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. 2021 Mar;30(3):647-673.
doi: 10.1007/s11136-020-02688-y. Epub 2020 Dec 7.

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

You-Shan Feng  1   2 , Thomas Kohlmann  3 , Mathieu F Janssen  4 , Ines Buchholz  3
Affiliations

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

You-Shan Feng et al. Qual Life Res. 2021 Mar.

Abstract

Purpose: Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L.

Methods: Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models.

Results: Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health.

Conclusions: The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.

Keywords: EQ-5D; EQ-5D-5L; Health-Related Quality of Life; Psychometric properties; Systematic review.

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Conflict of interest statement

All four authors are members of the EuroQol group. Outside of scientific meetings, group members do not receive any financial support.

Figures

Fig. 1
Fig. 1
Literature search and inclusion/exclusion results
Fig. 2
Fig. 2
a Proportion reporting no problems on the EQ-5D-5L profile “11111”: pooled across health conditions. b Proportion reporting no problems on the EQ-5D-5L profile “11111”: pooled for general and healthy populations
Fig. 2
Fig. 2
a Proportion reporting no problems on the EQ-5D-5L profile “11111”: pooled across health conditions. b Proportion reporting no problems on the EQ-5D-5L profile “11111”: pooled for general and healthy populations
Fig. 3
Fig. 3
a EQ-5D-5L index value mean: pooled across health conditions. b EQ-5D-5L index value mean: pooled across education level and employment status
Fig. 3
Fig. 3
a EQ-5D-5L index value mean: pooled across health conditions. b EQ-5D-5L index value mean: pooled across education level and employment status
Fig. 4
Fig. 4
a Pooled correlation coefficient for EQ-5D-5L index value with other physical health measures. b Pooled correlation coefficient for EQ-5D-5L index value with other mental, emotional, cognitive and fatigue/vitality health measures. c Pooled correlation coefficient for EQ-5D-5L index value with other global health, clinical and non-health measures
Fig. 4
Fig. 4
a Pooled correlation coefficient for EQ-5D-5L index value with other physical health measures. b Pooled correlation coefficient for EQ-5D-5L index value with other mental, emotional, cognitive and fatigue/vitality health measures. c Pooled correlation coefficient for EQ-5D-5L index value with other global health, clinical and non-health measures
Fig. 4
Fig. 4
a Pooled correlation coefficient for EQ-5D-5L index value with other physical health measures. b Pooled correlation coefficient for EQ-5D-5L index value with other mental, emotional, cognitive and fatigue/vitality health measures. c Pooled correlation coefficient for EQ-5D-5L index value with other global health, clinical and non-health measures
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References

Works Cited

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References for publications included for review

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