank correlation (range: 0.385-0.620) indicated an acceptable convergent validity between the correlative dimensions of the EQ-5D-3L and EQ-5D-Y-3L. The EQ-5D-Y-3L had a higher efficiency than the EQ-5D-3L at detecting differences across EQ VAS subgroups (ES = 1.793 for EQ-5D-3L, ES = 1.920 for EQ-5D-Y-3L). Mixed results were observed in sensitivity.

CONCLUSIONS

Both the EQ-5D-3L and EQ-5D-Y-3L are demonstrated to be valid and generally consistent for measuring HRQoL among adolescents aged 15-17 years in China. Respondents reported higher proportions of having problems using the EQ-5D-Y-3L than using the EQ-5D-3L. More research is warranted to compare the discriminant validity and test-retest reliability between the two measures.

Comparative performance and mapping algorithms between EQ-5D-5L and SF-6Dv2 among the Chinese general population

OBJECTIVES

To explore the comparative performance and develop the mapping algorithms between EQ-5D-5L and SF-6Dv2 in China.

METHODS

Respondents recruited from the Chinese general population completed both EQ-5D-5L and SF-6Dv2 during face-to-face interviews. Ceiling/floor effects were reported. Discriminative validity in self-reported chronic conditions was investigated using the effect sizes (ES). Test-retest reliability was evaluated using intra-class correlation coefficient (ICC) and Bland-Altman plots in a subsample. Correlation and absolute agreements between the two measures were estimated with Spearman's rank correlation coefficient and ICC, respectively. Ordinary least squares (OLS), generalized linear model, Tobit model, and robust MM-estimator were explored to estimate mapping equations between EQ-5D-5L and SF-6Dv2.

RESULTS

3320 respondents (50.3% males; age 18-90 years) were recruited. 51.1% and 12.2% of respondents reported no problems on all EQ-5D-5L and SF-6Dv2 dimensions, respectively. The mean EQ-5D-5L utility was higher than SF-6Dv2 (0.947 vs. 0.827, p < 0.001). Utilities were significantly different across all chronic conditions groups for both measures. The mean absolute difference of utilities between the two tests for EQ-5D-5L was smaller (0.033 vs. 0.043) than SF-6Dv2, with a slightly higher ICC (0.859 vs. 0.827). Fair agreement (ICC = 0.582) was observed in the utilities between the two measures. Mapping algorithms generated by the OLS models performed the best according to the goodness-of-fit indicators.

CONCLUSIONS

Both measures showed comparable discriminative validity. Systematic differences in utilities were found, and on average, the EQ-5D-5L generates higher values than the SF-6Dv2. Mapping algorithms between the EQ-5D-5L and SF-6Dv2 are reported to enable transformations between these two measures in China.

Comparison of the measurement properties of the EQ-5D-5L and SF-6Dv2 among overweight and obesity populations in China

OBJECTIVE

To evaluate and compare the measurement properties of the EQ-5D-5L and SF-6Dv2 among Chinese overweight and obesity populations.

METHODS

A representative sample of Chinese overweight and obesity populations was recruited stratified by age, gender, body mass index (BMI), and area of residence. Social-demographic characteristics and self-reported EQ-5D-5L and SF-6Dv2 responses were collected through the online survey. The agreement was assessed using intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman's rank correlation and effect sizes, respectively. The test-retest reliability was assessed using among a subgroup of the total sample. Sensitivity was compared using relative efficiency and receiver operating characteristic.

RESULTS

A total of 1000 respondents (52.0% male, mean age 51.7 years, 67.7% overweight, 32.3% obesity) were included in this study. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (30.6% vs. 2.1%). The mean (SD) utility was 0.851 (0.195) for EQ-5D-5L and 0.734 (0.164) for SF-6Dv2, with the ICC of the total sample was 0.639 (p < 0.001). The Spearman's rank correlation (range: 0.186-0.739) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The EQ-5D-5L showed basically equivalent discriminative capacities with the SF-6Dv2 (ES: 0.517-1.885 vs. 0.383-2.329). The ICC between the two tests were 0.939 for EQ-5D-5L and 0.972 for SF-6Dv2 among the subgroup (N = 150). The SF-6Dv2 had 3.7-170.1% higher efficiency than the EQ-5D-5L at detecting differences in self-reported health status, while the EQ-5D-5L was found to be 16.4% more efficient at distinguishing between respondents with diabetes and non-diabetes.

CONCLUSIONS

Both the EQ-5D-5L and SF-6Dv2 showed comparable reliability, validity, and sensitivity when used in Chinese overweight and obesity populations. The two measures may not be interchangeable given the systematic difference in utility values between the EQ-5D-5L and SF-6Dv2. More research is needed to compare the responsiveness.

Perspectives on Aging and Quality of Life

The aging of the world's population and the health problems accompanying it are becoming increasingly severe. Healthcare policies in developed countries focus on how to prevent and treat diseases associated with aging and how to maintain quality of life. Typical age-related diseases include deafness, cataracts, osteoarthritis, chronic obstructive pulmonary disease, diabetes mellitus, and dementia. Although the mechanisms by which these diseases develop differ, they are all caused by the accumulation of molecular and cellular damage over time. In addition, age-related diseases can cause a decline in physical and mental functions and the ability to perform activities of daily living, as well as the loss of roles in society and a sense of fulfillment in life. Therefore, there is a need for treatment and measures to accurately grasp and maintain quality of life. This review aims to introduce areas and representative papers expected to be contributed to the special issue of "Aging and Quality of Life".

Clinical Observation of General Anesthesia Combined with Spinal Anesthesia in Elderly Patients with Chronic Obstructive Pulmonary Disease

Objective

This work is aimed at evaluating the efficacy and safety of general anesthesia (GA) combined with spinal anesthesia (SA) (GA+SA) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods and Material. 50 elderly COPD patients were rolled randomly into a control group (simple GA) and observation group (GA+SA). The differences in operation time, postoperative recovery time (PRT), language expression time (LET), anesthetic dosage (AD), catheter extubation time (CET), respiratory circulation indicators (mean arterial pressure (MAP), heart rate (HR), SaO2, and PaO2), postoperative VRS score, pulmonary function (forced vital capacity (FVC)), forced expiratory volume in 1 s (FEV1)/FVC and forced expiratory flow (FEF 25%~75%), serum inflammatory factors (IL-6, IL-8, and TNF-α), Short Portable Mental Status Questionnaire (SPMSQ) score, and the incidence of respiratory system events were analyzed.

Results

The results showed that the PRT, LET, AD, and CET of the observation group were all shorter (P < 0.05). The postoperative MAP, HR, SaO2, and PaO2 levels of patients who received GA+SA were much higher than those who received simple GA (P < 0.05). The postoperative VRS score of the observation group was better than that of the controls (P < 0.05). The postoperative pulmonary function of patients in the observation group was better compared with that in the control group (P < 0.05). The postoperative serum inflammatory factors in the observation group were lower in contrast to the patients who received simple GA (P < 0.05). The postoperative cognitive function SPMSQ score of patients who received GA+SA was lower compared with the score of patients who received simple GA (P < 0.05). However, the probability of respiratory system events in the observation group was lower (P < 0.05).

Conclusion

In conclusion, GA+SA could significantly shorten the PRT and improve the recovery quality of elderly COPD patients. It can also reduce the postoperative inflammatory response and strengthen the pulmonary function and cognitive function. It also enhances the analgesic which is beneficial to patients' postoperative recovery. Therefore, GA+SA was a highly effective and safe anesthesia method for elderly patients with COPD, and it was worthy of clinical application.

Comparison of the measurement properties of SF-6Dv2 and EQ-5D-5L in a Chinese population health survey

BACKGROUND

SF-6Dv2, the latest version of SF-6D, has been developed recently, and its measurement properties remain to be evaluated and compared with the EQ-5D-5L. The aim of this study was to assess and compare the measurement properties of the SF-6Dv2 and the EQ-5D-5L in a large-sample health survey among the Chinese population.

METHODS

Data were obtained from the 2020 Health Service Survey in Tianjin, China. Respondents were randomly selected and invited to complete both the EQ-5D-5L and SF-6Dv2 through face-to-face interviews or self-administration. Health utility values were calculated by the Chinese value sets for the two measures. Ceiling and floor effects were firstly evaluated. Convergent validity and discriminate validity were examined using Spearman's rank correlation and effect sizes, respectively. The agreement was assessed using intraclass correlation coefficients (ICC). Sensitivity was compared using relative efficiency and receiver operating characteristic.

RESULTS

Among 19,177 respondents (49.3% male, mean age 55.2 years, ranged 18-102 years) included in this study, the mean utility was 0.939 (0.168) for EQ-5D-5L and 0.872 (0.184) for SF-6Dv2. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (72.8% vs. 36.1%). The Spearman's rank correlation (range: 0.30-0.69) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The SF-6Dv2 showed slightly better discriminative capacities than the EQ-5D-5L (ES: 0.126-2.675 vs. 0.061-2.256). The ICC between the EQ-5D-5L and SF-6Dv2 utility values of the total sample was 0.780 (p < 0.05). The SF-6Dv2 had 29.0-179.2% higher efficiency than the EQ-5D-5L at distinguishing between respondents with different external health indicators, while the EQ-5D-5L was found to be 8.2% more efficient at detecting differences in self-reported health status than the SF-6Dv2.

CONCLUSIONS

Both the SF-6Dv2 and EQ-5D-5L have been demonstrated to be comparably valid and sensitive when used in Chinese population health surveys. The two measures may not be interchangeable given the moderate ICC and the systematic difference in utility values between the SF-6Dv2 and EQ-5D-5L. Further research is warranted to compare the test-retest reliability and responsiveness.

Patient-caregiver agreement and test-retest reliability of the EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric patients with haematological malignancies

BACKGROUND

In 2019, the EuroQol Group developed a 'beta' 5-level version of EQ-5D-Y (Y-5L) by increasing the number of descriptive levels to five for each health dimension, as compared to the standard 3-level EQ-5D-Y (Y-3L).

OBJECTIVE

To assess patient-caregiver agreement and test-retest reliability of the Y-5L and Y-3L in paediatric patients with haematological malignancies.

METHODS

Paediatric inpatients aged 8-17 years were interviewed with the Y-5L and Y-3L questionnaires twice, while their caregivers were interviewed at the same time using the proxy versions of the questionnaires. Patient-caregiver agreement and test-retest reliability were assessed using Gwet's agreement coefficient (Gwet's AC1) for EQ-5D dimensions and the intraclass correlation coefficient (ICC) for the EQ VAS.

RESULTS

Ninety-six patient-caregiver dyads participated in the study. Patient-caregiver agreement on the EQ-5D-Y descriptive system was moderate to good for both the Y-3L and Y-5L, but poor on the EQ VAS. Test-retest reliability of the descriptive system was good to very good for the Y-3L and moderate to good for the Y-5L in children, and fair to good for both versions of EQ-5D-Y in proxies. The EQ VAS showed good test-retest reliability in both children and caregivers. In a subgroup analysis of results in younger patients aged 8-10 years, patient-caregiver agreement and test-retest reliability were also observed to range from moderate to very good.

CONCLUSION

Both the Y-3L and Y-5L descriptive systems showed acceptable patient-caregiver agreement and test-retest reliability when used to assess the HRQoL of children and adolescents with haematological malignancies, including in younger patients.

Self-Perceived Handicap Associated With Dysphonia and Health-Related Quality of Life of Asthma and Chronic Obstructive Pulmonary Disease Patients: A Case-Control Study

Purpose The association between voice alterations, health-related quality of life (HRQL), and chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), has previously been reported. The aim of this study was to test the hypothesis that HRQL and dysphonia-associated handicap of patients diagnosed with asthma or COPD are worse than healthy controls. Method A case-control study in which participants were recruited by a consecutive sampling method from a single institution was conducted. Three groups were created: (a) asthma (51 patients), (b) COPD (52 patients), and (c) 50 healthy controls. Self-reported handicap associated with dysphonia was assessed using the 30-item Voice Handicap Index (VHI-30); meanwhile, HRQL was tested via the European Quality of Life (EQ) Questionnaire and the EQ-visual analog scale. Also, aerodynamic assessment applied to phonation was assessed, and maximum phonation time and s/e index were registered. Results VHI scores were higher for asthma and COPD (7.19 ± 8.31 and 11.80 ± 15.18, respectively) than in the control group (3.72 ± 6.78). The EQ index was lower in asthma and COPD patients than in controls. The EQ-visual analog scale showed lower scores in asthma and COPD than in the controls. Conclusions HRQL was worse in COPD patients than in asthma patients. Even though the patient groups showed worse VHI and HRQL scores than the healthy controls, the scores fell within the normal variation range. No significant variations in the maximum phonation time index between groups were noted.

Translation, Pilot Psychometric Validation, and Comparative Performance of the Arabic Version of the Anti-Clot Treatment Scale (ACTS)

Background

Anticoagulation management is a complex process that is managed through careful monitoring, and patient satisfaction has a significant impact. Given the lack of a valid and reliable tool in Arabic to examine patient satisfaction, the present study aimed to translate and examine some of the psychometric properties of the Anti-Clot Treatment Scale (ACTS) among Saudi patients.

Materials and Methods

This was a cross-sectional, methodological study conducted among patients receiving warfarin. The questionnaire was subjected to translation by using a multistep method. The final Arabic translated version of the ACTS underwent face and content validity assessments by independent experts to ensure its conceptual equivalence to the original English version. Subsequently, pilot testing of convergent, discriminant, and criterion validities were examined.

Results

Overall, 136 patients participated in the study. All patients were asked to complete the generic Treatment Satisfaction Questionnaire for Medication (TSQM) alongside the ACTS tool. Convergent validity analyses revealed statistically significant positive correlations (p < 0.01) between the ACTS subscales and the four TSQM subdomains, as reflected by the Spearman correlation coefficient (r). Interestingly, the strongest correlations were observed between ACTS Burdens and the TSQM convenience domain (r = 0.61) and between ACTS Benefits and the TSQM effectiveness satisfaction score (r = 0.58). Similarly, discriminant validity was evidenced by moderate to high significant loading of all 12 items on each of their corresponding ACTS subscales.

Conclusion

These findings of adequate validity support the use of the ACTS in Saudi patients receiving anticoagulant medications to measure their specific satisfaction levels with this type of therapy. However, future research addressing the clinical impact of ACTS scores in the Saudi population is needed.

The anti-clot treatment scale (ACTS): validation of the translated Arabic version among patients undergoing warfarin therapy in Saudi Arabia

Background

Long-term anticoagulation therapy, particularly with warfarin, is usually associated with poor adherence and low patient satisfaction. However, previous studies have highlighted the possibility that individual perceptions of warfarin differ according to cultural practices. This study validated the psychometric properties of the translated Arabic version of the Anti-Clot Treatment Scale (ACTS) for patients on warfarin therapy in Saudi Arabia.

Methods

A cross-sectional multicenter study was conducted at the three main medical centers in Riyadh. Stratified sampling was employed to recruit Arabic-speaking patients who had been taking warfarin for a minimum of 3 months for any indication. The patients completed the specific ACTS along with the generic Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) at two clinic visits. The psychometric performance of the ACTS was evaluated using well-established criteria: feasibility, reliability, and validity.

Results

One hundred thirty-six patients participated in the study (mean age: 50.68 ± 14.6 years; range: 19–97). Overall, the patients reported moderate Burdens and Benefits scores (44 ± 9.9 and 11.92 ± 2.4, respectively) compared to the reference range for each subscale (12–60 and 3–15, respectively); however, they reported lower Burdens scores than other populations. Consistent with the original ACTS validation study, the criteria for acceptability (data targeting, floor/ceiling effects, and skewness) were satisfied; in fact, the Arabic version exhibited better item- and scale-level distributions of data than versions in other languages. The ACTS subscales also demonstrated satisfactory test-retest reliability with significant intraclass correlation coefficients ((ICC ≥ 0.5); p < 0.001) and good internal consistency (all Cronbach’s alpha values exceeded 0.7). Exploratory factor analysis supported the 2-factor loading model. Interestingly, the Arabic version exhibited greater convergent validity with the TSQM subdomains (r = 0.61).

Conclusions

This study provides convincing evidence that the Arabic versions of both the ACTS Burdens and ACTS Benefits scales are equivalent to other versions in terms of psychometric performance, as measured using reliability and validity criteria. These properties support the great potential of the Arabic ACTS to accurately reflect patient satisfaction, identify aspects of treatment that need improvement in clinical practice, and compare treatment satisfaction across different anticoagulant therapies or cultures in research.

Measurement properties of preference-based measures for economic evaluation in COPD: a systematic review

PURPOSE

Preference-based measures can provide measurements of health-related quality of life and be utilized for cost-effectiveness analyses of interventions in individuals with chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate whether generic preference-based measures are reliable, valid, and responsive in COPD.

METHODS

A systematic review was performed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Three databases were searched: MEDLINE, EMBASE, and CINAHL. Studies were included if the sample represented individuals with COPD and the aim was to evaluate one or more psychometric properties or the interpretability of generic preference-based measures.

RESULTS

Six hundred and sixty-seven abstracts were screened, 65 full-text articles were reviewed and 24 articles met the inclusion criteria. Measures which emerged from the search were the EQ-5D, the SF-6D, the Quality of Well-being scale, the 15D, and the Health Utilities Index 3. Evidence for the test-retest reliability of these measures was limited. Construct validity of the measures was well supported with correlations with generic health profiles being 0.37-0.68, and correlations with COPD-specific health profiles being 0.53-0.75. Evidence for known-groups validity of these measures was poor and data on responsiveness were mixed.

CONCLUSION

Generic preference-based measures' sensitivity to change and ability to discriminate between different disease severities in COPD was poorly supported. Future research may consider examining the development of COPD-specific preference-based measures that may allow for a more accurate detection of change and discrimination among disease severities to facilitate cost-effectiveness evaluations.