Health-related quality of life in patients with lower limb amputation - an assessment of the measurement properties of EQ-5D-3L and EQ-5D-5L using data from the Swedish Amputation and Prosthetics Registry

Olivia Ernstsson; Kerstin Hagberg; Mathieu F Janssen; Gouke J Bonsel; Seher Korkmaz; Niklas Zethraeus; Emelie Heintz

doi:10.1080/09638288.2021.2015628

Health-related quality of life in patients with lower limb amputation - an assessment of the measurement properties of EQ-5D-3L and EQ-5D-5L using data from the Swedish Amputation and Prosthetics Registry

Disabil Rehabil. 2022 Dec;44(26):8471-8479. doi: 10.1080/09638288.2021.2015628. Epub 2021 Dec 21.

Authors

Olivia Ernstsson¹, Kerstin Hagberg^{2

3}, Mathieu F Janssen^{4

5}, Gouke J Bonsel^{5

6}, Seher Korkmaz^{1

7}, Niklas Zethraeus¹, Emelie Heintz¹

Affiliations

¹ Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
² Advanced Reconstruction of Extremities and Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands.
⁵ EuroQol Foundation, Rotterdam, the Netherlands.
⁶ Department Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
⁷ Department of Digitalization and IT, Health and Care Administration, Region Stockholm, Sweden.

PMID: 34932426
DOI: 10.1080/09638288.2021.2015628

Abstract

Purpose: To assess the measurement properties of EQ-5D-3L and EQ-5D-5L in patients with a major lower limb amputation (LLA).

Methods: This was a retrospective register-based study using data from the Swedish Amputation and Prosthetics Registry (SwedeAmp). Patients with a six-months follow-up (including either EQ-5D-3L or EQ-5D-5L) after a major unilateral LLA were included. The measurement properties of EQ-5D-3L and EQ-5D-5L were compared in terms of feasibility, response patterns, informativity, and convergent and known-group validity.

Results: The sample included 700 patients with below-knee amputation (76%), above-knee amputation (18%), or knee disarticulation (7%). Responses to EQ-5D-3L and -5L were similar regarding feasibility (98% completion rate) and the proportion reporting no problems (7% and 6%). Compared to EQ-5D-3L, EQ-5D-5L showed higher absolute and relative informativity in all dimensions, with the largest improvement in the mobility dimension. In the analyses of convergent validity, the EQ-5D-5L generally showed stronger correlations with disease-specific measures. Only EQ-5D-5L was able to discriminate between subgroups with different amputation levels.

Conclusion: The findings support the use of EQ-5D-5L over EQ-5D-3L in patients with an LLA, mainly due to improved informativity and improved convergent and known-group validity.Implications for rehabilitationThe measurement properties of two EQ-5D versions, EQ-5D-3L and EQ-5D-5L, has so far not been evaluated in patients with a lower limb amputation (LLA)The results support the use of EQ-5D-5L over the use of EQ-5D-3L, mainly due to improved informativity and stronger correlations with disease-specific patient-reported outcome measuresThe five-level version of EQ-5D is recommended for future applications of EQ-5D in clinical outcome studies, health economic evaluations, and in the routine follow-up of patients with a major LLAIn the early rehabilitation process six months after an LLA, the majority of patients reported problems with mobility, pain/discomfort, and usual activities.

Keywords: EQ-5D; amputation; feasibility; quality of life; registries; validity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Amputation, Surgical
Artificial Limbs*
Health Status
Humans
Lower Extremity / surgery
Psychometrics / methods
Quality of Life*
Reproducibility of Results
Retrospective Studies
Surveys and Questionnaires
Sweden