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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2020

Open Access 01-12-2020 | Research

Responsiveness and minimal clinically important difference of the EQ-5D-5L in cervical intraepithelial neoplasia: a longitudinal study

Authors: Xin Hu, Mingxia Jing, Mei Zhang, Ping Yang, Xiaolong Yan

Published in: Health and Quality of Life Outcomes | Issue 1/2020

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Abstract

Background

With the widespread clinical application of the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L), whether the questionnaire scores are responsive to changes in patients’ health and how much changes in questionnaire scores represent patients’ real health changes require consideration. Consequently, we assessed responsiveness and estimated the minimal clinically important difference (MCID) of the EQ-5D-5L in surgically treated patients with cervical intraepithelial neoplasia (CIN) to determine the relationship between MCID and minimal detectable change (MDC).

Methods

We conducted a longitudinal, observational study. Participants were patients with CIN from the gynecology inpatient department of a grade-A tertiary hospital in Shihezi, Xinjiang, China. Participants completed the EQ-5D-5L and the Global Rating of Change Questionnaire (GRCQ) at baseline and one month post-surgery. The Wilcoxon signed-rank test was used to compare EQ-5D-5L scores pre- and post-treatment. We calculated the effect size (ES) and the standardized response mean (SRM) to quantitatively assess responsiveness. Distribution-based, anchor-based, and instrument-defined methods were used to estimate MCID. MCID to MDC ratios at individual- and group-levels were also calculated.

Results

Fifty patients with CIN completed the follow-up investigation (mean age 44.76 ± 8.72 years; mean follow-up time 32.28 ± 1.43 days). The index value and EQ visual analogue scale (EQ VAS) of the EQ-5D-5L improved by 0.025 and 6.92 (all p < 0.05) at follow-up as compared to baseline respectively. The ES and the SRM of the index value were 0.47 and 0.42 respectively, indicating small responsiveness; while the ES and the SRM of EQ VAS were 0.50 and 0.49 respectively, indicating small to moderate responsiveness. The average (range) of MCIDs for index value and EQ VAS were 0.039 (0.023–0.064) and 5.35 (3.12–6.99) respectively. These values can only be used to determine whether patients have experienced clinically meaningful health improvements at the group level.

Conclusions

The EQ-5D-5L has only small to moderate responsiveness in post-surgical patients with CIN, and the MCIDs developed in this study can be used for group-level health assessment. However, further study is needed concerning health changes at the individual level.
Literature
1.
Lax SF, Horn LC, Löning T. Kategorisierung der Tumoren der Cervix uteri. Der Pathologe. 2016;37(6):573–84.PubMedCrossRef
2.
Pirotta M, Ung L, Stein A, Conway EL, Mast TC, Fairley CK, et al. The psychosocial burden of human papillomavirus related disease and screening interventions. Sex Transm Infect. 2009;85(7):508–13.PubMedCrossRef
3.
Frederiksen ME, Njor S, Lynge E, Rebolj M. Psychological effects of diagnosis and treatment of cervical intraepithelial neoplasia: a systematic review. Sex Transm Infect. 2015;91(4):248–56.PubMedCrossRef
4.
McCredie MR, Sharples KJ, Paul C, Baranyai J, Medley G, Jones RW, et al. Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study. Lancet Oncol. 2008;9(5):425–34.PubMedCrossRef
5.
Wang XI, Huang F, Zhang S. Loop electrosurgical excision procedure vs. cold knife cone in treatment of cervical intraepithelial neoplasia: review of 447 cases. Ann Clin Lab Sci. 2017;47(6):663–7.PubMed
6.
Zhao Z, Pan X, Lv S, Xie Y, Zhang S, Qiao Y, et al. Quality of life in women with cervical precursor lesions and cancer: a prospective, 6-month, hospital-based study in China. Chin J Cancer. 2014;33(7):339–45.PubMedPubMedCentral
7.
Group TE. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef
8.
Yao Q, Liu C, Zhang Y, Xu L. Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3 L: a comparison of the 2008 and 2013 National Health Services Surveys. Health Qual Life Out. 2019;17(1):43.CrossRef
9.
Huang R, Rao H, Shang J, Chen H, Li J, Xie Q, et al. A cross-sectional assessment of health-related quality of life in Chinese patients with chronic hepatitis c virus infection with EQ-5D. Health Qual Life Out. 2018;16(1):124.CrossRef
10.
Liang Z, Zhang T, Lin T, Liu L, Wang B, Fu AZ, et al. Health-related quality of life among rural men and women with hypertension: assessment by the EQ-5D-5L in Jiangsu, China. Qual Life Res. 2019;28(8):2069–80.PubMedCrossRef
11.
Su M, Hua X, Wang J, Yao N, Zhao D, Liu W, et al. Health-related quality of life among cancer survivors in rural China. Qual Life Res. 2019;28(3):695–702.PubMedCrossRef
12.
Jia YX, Cui FQ, Li L, Zhang DL, Zhang GM, Wang FZ, et al. Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B. Qual Life Res. 2014;23(8):2355–63.PubMedCrossRef
13.
Golicki D, Niewada M, Buczek J, Karlińska A, Kobayashi A, Janssen MF, et al. Validity of EQ-5D-5L in stroke. Qual Life Res. 2015;24(4):845–50.PubMedCrossRef
14.
Tordrup D, Mossman J, Kanavos P. Responsiveness of the EQ-5D to clinical change: is the patient experience adequately represented? Int J Technol Assess. 2014;30(1):10–9.CrossRef
15.
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.PubMedPubMedCentralCrossRef
16.
Luo N, Liu G, Li M, Guan H, Jin X, Rand-Hendriksen K. Estimating an EQ-5D-5L value set for China. Value Health. 2017;20(4):662–9.PubMedCrossRef
17.
Sedaghat AR. Understanding the Minimal Clinically Important Difference (MCID) of patient-reported outcome measures. Otolaryngol Head Neck Surg. 2019;161(4):551–60.PubMedCrossRef
18.
Jaeschke R, Singer J, Guyatt GH. Measurement of health status ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407–15.PubMedCrossRef
19.
Kiley JP, Sri Ram J, Croxton TL, Weinmann GG. Challenges associated with estimating minimal clinically important differences in COPD—the NHLBI perspective. COPD. 2009;2(1):43–6.CrossRef
20.
Naylor JM, Hayen A, Davidson E, Hackett D, Harris IA, Kamalasena G, et al. Minimal detectable change for mobility and patient-reported tools in people with osteoarthritis awaiting arthroplasty. BMC Musculoskelet Disord. 2014;15:235.PubMedPubMedCentralCrossRef
21.
Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Methods to explain the clinical significance of health status measures. Mayo Clin Proc. 2002;77(4):371–83.PubMedCrossRef
22.
Chuang L, Cohen AT, Agnelli G, Gumbs PD, Bauersachs R, Kroep S, et al. Comparison of quality of life measurements: EQ-5D-5L versus disease/treatment-specific measures in pulmonary embolism and deep vein thrombosis. Qual Life Res. 2019;28(5):1155–77.PubMedCrossRef
23.
Lee CF, Luo N, Ng R, Wong NS, Yap YS, Lo SK, et al. Comparison of the measurement properties between a short and generic instrument, the 5-level EuroQoL Group’s 5-dimension (EQ-5D-5L) questionnaire, and a longer and disease-specific instrument, the Functional Assessment of Cancer Therapy—Breast (FACT-B), in Asian breast cancer patients. Qual Life Res. 2013;22(7):1745–51.PubMedCrossRef
24.
Gandhi M, Ang M, Teo K, Wong CW, Wei YC, Tan RL, et al. A vision ‘bolt-on’ increases the responsiveness of EQ-5D: preliminary evidence from a study of cataract surgery. Eur J Health Econ. 2020;21(4):501–11.PubMedCrossRef
25.
Nolan CM, Longworth L, Lord J, Canavan JL, Jones SE, Kon SSC, et al. The EQ-5D-5L health status questionnaire in COPD: validity, responsiveness and minimum important difference. Thorax. 2016;71(6):493–500.PubMedCrossRef
26.
McClure NS, Sayah FA, Ohinmaa A, Johnson JA. Minimally important difference of the EQ-5D-5L index score in adults with type 2 diabetes. Value Health. 2018;21(9):1090–7.PubMedCrossRef
27.
28.
Bilbao A, García-Pérez L, Arenaza JC, García I, Ariza-Cardiel G, Trujillo-Martín E, et al. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness. Qual Life Res. 2018;27(11):2897–908.PubMedCrossRef
29.
30.
31.
Wyrwich KW, Bullinger M, Aaronson N, Hays RD, Patrick DL, Symonds T, et al. Estimating clinically significant differences in quality of life outcomes. Qual Life Res. 2005;14(2):285–95.PubMedCrossRef
32.
Jayadevappa R, Cook R, Chhatre S. Minimal important difference to infer changes in health-related quality of life-a systematic review. J Clin Epidemiol. 2017;89:188–98.PubMedCrossRef
33.
34.
Luo N, Johnson JA, Coons SJ. Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Med Care. 2010;48(4):365–71.PubMedCrossRef
35.
de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Out. 2006;4:54.CrossRef
36.
Revicki D, Hays RD, Cella D, Sloan J. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61(2):102–9.PubMedCrossRef
37.
Sakthong P, Sonsa-ardjit N, Sukarnjanaset P, Munpan W. Psychometric properties of the EQ-5D-5L in Thai patients with chronic diseases. Qual Life Res. 2015;24(12):3015–22.PubMedCrossRef
38.
Hoehle LP, Phillips KM, Speth MM, Caradonna DS, Gray ST, Sedaghat AR. Responsiveness and minimal clinically important difference for the EQ-5D in chronic rhinosinusitis. Rhinol J. 2019;57(2):110–6.
39.
Coeytaux RR, Kaufman JS, Chao R, Mann JD, DeVellis RF. Four methods of estimating the minimal important difference score were compared to establish a clinically significant change in Headache Impact Test. J Clin Epidemiol. 2006;59(4):374–80.PubMedCrossRef
40.
McClure NS, Sayah FA, Xie F, Luo N, Johnson JA. Instrument-defined estimates of the minimally important difference for EQ-5D-5L index scores. Value Health. 2017;20(4):644–50.PubMedCrossRef
41.
Dontje ML, Dall PM, Skelton DA, Gill JMR, Chastin SFM. Reliability, minimal detectable change and responsiveness to change: indicators to select the best method to measure sedentary behaviour in older adults in different study designs. PLoS ONE. 2018;13(4):e0195424.PubMedPubMedCentralCrossRef
42.
de Boer MR, de Vet HC, Terwee CB, Moll AC, Völker-Dieben HJ, van Rens GH. Changes to the subscales of two vision-related quality of life questionnaires are proposed. J CLIN EPIDEMIOL. 2005;58(12):1260–8.PubMedCrossRef
43.
Xie Y, Zhao F, Lu S, Huang H, Pan X, Yang C, et al. Assessment of quality of life for the patients with cervical cancer at different clinical stages. Chin J Cancer. 2013;32(5):275–82.PubMedPubMedCentralCrossRef
44.
de Tejada MGS, Bilbao A, Ansola L, Quirós R, García-Perez L, Navarro G, et al. Responsiveness and minimal clinically important difference of the Minnesota living with heart failure questionnaire. Health Qual Life Out. 2019;17(1):36.CrossRef
45.
Vratsistas-Curto A, Sherrington C, McCluskey A. Responsiveness of five measures of arm function in acute stroke rehabilitation. Clin Rehabil. 2018;32(8):1098–107.PubMedCrossRef
46.
Cheung PWH, Wong CKH, Lau ST, Cheung JPY. Responsiveness of the EuroQoL 5-dimension (EQ-5D) in adolescent idiopathic scoliosis. Eur Spine J. 2018;27(2):278–85.PubMedCrossRef
47.
Chen P, Lin K, Liing R, Wu C, Chen C, Chang K. Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation. Qual Life Res. 2016;25(6):1585–96.PubMedCrossRef
48.
Gandhi M, Ang M, Teo K, Wong CW, Wei YC, Tan RL, et al. EQ-5D-5L is more responsive than EQ-5D-3L to treatment benefit of cataract surgery. Patient. 2019;12(4):383–92.PubMedCrossRef
49.
Fermont JM, Blazeby JM, Rogers CA, Wordsworth S. The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery. PLoS ONE. 2017;12(12):e0189190.PubMedPubMedCentralCrossRef
50.
Crossman-Barnes C, Sach T, Wilson A, Barton G. The construct validity and responsiveness of the EQ-5D-5L, AQL-5D and a bespoke TTO in acute asthmatics. Qual Life Res. 2020;29(3):619–27.PubMedCrossRef
51.
Golicki D, Niewada M, Karlińska A, Buczek J, Kobayashi A, Janssen MF, et al. Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res. 2015;24(6):1555–633.PubMedCrossRef
52.
Koorevaar RCT, Kleinlugtenbelt YV, Landman EBM, Van’t Riet E, Bulstra SK. Psychological symptoms and the MCID of the DASH score in shoulder surgery. J Orthop Surg Res. 2018;13(1):246.PubMedPubMedCentralCrossRef
53.
Basra MKA, Salek MS, Camilleri L, Sturkey R, Finlay AY. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. Dermatology. 2015;230(1):27–33.PubMedCrossRef
54.
Nelson JH, Averette HE, Richart RM. Cervical intraepithelial neoplasia (dysplasia and carcinoma in situ) and early invasive cervical carcinoma. CA Cancer J Clin. 1989;39(3):157–78.PubMedCrossRef
55.
Sandvall B, Okoroafor UC, Gerull W, Guattery J, Calfee RP. Minimal clinically important difference for PROMIS physical function in patients with distal radius fractures. J Hand Surg Am. 2019;44(6):454–9.PubMedCrossRef
56.
Lyman S, Lee Y, McLawhorn AS, Islam W, MacLean CH. What are the minimal and substantial improvements in the HOOS and KOOS and JR versions after total joint replacement? CLIN ORTHOP RELAT R. 2018;476(12):2432–41.CrossRef
57.
Rao D, Gela N, Daley EM, Kattezham R, Rodriguez G, Cella D. Developing a measure of health-related quality of life for women with cervical dysplasia resulting from human papillomavirus infection. Int J Std AIDS. 2010;21(10):697–701.PubMedPubMedCentralCrossRef
58.
Beaton DE, Boers M, Wells GA. Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. Curr Opin Rheumatol. 2002;14(2):109–14.PubMedCrossRef
59.
Engel L, Beaton DE, Touma Z. Minimal clinically important difference: a review of outcome measure score interpretation. Rheum Dis Clin N Am. 2018;44(2):177–88.CrossRef
60.
Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.PubMedCrossRef
Metadata
Title
Responsiveness and minimal clinically important difference of the EQ-5D-5L in cervical intraepithelial neoplasia: a longitudinal study
Authors
Xin Hu
Mingxia Jing
Mei Zhang
Ping Yang
Xiaolong Yan
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2020
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-020-01578-8

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