Psychometric evaluation of EQ-5D-5L in OHCA survivors from the TTM2 trial: a post hoc analysis

Mattias Bohm^{1

2}, Kristofer Årestedt^{3

4}, Susann Ullén⁵, Niklas Nielsen^{6

7}, Josef Dankiewicz^{6

8}, Hans Friberg^{6

2}, Erik Blennow Nordström^{1

9}, Alain Cariou¹⁰, Janus Christian Jakobsen^{11

12}, Anders Morten Grejs^{13

14}, Matthias Haenggi¹⁵, Naomi E Hammond^{16

17}, Katarina Heimburg^{1

8}, Thomas R Keeble^{18

19}, Christoph Leithner²⁰, Christian Rylander²¹, Johan Undén^{22

23}, Matt P Wise²⁴, Tobias Cronberg^{1

25}, Gisela Lilja^{1

25}

Affiliations

¹ Brain Injury After Cardiac Arrest Research Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
² Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
³ Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
⁴ Department of Research, Region Kalmar County, Kalmar, Sweden.
⁵ Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden.
⁶ Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
⁷ Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
⁸ Department of Cardiology, Skåne University Hospital, Lund, Sweden.
⁹ Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
¹⁰ Medical Intensive Care Unit, Cochin University Hospital, AP-HP Centre Université Paris Cité, Paris, France.
¹¹ Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Denmark.
¹² Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark.
¹³ Department of Intensive Care Medicine, Aarhus University Hospital, Denmark.
¹⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁵ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
¹⁶ Critical Care Program, The George Institute for Global Health, UNSW Sydney, Barangaroo, Australia.
¹⁷ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.
¹⁸ Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK.
¹⁹ ARU School of Medicine & MTRC, Chelmsford, Essex, UK.
²⁰ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Augustenburger Platz 1, 13353 Berlin, Germany.
²¹ Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
²² Anaesthesiology and Intensive Care Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
²³ Department of Operation and Intensive Care, Hallands Hospital, Halmstad, Sweden.
²⁴ Adult Critical Care, University Hospital of Wales, Cardiff, UK.
²⁵ Department of Neurology, Skåne University Hospital, Lund, Sweden.

PMID: 40530409
PMCID: PMC12173684
DOI: 10.1016/j.resplu.2025.100994

Psychometric evaluation of EQ-5D-5L in OHCA survivors from the TTM2 trial: a post hoc analysis

Mattias Bohm et al. Resusc Plus. 2025.

. 2025 May 29:24:100994.

doi: 10.1016/j.resplu.2025.100994. eCollection 2025 Jul.

Authors

Affiliations

¹ Brain Injury After Cardiac Arrest Research Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
² Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
³ Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
⁴ Department of Research, Region Kalmar County, Kalmar, Sweden.
⁵ Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden.
⁶ Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
⁷ Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
⁸ Department of Cardiology, Skåne University Hospital, Lund, Sweden.
⁹ Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
¹⁰ Medical Intensive Care Unit, Cochin University Hospital, AP-HP Centre Université Paris Cité, Paris, France.
¹¹ Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Denmark.
¹² Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark.
¹³ Department of Intensive Care Medicine, Aarhus University Hospital, Denmark.
¹⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁵ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
¹⁶ Critical Care Program, The George Institute for Global Health, UNSW Sydney, Barangaroo, Australia.
¹⁷ Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia.
¹⁸ Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK.
¹⁹ ARU School of Medicine & MTRC, Chelmsford, Essex, UK.
²⁰ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Augustenburger Platz 1, 13353 Berlin, Germany.
²¹ Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
²² Anaesthesiology and Intensive Care Medicine, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
²³ Department of Operation and Intensive Care, Hallands Hospital, Halmstad, Sweden.
²⁴ Adult Critical Care, University Hospital of Wales, Cardiff, UK.
²⁵ Department of Neurology, Skåne University Hospital, Lund, Sweden.

PMID: 40530409
PMCID: PMC12173684
DOI: 10.1016/j.resplu.2025.100994

Abstract

Aims: Our aim was to investigate the psychometric properties of the health assessment instrument EQ-5D-5L in OHCA survivors.

Methods: We included survivors from the Targeted Hypothermia versus Targeted Normothermia after OHCA (TTM2) trial, who completed EQ-5D-5L at 6 months. Confirmatory factor analysis was used to evaluate the hypothesised unidimensional latent structure of EQ level sum score (EQ LSS), summarizing scores across Mobility, Self-care, Usual activities, Pain/discomfort, and Anxiety/depression. Differential item functioning was evaluated for age. We examined internal consistency and precision for the EQ LSS. We evaluated construct validity of EQ LSS, EQ value and EQ VAS, using the modified Rankin Scale and Montreal Cognitive Assessment, representing functional outcome and cognitive function-two common health challenges experienced by OHCA survivors.

Results: 783 of 939 (84%) eligible survivors were included. Confirmatory factor analysis showed good model fit and strong factor loadings for all dimensions (0.61-0.90). We observed a significant but negligible effect of age on Mobility (β = 0.29, p < 0.001, ΔR² = 0.019). Internal consistency was 0.88. The floor effect was 35%. Survivors with more functional dependency and/or cognitive problems reported significantly worse health by EQ LSS, EQ value, and EQ VAS (all, p < 0.001).

Conclusion: The psychometric properties of EQ LSS support its use to measure health status in OHCA research. The strong association between health and functional dependency indicate robust and comparable construct validity for EQ LSS, EQ value, and EQ VAS in this sample.

Keywords: Cross-sectional studies; Health status; Heart arrest; Patient reported outcome measures; Psychometrics; Validation study.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The co-author Tobias Cronberg serves as a member of the editorial board of the Resuscitation journal. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
The figure illustrates the confirmatory factor analysis (CFA) of EQ-5D-5L amongst OHCA survivors from the TTM2-trial (n = 783). The CFA was based on polychoric correlations with Weighted Least Square Mean and Variance (WLSMV) adjusted estimation. The model represents an all-effect model with standardised factor loadings and error variances (ε_1–5). Abbreviations: CFI – Comparative Fit Index; CI – confidence interval; df – degrees of freedom; OHCA – out-of-hospital cardiac arrest; RMSEA – Root Mean Square Error of Approximation; SRMR – Standardized Root Mean Square Residual; TLI – Tucker-Lewis Index; TTM2-trial – the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial.

**Fig. 2**
Illustration of the association between health by EQ-5D-5L and modified Rankin Scale (mRS) categories (n = 783). A. EQ level sum score (EQ LSS) ranges between 5 and 25, with higher values indicate more health problems. B. EQ value was based on the Swedish value set, which ranges between 0.243 and 0.976 (indicated by the horizontal dashed lines), with higher values indicating less health problems. C. EQ VAS ranges between 0 and 100, with higher values indicating better overall health.

See this image and copyright information in PMC

References

1. Haywood K., Whitehead L., Nadkarni V.M., et al. COSCA (Core Outcome Set for Cardiac Arrest) in adults: an Advisory statement from the International Liaison Committee on Resuscitation. Resuscitation. 2018;127:147–163. - PubMed
1. Sawyer K.N., Camp-Rogers T.R., Kotini-Shah P., et al. Sudden cardiac arrest survivorship: a scientific statement from the American Heart Association. Circulation. 2020;141:e654–e685. - PubMed
1. Devlin N.J., Brooks R. EQ-5D and the EuroQol group: past, present and future. Appl Health Econ Health Policy. 2017;15:127–137. - PMC - PubMed
1. Parkin D., Rice N., Devlin N. Statistical analysis of EQ-5D profiles: does the use of value sets bias inference? Med Decis Making. 2010;30:556–565. - PubMed
1. Devlin N., Parkin D., Janssen B. Springer; Cham, Switzerland: 2020. Methods for Analysing and Reporting EQ-5D Data. - PubMed

LinkOut - more resources

Full Text Sources
- Elsevier Science
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Psychometric evaluation of EQ-5D-5L in OHCA survivors from the TTM2 trial: a post hoc analysis

Affiliations

Psychometric evaluation of EQ-5D-5L in OHCA survivors from the TTM2 trial: a post hoc analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources