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Responsiveness of generic health-related quality of life measures in stroke

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Abstract

Objective: To compare five preference-based generic measures of health-related quality of life (HRQOL) in terms of change scores, correlations among change scores, responsiveness, and quality adjusted life-years (QALYs) gained. Design: Observational longitudinal cohort study where clinical measures and self-assessed HRQOL measures were administered to stroke patients at baseline and at 6 months. Patients were categorized as ‘stable’, ‘some improvement’ and ‘large improvement’ using the Barthel Index, Modified Rankin Scale (MRS), and Center for Epidemiologic Studies Depression Scale (CES-D). For each group, paired t -tests and variants of effect size were used to compare the responsiveness of preference-based HRQOL summary scores, including the EQ-5D VAS and index-based score, SF-6D, and Health Utilities Index (HUI) Mark 2 (HUI2) and Mark 3 (HUI3) overall utility scores. Results: Ninety-eight of 124 (79%) patients completed the 6-month follow-up. Change scores of the EQ-Index, HUI2, and HUI3 were strongly correlated with changes in the Barthel Index and MRS, while the EQ-5D VAS had higher correlation with CES-D change scores than the other measures. The SF-6D, HUI3, and EQ-Index were generally more responsive than the HUI2 and EQ-5D Visual analogue scale (EQ-VAS). QALY estimates based on the EQ-5D index and HUI3 were twice as large as estimates based on the SF-6D and HUI2. Conclusions : The results of this study may assist in informing the selection of a preference-based generic HRQOL measure, although choice will also depend on study goals and context. We would caution against the generalization of the study results on responsiveness to conditions when more subtle change is expected.

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Abbreviations

CES-D:

Center for Epidemiologic Studies Depression Scale

EQ-VAS:

EQ-5D visual analogue scale

HRQOL:

health-related quality of life

HUI:

Health Utilities Index

MRS:

Modified Rankin Scale

QALYs:

quality-adjusted life years

SF-36:

Medical Outcomes Study (MOS) short-form health survey

SRM:

standardized response mean

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Authors and Affiliations

  1. College of Pharmacy, University of Illinois at Chicago, Chicago, IL, Rm 164, MC 886, 833 South Wood Street, 60612, USA

    A. Simon Pickard

  2. Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, USA

    Jeffrey A. Johnson & David H. Feeny

  3. Institute of Health Economics, USA

    Jeffrey A. Johnson & David H. Feeny

  4. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB

    David H. Feeny

  5. Health Utilities Inc., Dundas, Ont., Canada

    David H. Feeny

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  1. A. Simon Pickard
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  2. Jeffrey A. Johnson
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  3. David H. Feeny
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Correspondence to A. Simon Pickard.

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Simon Pickard, A., Johnson, J.A. & Feeny, D.H. Responsiveness of generic health-related quality of life measures in stroke. Qual Life Res 14, 207–219 (2005). https://doi.org/10.1007/s11136-004-3928-3

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