The British Journal of Rheumatology, Vol 36, 551-559, Copyright © 1997 by British Society for Rheumatology
NP Hurst, P Kind, D Ruta, M Hunter and A Stubbings
The EuroQol (EQ-5D) generic health index comprises a five-part
questionnaire and a visual analogue self-rating scale. The questionnaire
may be used as a health index to calculate a 'utility' value or as a health
profile. The validity, reliability and responsiveness of EQ-5D were tested
in 233 patients with rheumatoid arthritis stratified by functional class.
EQ-5D demonstrated moderate to high correlations with measures of
impairment and high correlations with disability measures. Stepwise
regression models showed that EQ-5D utility values and visual analogue
scores were explained best as a function of pain, disability, disease
activity and mood (R2 approximately 70%), although other variables
(side-effects, years of education) were required to explain the visual
analogue scores. The EQ- 5D health index and visual analogue scale are more
responsive than any of the other measures, except pain and doctor-assessed
disease activity. The reliability of the EQ-5D index and EQ-5D visual
analogue scale is as good or better than that of all other instruments
except the Health Assessment Questionnaire. Some patients with severe long-
standing disease had health states which attracted utility values below
zero, i.e. from a societal perspective they were regarded as being in
states 'worse than death'. The practical and ethical implications of these
utility valuations are discussed, and at present the utility values should
be used and interpreted with caution. With this caveat, EQ-5D is simple to
use, valid, responsive to change and sufficiently reliable for group
comparisons. It is of potential use as an outcome measure in clinical
trials, audit and health economic studies, but further work is required on
its performance in other clinical contexts and on the interpretation of the
utility values.
ORIGINAL PAPERS
Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D)
Department of Rheumatology, Western General Hospitals Trust, Edinburgh.
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