A head-to-head comparison of five-level (EQ-5D-5L-Y) and three-level EQ-5D-Y questionnaires in paediatric patients

  • Carlos King Ho WongEmail author
  • Prudence Wing Hang Cheung
  • Nan Luo
  • Jason Pui Yin CheungEmail author
Original Paper



The aim of this study was to assess the psychometric properties of a youth version of the EQ-5D five-level questionnaire (5LY) and its three-level version (3LY) in a sample of Chinese paediatric patients.


A consecutive sample of idiopathic scoliosis patients were recruited from a referral outpatient scoliosis center at Hong Kong, China in October 2017 and completed the two versions of EQ-5D-Y. Redistribution properties in each dimension of EQ-5D-Y were analyzed between 5LY and 3LY by logistics regressions. Absolute reduction and relative reduction in ceiling effects from the 3LY to the 5LY were calculated. Test–retest reliability was assessed by examining the Gwet’s agreement coefficient (Gwet’s AC) for five individual dimension responses over the 2-week period.


A total of 129 idiopathic scoliosis patients completed the two versions of EQ-5D-Y at baseline assessment, among which 70 patients completed the test–retest interview in 2–3 weeks after baseline assessment. For redistribution properties, the proportion of inconsistency was low in all the dimensions, ranging from 0.0% (“Usual activities”) to 3.9% (“Pain/discomfort”). Ceiling effects were reduced in four dimensions. “Usual activities” dimension showed significant reduction (absolute and relative reductions: 3.9% and 4.3%; p = 0.025) and the “worried/sad/unhappy” dimension showed the largest significant reduction in ceiling effects (absolute and relative reductions: 7.8% and 9.8%; p = 0.012). The 3LY and 5LY showed very good agreement (> 80%) of individual dimension responses between two assessments, except for the “worried/sad/unhappy” dimension in 3LY.


Through this head-to-head comparison, the 5LY had significant improvements in ceiling effects in two dimensions when compared to 3LY but other measurement properties of 3LY and 5LY performed similar in the idiopathic scoliosis patient group.


EQ-5D-5L EQ-5D-Y Children Youth Psychometric properties Idiopathic scoliosis 

JEL Classification

I10 J13 



Authors would like to thank Dr Michael Herdman, Dr Simone Kreimeier and Prof Wolfgang Greiner for their input to the development process of 5LY, and two anonymous reviewers for valuable comments and suggestions.

Author contributions

CKHW wrote the manuscript, researched data, contributed to statistical analysis and interpretation of results. PWHC wrote the manuscript, acquisition of data and interpretation of results. NL contributed to study design, interpretation of results and reviewed/edited the manuscript. JPYC contributed to acquisition of data and reviewed/edited the manuscript. All authors approved the final version of manuscript.


This work was funded by the General Research Fund (#17119518 and #17156416), Research Grant Council, Hong Kong SAR.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

Ethics approval for this study was obtained from the Institutional Review Board of the Hong Kong West Cluster of the Hospital Authority.

Supplementary material

10198_2018_1026_MOESM1_ESM.docx (205 kb)
Supplementary material 1 (DOCX 205 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Family Medicine and Primary CareThe University of Hong KongHong Kong SARChina
  2. 2.Department of Orthopaedics and TraumatologyThe University of Hong KongHong Kong SARChina
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore

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