European Spine Journal

, Volume 27, Issue 2, pp 278–285 | Cite as

Responsiveness of the EuroQoL 5-dimension (EQ-5D) in adolescent idiopathic scoliosis

  • Prudence Wing Hang Cheung
  • Carlos King Ho Wong
  • Sin Ting Lau
  • Jason Pui Yin Cheung
Original Article



To test the responsiveness of the EuroQoL 5-dimension (EQ-5D) utility scores for adolescent idiopathic scoliosis (AIS).


A baseline sample of 227 AIS patients was recruited between August and October 2015, and was surveyed prospectively to 9–12 months follow-up. EQ-5D-5L utility scores were derived using a two-step approach: (1) cross-walking from five-level responses to three-level responses and (2) applying the EQ-5D-3L Chinese population value set. An anchor approach was adopted to assess the responsiveness of EQ-5D. Effect size statistics (standardized effect size and standardized response mean) and independent t test were used to assess the responsiveness, as well as to analyze the ability of measures to detect score changes with global health condition changes or discriminate between the worsened and unchanged/improved groups.


Approximately two-thirds of follow-up patients (64.2%) reported no change in global health condition based on the self-reported health anchor, whilst 4.6 and 31.3% of patients rated worse and better in current health condition compared to baseline, respectively. In the subgroup where health worsened, EQ-5D utility scores were responsive to detect negative changes. EQ-5D utility scores had slight improvement in the group where health improved, despite a high mean score of 0.92 at baseline. Neither statistical significance nor moderate–large effect size was observed in mean changes among unchanged group. Responsiveness property of the EQ-5D utility score was generally satisfactory with respect to each health condition group.


EQ-5D is found to be able to capture positive changes, and responsive in detecting important clinical changes in the improved group of this AIS population.


Adolescent idiopathic scoliosis Responsiveness Anchor EQ-5D Utility 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Miller NH (1999) Cause and natural history of adolescent idiopathic scoliosis. Orthop Clin N Am 30:343–352CrossRefGoogle Scholar
  2. 2.
    Lonstein JE, Bradford DS, Winter RB, Ogilvie J (1995) Idiopathic scoliosis Moe’s textbook of scoliosis and other spinal deformities, 3rd edn. WB Saunders, PhiladelphiaGoogle Scholar
  3. 3.
    Reamy BV, Slakey JB (2001) Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician 64:111–116PubMedGoogle Scholar
  4. 4.
    Tan KJ, Moe MM, Vaithinathan R, Wong HK (2009) Curve progression in idiopathic scoliosis: follow-up study to skeletal maturity. Spine 34:697–700CrossRefPubMedGoogle Scholar
  5. 5.
    Schreiber S, Parent EC, Moez EK, Hedden DM, Hill D, Moreau MJ, Lou E, Watkins EM, Southon SC (2015) The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis-an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”. Scoliosis 10:24CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Payne WK 3rd, Ogilvie JW, Resnick MD, Kane RL, Transfeldt EE, Blum RW (1997) Does scoliosis have a psychological impact and does gender make a difference? Spine 22:1380–1384CrossRefPubMedGoogle Scholar
  7. 7.
    Weinstein SL, Ponseti IV (1983) Curve progression in idiopathic scoliosis. J Bone Jt Surg (American volume) 65:447–455CrossRefGoogle Scholar
  8. 8.
    Cheung PW, Wong CK, Samartzis D, Luk KD, Lam CL, Cheung KM, Cheung JP (2016) Psychometric validation of the EuroQoL 5-dimension 5-level (EQ-5D-5L) in Chinese patients with adolescent idiopathic scoliosis. Scoliosis Spinal Disord 11:19CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Guyatt G, Walter S, Norman G (1987) Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 40:171–178CrossRefPubMedGoogle Scholar
  10. 10.
    Whitehead SJ, Ali S (2010) Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull 96:5–21CrossRefPubMedGoogle Scholar
  11. 11.
  12. 12.
    Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC (2012) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res 21:651–657CrossRefPubMedGoogle Scholar
  13. 13.
    Cobb J (1948) Outline for the study of scoliosis. In: Blount WP, Banks SW (eds) The American Academy of orthopaedic surgeons instructional course lectures, 5th edn. JW Edwards, Ann Arbor, pp 261–275Google Scholar
  14. 14.
    Sanders JO, Browne RH, McConnell SJ, Margraf SA, Cooney TE, Finegold DN (2007) Maturity assessment and curve progression in girls with idiopathic scoliosis. J Bone Jt Surg Am 89:64–73CrossRefGoogle Scholar
  15. 15.
    Pan CW, Sun HP, Wang X, Ma Q, Xu Y, Luo N, Wang P (2015) The EQ-5D-5L index score is more discriminative than the EQ-5D-3L index score in diabetes patients. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 24:1767–1774CrossRefGoogle Scholar
  16. 16.
    van Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, Lloyd A, Scalone L, Kind P, Pickard AS (2012) Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health J Int Soc Pharmacoecon Outcomes Res 15:708–715CrossRefGoogle Scholar
  17. 17.
    Liu GG, Wu H, Li M, Gao C, Luo N (2014) Chinese time trade-off values for EQ-5D health states. Value Health J Int Soc Pharmacoecon Outcomes Res 17:597–604CrossRefGoogle Scholar
  18. 18.
    Blum L, Korner-Bitensky N (2008) Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther 88:559–566CrossRefPubMedGoogle Scholar
  19. 19.
    Cella D, Bullinger M, Scott C, Barofsky I (2002) Group vs individual approaches to understanding the clinical significance of differences or changes in quality of life. Mayo Clin Proc 77:384–392CrossRefPubMedGoogle Scholar
  20. 20.
    Kamper SJ, Maher CG, Mackay G (2009) Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther 17:163–170CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Cohen J (1988) Statistical power analysis for behavioral science, 2nd edn. Lawrence Earlbaum Associates, HilsdaleGoogle Scholar
  22. 22.
    Jain A, Sponseller PD, Negrini S, Newton PO, Cahill PJ, Bastrom TP, Marks MC (2015) SRS-7: a valid, responsive, linear, and unidimensional functional outcome measure for operatively treated patients with AIS. Spine 40:650–655CrossRefPubMedGoogle Scholar
  23. 23.
    Bennett JT, Samdani AF, Bastrom TP, Ames RJ, Miyanji F, Pahys JM, Marks MC, Lonner BS, Newton PO, Shufflebarger HL, Yaszay B, Flynn JM, Betz RR, Cahill PJ (2017) Factors affecting the outcome in appearance of AIS surgery in terms of the minimal clinically important difference. Eur Spine J 26:1782–1788CrossRefPubMedGoogle Scholar
  24. 24.
    Rodrigues LMR, Gotfryd AO, Machado AN, Defino M, Asano LYJ (2017) Adolescent idiopathic scoliosis: surgical treatment and quality of life. Acta Ortop Bras 25:85–89CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Akazawa T, Kotani T, Sakuma T, Minami S, Torii Y, Orita S, Inage K, Fujimoto K, Shiga Y, Inoue G, Miyagi M, Saito W, Ohtori S, Niki H (2017) Midlife changes of health-related quality of life in adolescent idiopathic scoliosis patients who underwent spinal fusion during adolescence. Eur J Orthop Surg Traumatol. doi: 10.1007/s00590-017-2027-4
  26. 26.
    Wong CKH, Cheung PWH, Samartzis D, Luk KD, Cheung KMC, Lam CLK, Cheung JPY (2017) Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis. PLoS One 12:e0175847CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Revicki DA, Leidy NK, Brennan-Diemer F, Sorensen S, Togias A (1998) Integrating patient preferences into health outcomes assessment: the multiattribute Asthma Symptom Utility Index. Chest 114:998–1007CrossRefPubMedGoogle Scholar
  28. 28.
    Golicki D, Niewada M, Karlinska A, Buczek J, Kobayashi A, Janssen MF, Pickard AS (2015) Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 24:1555–1563CrossRefGoogle Scholar
  29. 29.
    Lee CF, Luo N, Ng R, Wong NS, Yap YS, Lo SK, Chia WK, Yee A, Krishna L, Wong C, Goh C, Cheung YB (2013) Comparison of the measurement properties between a short and generic instrument, the 5-level EuroQoL Group’s 5-dimension (EQ-5D-5L) questionnaire, and a longer and disease-specific instrument, the Functional assessment of cancer therapy-breast (FACT-B), in Asian breast cancer patients. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 22:1745–1751CrossRefGoogle Scholar
  30. 30.
    Nolan CM, Longworth L, Lord J, Canavan JL, Jones SE, Kon SS, Man WD (2016) The EQ-5D-5L health status questionnaire in COPD: validity, responsiveness and minimum important difference. Thorax 71:493–500CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Wiebe S, Guyatt G, Weaver B, Matijevic S, Sidwell C (2003) Comparative responsiveness of generic and specific quality-of-life instruments. J Clin Epidemiol 56:52–60CrossRefPubMedGoogle Scholar
  32. 32.
    Oppe M, Devlin NJ, van Hout B, Krabbe PF, de Charro F (2014) A program of methodological research to arrive at the new international EQ-5D-5L valuation protocol. Value Health J Int Soc Pharmacoecon Outcomes Res 17:445–453CrossRefGoogle Scholar
  33. 33.
    Golicki D, Niewada M, Bv Hout, Janssen MF, Pickard AS (2014) Interim EQ-5D-5L value set for Poland: first crosswalk value set in central and Eastern Europe. Value Health Reg Issues 4:19–23CrossRefGoogle Scholar
  34. 34.
    Luo N, Cheung YB, Ng R, Lee CF (2015) Mapping and direct valuation: do they give equivalent EQ-5D-5L index scores? Health Qual Life Outcomes 13:166CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Chatterji R, Naylor JM, Harris IA, Armstrong E, Davidson E, Ekmejian R, Descallar J (2017) An equivalence study: are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey? Health Qual Life Outcomes 15:18CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Orthopaedics and TraumatologyThe University of Hong KongHong Kong SARChina
  2. 2.Department of Family Medicine and Primary CareThe University of Hong KongHong Kong SARChina

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