Assessing responsiveness of the EQ-5D-3L, the Oxford hip score and the Oxford knee score in the NHS patient reported outcome measures
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Published version
Author(s)
Kang, S
Type
Journal Article
Abstract
Background The degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, and the Oxford Hip Score (OHS) and the Oxford Knee Score (OKS) by various methods. Data from NHS Patient Reported Outcome Measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009-2015) was analysed for patients who underwent primary hip surgery (N=181,424) and primary knee surgery (N=191,379). Methods Paired data specific univariate responsiveness was investigated using the Standardized Response Mean (SRM), the Standardized Effect Size (SES), and the Responsiveness Index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e., paired data specific MCID), adjusting baseline covariates such as age, gender and comorbidities in the Box–Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by patient’s self-assessed transition level. Results The results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high; 51 (54) % in the OHS and 73 (58) % in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e., A little better vs. About the same vs. A little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen’s thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48) % in the hip and 42 (44%) for the knee replacement population. Conclusions Distinctive percentage differences in patients’ perception of improvement were observed when the paired data specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice for use at the individual-patient level. This study shows the importance of analytic methods and instruments in investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instrument in terms of cross-validation.
Date Issued
2021-01-07
Date Acceptance
2020-11-29
ISSN
1749-799X
Publisher
BioMed Central
Start Page
1
End Page
12
Journal / Book Title
Journal of Orthopaedic Surgery and Research
Volume
16
Issue
18
Copyright Statement
© The Author(s). 2021, corrected publication 2021. Open Access This article is licensed under a Creative Commons Attribution
4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence,
and indicate if changes were made. The images or other third party material in this article are included in the article's Creative
Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative
Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need
to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/
licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.
0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence,
and indicate if changes were made. The images or other third party material in this article are included in the article's Creative
Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative
Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need
to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/
licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.
0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Identifier
https://josr-online.biomedcentral.com/articles/10.1186/s13018-020-02126-2
Subjects
EQ-5D-3L Index
Hip and knee replacement
Internal responsiveness
OHS
OKS
Patient-reported outcome
Orthopedics
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2021-01-07