Comparing the validity and responsiveness of the EQ-5D-5L to the Oxford hip and knee scores and SF-12 in osteoarthritis patients 1 year following total joint replacement
- 435 Downloads
(1) To assess responsiveness of the EQ-5D-5L compared to Oxford hip and knee scores and the SF-12 in osteoarthritis patients undergoing total hip (THR) or knee (TKR) replacement surgery; (2) to compare distribution and anchor-based methods of assessing responsiveness.
Questionnaires were mailed to consecutive patients following surgeon referral for primary THR or TKR and 1 year post-surgery. We assessed effect size (ES), standardized response mean (SRM), and standard error of measurement (SEM). Minimum important difference (MID) was the mean change in patients reporting somewhat better in hip or knee, health in general, and those who were satisfied with surgery (5-point scales). Responders were compared using MID versus 1 and 2SEM.
The sample of 537 (50% TKR) was composed of 56% female with a mean age of 64 years (SD 10). EQ-5D-5L ES was 1.86 (THR) and 1.19 (TKR) compared to 3.00 and 2.05 for Oxford scores, respectively. MID for the EQ-5D-5L was 0.22 (THR) and 0.20 (TKR) for patients who rated their hip or knee as somewhat better. There was a wide variation in the MID and the percentage of responders, depending on the joint, method of assessment, and the outcome measure. The percent agreement of responder classification using 2SEM vs. MID ranged from 79.6 to 99.6% for the EQ-5D-5L and from 69.4 to 94.8% for the Oxford scores.
Responsiveness of the EQ-5D-5L was acceptable in TKR and THR. Caution should be taken in interpreting responder to TJR based on only one method of assessment.
KeywordsEQ-5D-5L Validity Responsiveness Total joint replacement Minimum important difference Oxford hip and knee Scores
This study was funded by Canadian Institutes of Health Research (CIHR) (Grant #ETG92252) and Alberta Innovates-Health Solutions (Grant # 200700596). We thank the research personnel who were responsible for project management and data collection: Lynda Loucks, Sarah Tran, Allan Hennigar, Ammar Al Khudairy, and Michaela Wallace.
Compliance with ethical standards
Conflict of interest
The first author is a member of the EuroQol Group, a not-for-profit group that develops and distributes instruments that assess and value health.
All persons gave their informed consent prior to inclusion in the study.
- 2.Franklin, P. D., Lewallen, D., Bozic, K., Hallstrom, B., Jiranek, W., & Ayers, D. C. (2014). Implementation of patient-reported outcome measures in U.S. Total joint replacement registries: rationale, status, and plans. Journal of Bone and Joint Surgery, 96(Suppl 1), 104–109.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Messick, S. (1989). Validity. In (In R. Linn (Ed.), Educational measurement (pp. 13–103). New York: Macmillan Publishing Company.Google Scholar
- 27.Dawson, J., Fitzpatrick, R., Carr, A., & Murray, D. (1996). Questionnaire on the perceptions of patients about total hip replacement. The Bone & Joint Journal, 78, 185–190.Google Scholar
- 28.Dawson, J., Fitzpatrick, R., Murray, D., & Carr, A. (1998). Questionnaire on the perceptions of patients about total knee replacement. The Bone & Joint Journal, 80, 63–69.Google Scholar
- 29.Murray, D. W., Fitzpatrick, R., Rogers, K., Pandit, H., Beard, D. J., Carr, A. J., et al. (2007). The use of the Oxford hip and knee scores. The Bone & Joint Journal, 89, 1010–1014.Google Scholar
- 35.Conner-Spady, B. L., Marshall, D. A., Bohm, E., Dunbar, M. J., Loucks, L., Khudairy, A., A. et al (2015). Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Quality of Life Research, 24, 1775–1784.CrossRefPubMedGoogle Scholar
- 38.Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates.Google Scholar
- 67.Escobar, A., Gonzalez, M., Quintana, J. M., Vrotsou, K., Bilbao, A., Herrera-Espineira, C., et al. (2012). Patient acceptable symptom state and OMERACT-OARSI set of responder criteria in joint replacement. Identification of cut-off values. Osteoarthritis Cartilage, 20, 87–92.CrossRefPubMedGoogle Scholar