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      Measurement properties of EQ-5D-3L and EQ-5D-5L in recording self-reported health status in older patients with substantial multimorbidity and polypharmacy

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          The EQ-5D-3L and EQ-5D-5L are two generic health-related quality of life measures, which may be used in clinical and health economic research. They measure impairment in 5 aspects of health: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The aim of this study was to assess the performance of the EQ-5D-3L and EQ-5D-5L in measuring the self-reported health status of older patients with substantial multimorbidity and associated polypharmacy.


          Between 2017 and 2019, we administered EQ-5D-3L and EQ-5D-5L to a subset of patients participating in the OPERAM trial at 6 months and 12 months after enrolment. The OPERAM trial is a two-arm multinational cluster randomised controlled trial of structured medication review assisted by a software-based decision support system versus usual pharmaceutical care, for older people (aged ≥ 70 years) with multimorbidity and polypharmacy. In the psychometric analyses, we only included participants who completed the measures in full at 6 and 12 months. We assessed whether responses to the measures were consistent by assessing the proportion of EQ-5D-5L responses, which were 2 or more levels away from that person’s EQ-5D-3L response. We also compared the measures in terms of informativity, and discriminant validity and responsiveness relative to the Barthel Index, which measures independence in activities of daily living.


          224 patients (mean age of 77 years; 56% male) were included in the psychometric analyses. Ceiling effects reported with the EQ-5D-5L (22%) were lower than with the EQ-5D-3L (29%). For the mobility item, the EQ-5D-5L demonstrated better informativity (Shannon’s evenness index score of 0.86) than the EQ-5D-3L (Shannon’s evenness index score of 0.69). Both the 3L and 5L versions of EQ-5D demonstrated good performance in terms of discriminant validity, i.e. (out of all items of the EQ-5D-3L and EQ-5D-5L, the pain/discomfort and anxiety/depression items had the weakest correlation with the Barthel Index. Both the 3L and 5L versions of EQ-5D demonstrated good responsiveness to changes in the Barthel Index.


          Both EQ-5D-3L and EQ-5D-5L demonstrated validity and responsiveness when administered to older adults with substantial multimorbidity and polypharmacy who were able to complete the measures.

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          Most cited references 32

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          STOPP/START criteria for potentially inappropriate prescribing in older people: version 2

          Purpose: screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. Methods: we reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. Results: the expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. Conclusion: STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts.
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            A Wilcoxon-type test for trend.

             J Cuzick (2015)
            An extension of the Wilcoxon rank-sum test is developed to handle the situation in which a variable is measured for individuals in three or more (ordered) groups and a non-parametric test for trend across these groups is desired. The uses of the test are illustrated by two examples from cancer research.
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              Validity and reliability of measurement instruments used in research.

              Issues related to the validity and reliability of measurement instruments used in research are reviewed. Key indicators of the quality of a measuring instrument are the reliability and validity of the measures. The process of developing and validating an instrument is in large part focused on reducing error in the measurement process. Reliability estimates evaluate the stability of measures, internal consistency of measurement instruments, and interrater reliability of instrument scores. Validity is the extent to which the interpretations of the results of a test are warranted, which depends on the particular use the test is intended to serve. The responsiveness of the measure to change is of interest in many of the applications in health care where improvement in outcomes as a result of treatment is a primary goal of research. Several issues may affect the accuracy of data collected, such as those related to self-report and secondary data sources. Self-report of patients or subjects is required for many of the measurements conducted in health care, but self-reports of behavior are particularly subject to problems with social desirability biases. Data that were originally gathered for a different purpose are often used to answer a research question, which can affect the applicability to the study at hand. In health care and social science research, many of the variables of interest and outcomes that are important are abstract concepts known as theoretical constructs. Using tests or instruments that are valid and reliable to measure such constructs is a crucial component of research quality.

                Author and article information

                Health Qual Life Outcomes
                Health Qual Life Outcomes
                Health and Quality of Life Outcomes
                BioMed Central (London )
                29 September 2020
                29 September 2020
                : 18
                [1 ]GRID grid.6612.3, ISNI 0000 0004 1937 0642, Institute of Pharmaceutical Medicine (ECPM), , University of Basel, ; Basel, Switzerland
                [2 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Academic Unit for Health Economics, Institute for Health Sciences, , University of Leeds, ; Leeds, UK
                [3 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Institute of Primary Health Care (BIHAM), , University of Bern, ; Bern, Switzerland
                [4 ]GRID grid.7942.8, ISNI 0000 0001 2294 713X, Institut de Recherche Santé et Société, , Université Catholique de Louvain, ; Brussels, Belgium
                [5 ]GRID grid.7872.a, ISNI 0000000123318773, Pharmaceutical Care Research Group, School of Pharmacy, , University College Cork, ; Cork, Ireland
                [6 ]GRID grid.5477.1, ISNI 0000000120346234, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, , Utrecht University, ; Utrecht, The Netherlands
                [7 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Department of General Internal Medicine, Inselspital, Bern University Hospital, , University of Bern, ; Bern, Switzerland
                [8 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, CTU Bern, , University of Bern, ; Bern, Switzerland
                [9 ]GRID grid.7872.a, ISNI 0000000123318773, Department of Medicine (Geriatrics), School of Medicine, , University College Cork, ; Cork, Ireland
                © The Author(s) 2020

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                Funded by: FundRef, Universität Basel;
                Funded by: FundRef, Horizon 2020;
                Award ID: 6342388
                Funded by: FundRef, Staatssekretariat für Bildung, Forschung und Innovation;
                Award ID: 15.0137
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                © The Author(s) 2020

                Health & Social care


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