Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain
Open accessAbstract
BACKGROUND: Assessments of health-related quality of life and particularly utility values are important components of health economic analyses. Several instruments have been developed to measure utilities. However no consensus has emerged regarding the most appropriate instrument within a therapeutic area such as chronic pain. The study compared two instruments - EQ-5D and SF-6D - for their performance and validity in patients with chronic pain. METHODS: Pooled data from three randomised, controlled clinical trials with two active treatment groups were used. The included patients suffered from osteoarthritis knee pain or low back pain. Differences between the utility measures were compared in terms of mean values at baseline and endpoint, Bland-Altman analysis, correlation between the dimensions, construct validity, and responsiveness. RESULTS: The analysis included 1977 patients, most with severe pain on the Numeric Rating Scale. The EQ-5D showed a greater mean change from baseline to endpoint compared with the SF-6D (0.43 to 0.58 versus 0.59 to 0.64). Bland-Altman analysis suggested the difference between two measures depended on the health status of a patient. Spearmans rank correlation showed moderate correlation between EQ-5D and SF-6D dimensions. Construct validity showed both instruments could differentiate between patient subgroups with different severities of adverse events and analgesic efficacies but larger differences were detected with the EQ-5D. Similarly, when anchoring the measures to a disease-specific questionnaire - Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) - both questionnaires could differentiate between WOMAC severity levels but the EQ-5D showed greater differences. Responsiveness was also higher with the EQ-5D and for the subgroups in which improvements in health status were expected or when WOMAC severity level was reduced the improvements with EQ-5D were higher than with SF-6D. CONCLUSIONS: This analysis showed that the mean EQ-5D scores were lower than mean SF-6D scores in patients with chronic pain. EQ-5D seemed to have higher construct validity and responsiveness in these patients.
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The EQ-5D-5 L has been shown to have good construct validity and responsiveness in a chronic pain cohort.
“The EQ-5D-5 L has been shown to have good construct validity and responsiveness in a chronic pain cohort [43].”
From Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial. (2018) · cites this paper as [43]
The Conclusions report higher construct validity and responsiveness for EQ-5D in patients with chronic pain. But the Background describes the instrument assessed as having three levels per dimension, while the Discussion says the usefulness of the newer EQ-5D-5L had yet to be fully investigated. The finding therefore does not establish the claim for the 5L version. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe EQ-5D has good construct validity and responsiveness among people with chronic pain.
“The EQ-5D has been shown to have good construct validity and responsiveness among people with chronic pain.56”
The European Quality of Life Questionnaire (EQ-5D-3L) has been validated in chronic pain samples, and the Swedish version has been validated in several Swedish samples.
“The EQ-5D-3L has been validated in chronic pain samples [62], and the Swedish version of the EQ-5D-3L has been validated in several Swedish samples [63–65].”
From ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial. (2021) · cites this paper as [62]
Uncertainty in the economic analysis will be explored using a combination of univariate and multivariate analyses, and decision uncertainty will be addressed using cost-effectiveness acceptability curves.
“Uncertainty in the analysis will be explored using a combination of univariate and multivariate analyses, and decision uncertainty will be addressed using cost-effectiveness acceptability curves.56”
From Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial (2014) · cites this paper as [56]
The Discussion (page unavailable) considers how the choice of utility measure might affect cost-effectiveness conclusions, but does not describe the claimed uncertainty-analysis plan. Searches for cost-effectiveness acceptability curves and univariate and multivariate analyses found no passage addressing those methods. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Obradovic, M., Lal, A., & Liedgens, H.
- Affiliations
- Grünenthal Group (Germany) (DE)
- Corresponding author
- Liedgens, Hiltrud
- ORCID
- Liedgens, Hiltrud
- Venue
- Health and Quality of Life Outcomes
- Published
- 2013-07-01
- Volume
- 11
- Issue
- 1
- Pages
- 110-110
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC3722016
- OpenAlex
- W2105957182
- Cited by
- 233
- References
- 33
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 18 · 2023: 18 · 2022: 11 · 2021: 19 · 2020: 22 · 2019: 29 · 2018: 29 · 2017: 19 · 2016: 16 · 2015: 15 · 2014: 13 · 2013: 3
- FWCI
- 5.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- EQ-5D, SF-6D, chronic pain, health-related quality of life, health utility, construct validity, responsiveness, knee osteoarthritis, low back pain, WOMAC, questionnaire comparison
- MeSH terms
- Aged, Female, Health Status Indicators, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Reproducibility of Results, Randomized Controlled Trials as Topic, Low Back Pain, Statistics, Nonparametric, Osteoarthritis, Knee, Chronic Pain
About these checks
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