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ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2021 June;57(3):337-46

DOI: 10.23736/S1973-9087.21.06335-8


language: English

Comparison between EQ-5D-5L and PROMIS-10 to evaluate health-related quality of life 3 months after stroke: a cross-sectional multicenter study

Joris A. DE GRAAF 1 , Johanna M. VISSER-MEILY 1, 2, Vera P. SCHEPERS 1, 2, Annette BAARS 3, L. Jaap KAPPELLE 4, Patricia E. PASSIER 5, Marieke J. WERMER 6, Daniëlle C. DE WIT 7, Marcel W. POST 1, 8

1 Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands; 2 Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center, Utrecht, the Netherlands; 3 Department of Rehabilitation, Rijnstate Hospital, Arnhem, the Netherlands; 4 Department of Neurology, UMC Utrecht Brain Center, University Medical Center of Utrecht, Utrecht, the Netherlands; 5 Department of Rehabilitation, St. Antonius Hospital, Nieuwegein, the Netherlands; 6 Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; 7 Department of Rehabilitation, Franciscus Gasthuis and Vlietland Hospital, Rotterdam, the Netherlands; 8 Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

BACKGROUND: Although the use of patient-reported outcome measures to assess Health-Related Quality of Life (HRQoL) has been advocated, it is still open to debate which patient-reported outcome measure should be preferred to evaluate HRQoL after stroke.
AIM: To compare the measurement properties (including concurrent validity and discriminant ability) between the 5-dimensional 5-level EuroQol (EQ-5D-5L) and the Patient-Reported Outcomes Measurement Information System 10-Question Global Health Short Form (PROMIS-10) to evaluate HRQoL 3 months after stroke.
DESIGN: Cross-sectional study.
SETTING: Neurology outpatient clinics in 6 Dutch hospitals.
POPULATION: The participants 360 consecutive individuals with stroke. Their median age was 71 years, 143 (39.7%) were female and 335 (93.0%) had suffered an ischemic stroke.
METHODS: The EQ-5D-5L, PROMIS-10, modified Rankin Scale and two items on experienced decrease in health and activities post-stroke were administered by a stroke nurse or nurse practitioner through a telephone interview 3 months after stroke. The internal consistency, distribution, floor/ceiling effects, inter-correlations and discriminant ability (using the modified Rankin Scale and experienced decrease in health and in activities post-stroke as external anchors) were calculated for both the EQ-5D-5L and PROMIS-10.
RESULTS: Ninety-six percent of the participants were living at home and 50.9% experienced minimal or no disabilities (modified Rankin Scale 0-1) 3 months after stroke. A ceiling effect and a non-normal left skewed distribution were observed in the EQ-5D-5L. The PROMIS-10 showed higher internal consistency (α=0.90) compared to the EQ-5D-5L (α=0.75). Both the EQ-5D-5L and the PROMIS-10 were strongly correlated with the modified Rankin Scale (r=0.62 and 0.60 respectively). The PROMIS-10 showed better discriminant ability in less affected individuals with stroke, whereas the EQ-5D-5L showed slightly better discriminant ability in more affected individuals with stroke.
CONCLUSIONS: Both EQ-5D-5L and PROMIS-10 prove to be useful instruments to evaluate HRQoL in patients who are living at home 3 months after stroke.
CLINICAL REHABILITATION IMPACT: The clinical rehabilitation impact depended on the setting and underlying goal which patient-reported outcome measure is preferred to evaluate HRQoL 3 months after stroke. The PROMIS-10 should be preferred to detect differences in less affected stroke patients, whereas the EQ-5D-5L provides slightly more information in more affected stroke patients.

KEY WORDS: Stroke; Patient reported outcome measures; Quality indicators, health care; Quality of Life; Health status

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