Abstract:
BACKGROUND:As a generic measure of health-related quality of life among patients awaiting THA or TKA, the three-level version of the EQ-5D (EQ-5D-3L), which has three response levels of severity (no problems, some problems, and extreme problems/unable) to five questions, is widely used. Previous studies indicated that the ceiling effect of the EQ-5D-3L limits its application. The five-level version of the EQ-5D (EQ-5D-5L) was developed to enhance the measurement properties of the tool by adding two levels: slight problems and severe problems. However, only a few small studies have compared the EQ-5D-3L and EQ-5D-5L in patients awaiting THA and TKA. QUESTIONS/PURPOSES:The purpose of this study was to examine the performance of the EQ-5D-3L and EQ-5D-5L among patients awaiting THA or TKA in terms of (1) response patterns, (2) convergent construct validity, (3) known-group validity, and (4) informativity and discriminatory power. METHODS:This is a retrospective analysis of the Alberta Bone and Joint Health Data Repository, which recorded information on all patients receiving hip or knee arthroplasties between April 2010 and March 2017 in Alberta, Canada (n = 37,377). Patients receiving THA or TKA and who completed the EQ-5D and WOMAC at baseline (presurgery) were included in this study (n = 24,766). The EQ-5D-3L was administered to all patients in 2010, and was gradually replaced by the EQ-5D-5L between 2013 and 2016; the EQ-5D-5L reached full application in all clinics by 2017.A propensity score was used to match patients 1:1 who completed either the EQ-5D-3L or EQ-5D-5L before surgery. Response patterns have been explored using ceiling and floor effects and distribution across severity levels of each dimension. Convergent construct validity was examined using Spearman's correlation (rho) against the WOMAC. Known-group validity was examined by gender, preoperative risk factors, mental health, obesity, and WOMAC physical function score. Informativity and discriminatory power were examined using the Shannon (H') and Shannon evenness (J') indices. A total of 3446 pairs of patients awaiting THA (55% women; mean age, 66 years) and 5428 pairs of patients awaiting TKA (59% women; mean age 67 years) were included in this analysis; the study group included all patients who were kept in the propensity score matching. RESULTS:Ceiling and floor effects were comparable and small (less than 0.5%) for both versions; the responses across severity levels for each dimension were more evenly distributed for the EQ-5D-5L. Convergent construct validity was stronger for the EQ-5D-5L as it consistently had stronger correlations with the WOMAC overall and domain scores than the EQ-5D-3L (rho(3L-THA), -0.77 to -0.31; rho(3L-TKA), -0.71 to -0.24; rho(5L-THA), -0.71 to -0.17; rho(5L-TKA), -0.64 to -0.17; all p values < 0.001). The hypotheses of known-group analyses were confirmed for both versions. The EQ-5D-5L demonstrated stronger informativity and discriminatory power than the EQ-5D-3L, particularly for the mobility dimension (THA, H'(5L/3L)=1.66/0.37, J'(5L/3L)=0.72/0.23; TKA, H'(5L/3L)=1.66/0.41, J'(5L/3L)=0.71/0.26). CONCLUSIONS:This study demonstrates the superior construct validity, and informativity and discriminatory power of the EQ-5D-5L compared with the EQ-5D-3L among patients awaiting THA or TKA. CLINICAL RELEVANCE:Compared with the three-level version, the five-level version of the EQ-5D differentiates between patients awaiting THA and TKA much better based on their mobility, which is a key health aspect or outcome in these patients. Our findings suggest that the EQ-5D-5L is more appropriate for this population.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Jin X,Al Sayah F,Ohinmaa A,Marshall DA,Smith C,Johnson JAdoi
10.1097/CORR.0000000000000662subject
Has Abstractpub_date
2019-07-01 00:00:00pages
1632-1644issue
7eissn
0009-921Xissn
1528-1132journal_volume
477pub_type
杂志文章abstract::Total knee arthroplasty (TKA) has evolved during the past 30 years to a well-defined technical surgery with excellent results for as many as 20 years of followup. The concepts of exposure, ligament balancing, and joint alignment have been established clearly by Insall and others. In the early 1990s, Repicci introduced...
journal_title:Clinical orthopaedics and related research
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abstract::Intraoperative proximal femur fractures are a significant concern during noncemented total hip arthroplasty. The current study was performed to investigate the hypothesis that broaching the femur and inserting the stem without using mallet applied impact loads will reduce the risk of intraoperative fracture. Rosette s...
journal_title:Clinical orthopaedics and related research
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abstract::The radiographs of 57 patients who had undergone 58 callus distractions and 13 epiphyseal distractions were evaluated. During the course of treatment, the density of the distraction areas on radiographs was measured in total and along the medial, lateral, ventral, and dorsal margins using a digital radiograph processi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199602000-00036
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND:Revision TKA is a serious adverse event with substantial consequences for the patient. As the demand for TKA rises, reducing the risk of revision TKA is becoming increasingly important. Predictive tools based on machine-learning algorithms could reform clinical practice. Few attempts have been made to combin...
journal_title:Clinical orthopaedics and related research
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doi:10.1097/CORR.0000000000001343
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journal_title:Clinical orthopaedics and related research
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doi:10.1097/00003086-199907000-00006
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abstract:UNLABELLED:Ankle arthroplasty is increasingly used to treat advanced ankle arthritis. Earlier prostheses have given way to second-generation implants, on which we are accumulating medium-term data. The Scandinavian Total Ankle Replacement (STAR) is a three-component uncemented implant in wide use in Europe and the only...
journal_title:Clinical orthopaedics and related research
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doi:10.1007/s11999-009-0971-y
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abstract::A conservative approach to foot problems is especially useful in patients with diabetes, rheumatoid arthritis, diminished circulatory changes, and those who are too debilitated for surgical treatment. If one will start with either the medial heel wedge or the anterior heel correction, some response should be evident w...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-03-01 00:00:00
abstract::Bone remodeling after cementless total hip arthroplasty was evaluated by dual energy x-ray absorptiometry in a longitudinal study of 32 hips. After insertion of a fully porous surface anatomic stem made of cobalt chromium, bone mineral density was analyzed until at least 2 years postoperatively. Bone remodeling was ev...
journal_title:Clinical orthopaedics and related research
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doi:10.1097/00003086-199706000-00017
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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doi:
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,随机对照试验
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更新日期:2018-02-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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journal_title:Clinical orthopaedics and related research
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更新日期:1994-04-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,随机对照试验
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更新日期:2019-08-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:2008-01-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-06-01 00:00:00